Maternal and Child Health Journal最新文献

{"title":"Examining the Impact of Integrated Obstetric Simulation Training on the Quality of Antenatal Care in Northern Ghana.","authors":"Ntemena Kapula, Osamuedeme J Odiase, Helen H Habib, Muna Bashir, Raymond Aborigo, Patience A Afulani","doi":"10.1007/s10995-024-04024-z","DOIUrl":"10.1007/s10995-024-04024-z","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to assess if an integrated simulation-based training on respectful maternity care (RMC) and management of obstetric and neonatal emergencies could improve the quality of antenatal care (ANC).</p><p><strong>Methods: </strong>The data are from two cross-sectional surveys administered in the East Mamprusi District of Northern Ghana in 2017 to evaluate the impact of integrated simulation-based training for healthcare providers. Surveys were administered to two groups of women aged 15-49 who delivered in a health facility before (baseline; n = 266) and 6 months after (end-line; n = 320) the intervention began. We assessed the quality of antenatal care pre- and post-training across two dimensions: service provision and experience of care. Analyses included linear and logistic regression.</p><p><strong>Results: </strong>Women in the end-line group reported higher quality of antenatal care than those in the baseline group. The average ANC experience of care score increased by 10 points at the end-line (Coeff = 10.3, 95%CI: 9.0,11.6), whereas the mean ANC service provision score increased by three points (Coeff = 2.6, 95% CI: 2.2, 3.1). End-line participants were more likely to have an ultrasound (OR: 24.1, 95%CI: 11.5, 50.3). Parity, tribe, education, employment, partner occupation, six or more antenatal visits, ANC facility, and provider type were also associated with ANC quality.</p><p><strong>Conclusions: </strong>Integrated simulation-based training for health providers has the potential to improve the quality of ANC. Incorporating such training into continuing professional development courses will aid global efforts to increase the quality of care throughout the maternity continuum of care.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"95-107"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689282","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":"Pediatric Subspecialist Referrals to Peer Support for Families.","authors":"Edward L Schor, Tali Klima, Holly K M Henry, Allison Gray, Megumi J Okumura","doi":"10.1007/s10995-024-04033-y","DOIUrl":"10.1007/s10995-024-04033-y","url":null,"abstract":"<p><strong>Background and objectives: </strong>Families of children with special health care needs (CSHCN) have reported to benefit from social, emotional, and informational support from other families (peer support) with similarly affected children. Pediatric subspecialists often serve as the primary medical providers for CSHCN, as well as educators for these children's families. The extent to which subspecialists refer families to sources of peer support is unknown.</p><p><strong>Methods: </strong>A statewide online survey of California pediatric subspecialists investigated opinions about the potential value and challenges of peer support. Data was obtained on the frequency with which families in their practices were referred to peer support, practice characteristics, and personal demographics. Weighted data, descriptive statistics, and regression models were used to characterize and predict factors affecting referral services.</p><p><strong>Results: </strong>There were 388 respondents, a response rate of 14.5%. Subspecialists were generally unfamiliar with peer support resources in their communities, but many more knew of peer support programs in their institutions. Most (> 85%) held positive views about peer support, though only 40% of practices often referred families for such support. Individual opinions did not predict practice referral processes for peer support which were more influenced by knowledge of resources, and availability of time, staffing, and institutional peer support resources.</p><p><strong>Conclusion: </strong>Offering referral to peer support services is compatible with pediatric subspecialty care. Educating physicians about available resources, assigning responsibility, providing staff time for referring families, and incorporating parent mentors into subspecialty practices can increase access. Future studies of families' referral experiences are needed.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"57-66"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814631","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":"Interventions to Enhance Facility Deliveries in Low- and Middle-Income Countries: A Scoping Review.","authors":"Etsuko Nishimura, Kaori Ochiai, Erika Ota","doi":"10.1007/s10995-024-04032-z","DOIUrl":"10.1007/s10995-024-04032-z","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of this review were to identify and map evidence of interventions to enhance facility deliveries in low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>A search for all relevant existing reports in the literature was conducted in December 2020 using the following online bibliographic databases: PubMed, EMBASE, and CENTRAL. A manual search of the reference lists of relevant systematic reviews and all identified studies was performed to identify additional studies. Two reviewers independently screened the titles and abstracts of the retrieved studies, and then screened the full text identified as inclusion in the initial screening.</p><p><strong>Results: </strong>The search of electronic databases and hand searching identified a total of 6682 articles. A total of 40 reports were identified for full-text review, and 31 reports were excluded. Finally, nine trials were included in the scoping review, and a total of 29,892 women were included in this review. Of nine trials, one was conducted in Nepal, and the other eight trials were performed in Africa: Kenya, Uganda, Nigeria, Tanzania, and Zambia. Our review found the following effective interventions to enhance facility deliveries: group antenatal care (ANC), birth plans, full vouchers, conditional cash transfers (CCTs), non-monetary incentives, and short message service (SMS).</p><p><strong>Conclusion: </strong>Women who received group ANC, promotion of birth plans, full vouchers, CCTs, non-monetary incentives, and SMS were significantly more likely to deliver at a facility.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"31-47"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792611","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 Unmet Needs in Health Care and Social Services and Exposure to Violence Among Parents.","authors":"Marianne Sipilä, Mika Helminen, Tuovi Hakulinen, Eija Paavilainen","doi":"10.1007/s10995-024-04021-2","DOIUrl":"10.1007/s10995-024-04021-2","url":null,"abstract":"<p><strong>Objective: </strong>Existing research has shown that parental exposure to violence has negative consequences on health outcomes, but the effect of such exposure on unmet health care and social service need is unknown. This study aims to investigate the association between unmet health care and social services and parental violence exposure among parents with children.</p><p><strong>Study design: </strong>This study used the data of 6289 parents aged 18-60 years who had at least one child under 18 years living in the same household. Parental violence exposure was measured. Unmet child and adult health care and social service need was operationalized through questions on the services needed, those that had not been received, and those that were considered inadequate.</p><p><strong>Results: </strong>Parents who experienced any kind of violence had more unmet service need. There were more women among parents with violence experience (65.4%) than those with no violence experience (51.9%). Violence experience increased the odds of unmet need for general adult healthcare services (OR 2.02, CI 1.64-2.57), maternity and child health clinics (OR 2.52, CI 2.00-3.18), family guidance clinics and home help (OR 2.38, CI 1.60-3.54), mental health or child welfare services (OR 2.05, CI 1.52-2.75), and school health care (OR 1.99, 1.50-2.65). After adjusting for sociodemographic factors, the associations between exposure to violence experience and unmet needs for healthcare and social services remained statistically significant.</p><p><strong>Conclusion: </strong>Violence in close relationships profoundly impacts health and well-being. By addressing unmet health care needs and supporting parents, we can break the cycle of violence and promote better mental health outcomes. Preventive policies and early interventions are essential to mitigate the consequences of violence in families.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"114-125"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751964","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":"Information Sharing to Enhance Early Childhood Services.","authors":"Deborah G Badawi, Otonyemiete Georgewill, Felicia Jones","doi":"10.1007/s10995-024-04025-y","DOIUrl":"10.1007/s10995-024-04025-y","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate stakeholder willingness to share information among various social service providers, and to determine perceived barriers to accessing these services in our state.</p><p><strong>Description: </strong>The Maryland Family Network and the Maryland Chapter, American Academy of Pediatrics partnered to collect information on family information sharing preferences and barriers to services. We received 22 Survey Monkey responses and had 41 focus group participants aged 25 to 44 years and all regions of the state were represented. Nearly half of participants were Black or African American and participants indicated a broad range of family income.</p><p><strong>Assessment: </strong>Most participants were a part of multiple assistance programs and were comfortable with all their information being shared, except their social security number. One third of participants noted they did not face barriers to accessing services. The other two thirds noted confusing applications, technology limitations and the need for self-advocacy as significant barriers.</p><p><strong>Conclusion: </strong>Families are very comfortable sharing information among early childhood service providers, and in fact favor having a single basic application that allows them to check off the agencies to which they would like to apply. Barriers to accessing services are logistical as well as cultural.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"12-16"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717456","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 Early Infancy of a Parent and Baby Mental Health Unit: A Reflection.","authors":"Sophie Isobel, Alison Green, Sylvia Lim-Gibson","doi":"10.1007/s10995-024-04027-w","DOIUrl":"10.1007/s10995-024-04027-w","url":null,"abstract":"<p><strong>Purpose: </strong>This article describes the experience of establishing a new parent and baby mental health unit, including challenges in the first year of operation. The article aims to narrate the experience for the purpose of informing other new mental health services and contributing to service development knowledge.</p><p><strong>Description: </strong>The analogy of the early infancy period is used to highlight the parallel process of adjustment, confidence and identity formation occurring as part of the unit development and by the parents who are admitted.</p><p><strong>Assessment: </strong>Key challenges are presented as \"We had a baby and moved house at the same time\", \"We had a baby with someone we just met\", \"We had ghosts in our communal nursery\" and \"We were juggling the baby and the bathwater\".</p><p><strong>Conclusion: </strong>The establishment of a new unit provides an opportunity to reflect on the complexity of building workforce, service and clinical capacity within the constraints of public health services. The challenges along the way have helped to build empathy for the experiences of the admitted parents who equally find that things have not gone how they have planned, while finding emerging opportunities for growth, resilience and change.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"17-22"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740985","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":"A Needs Assessment of Labor and Delivery Nurses Performing NRP in the Delivery Room.","authors":"Michael Zujkowski, Shelley Ehrlich, Chunyan Liu, Qin Sun, Matthew Zackoff, Jennifer M Brady, Beth Ann Johnson, Shanmukha Mukthapuram","doi":"10.1007/s10995-024-04030-1","DOIUrl":"10.1007/s10995-024-04030-1","url":null,"abstract":"<p><strong>Introduction: </strong>Labor and delivery (L&D) nurses are often responsible for initiating the critical first steps of the Neonatal Resuscitation Program (NRP). Identification of knowledge gaps and underlying reasons for NRP non-adherence is crucial for designing educational interventions.</p><p><strong>Methods: </strong>A convenience sample of 37 L&D nurses from two delivery hospitals were enrolled. Participants completed a Likert scale survey capturing years of experience and comfort level in performing neonatal resuscitation followed by a video recorded standardized manikin-based simulation of a neonatal resuscitation. NRP adherence was assessed using an Observed Structured Clinical Examination (OSCE) assessment tool with prior validity evidence. Percentage of correctly completed OSCE items, median time to initiation of positive pressure ventilation (PPV), and achievement of effective PPV were analyzed using descriptive statistics.</p><p><strong>Results: </strong>Participants reported a median of 2.5 years of L&D experience, and a 4/6 confidence level for performing NRP. Fifty-seven percent of items (12/21) items were correctly completed. Participants took 55 s to initiate PPV with 57% initiating PPV within the target of 60 s. The time to effective PPV was 109 s, with 32% of participants achieving this within 60 s. Years of L&D experience had a strong correlation with percentage of correctly completed OSCE items (r = 0.63).</p><p><strong>Discussion: </strong>Despite high self-perceived confidence, initiating and achieving effective PPV within the 60 s time window mandated by NRP remains an area for significant improvement for L&D nurses. Next steps include the design and implementation of targeted training to address performance gaps and longer-term tracking for retention of knowledge.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"23-30"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911003","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":"Changes in Child Health Care, Health, and Caregiver Mental Health During the COVID-19 Pandemic in Children with Autism and Special Health Care Needs.","authors":"Jessica E Rast, Kaitlin H Koffer Miller, Jennifer Bromberg, Jonas Ventimiglia, Kristy A Anderson, Lindsay L Shea","doi":"10.1007/s10995-024-04020-3","DOIUrl":"10.1007/s10995-024-04020-3","url":null,"abstract":"<p><strong>Purpose: </strong>The COVID-19 pandemic and subsequent mitigation efforts impacted communities in many ways and placed immense strain on the health care system, impacting access to services. The purpose of this study was to examine changes in prevalence of child health care, child health, and caregiver and household health within children with autism and children with special health care needs (CSHCN) pre-pandemic to early pandemic years.</p><p><strong>Methods: </strong>We examined data from the National Survey of Children's Health to examine changes in child health care, child health, and caregiver and household health for autistic children and CSHCN from 2018 to 2021.</p><p><strong>Results: </strong>About one-third of children with autism and CSHCN missed preventive checkups due to the COVID-19 pandemic and half had virtual care in 2021. Parents of children with autism had less help with care coordination in 2020 compared to previous years. In CSHCN prevalence of anxiety increased from 2018/2019 to 2021, with a concurrent increase in need for mental health care, this was not seen in children with autism. Finally, difficulty paying medical bills and for food was less common in 2020 and 2021 (compared to 2018/2019).</p><p><strong>Conclusions: </strong>The COVID-19 pandemic changed the healthcare landscape for everyone, including children with autism and CSHCN as highlighted in this study. Understanding the disruptions and how they impacted populations differently can be helpful in informing plans long-term emergency preparedness. This planning should involve disability inclusive policies, to ensure the most vulnerable groups retain health care access as needed.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"78-86"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689281","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":"Maternal Perceptions and Feeding Practices Associated with Infant Nutritional Status.","authors":"Velia Margarita Cárdenas Villarreal, Ernesto Cortes Castell, María Mercedes Rizo Baeza, Nora Hernández Martínez, Norma Edith Cruz Chávez, Karen Paola Camarillo Cárdenas","doi":"10.1007/s10995-024-04016-z","DOIUrl":"10.1007/s10995-024-04016-z","url":null,"abstract":"<p><strong>Introduction: </strong>Malnutrition in early childhood has long-term health consequences, including increased obesity risk due to catch-up growth in undernourished infants. While maternal perceptions and feeding practices affect infant malnutrition, limited evidence exists in middle-income countries like Mexico. This study examines the associations between maternal perceptions, feeding practices, and nutritional status in infants aged 6-12 months in northeastern Mexico.</p><p><strong>Methods: </strong>A total of 192 mother-infant dyads were assed using questionnaires and anthropometric measurements. Maternal variables included perception of hunger and satiety, infant weight perception, feeding attitudes, self-efficacy, fatigue, and feeding practices. Infant nutritional status was determined using WHO Anthro, and multiple logistic regression identified associations between maternal and infant factors and nutritional status.</p><p><strong>Results: </strong>38% of infants were overweight/obese, and 7% were underweight. Low maternal self-efficacy, low perception of hunger and satiety signs, non-recommended feeding attitudes, and inaccurate perception of infant weight were identified. Maternal nocturnal sleep hours, type of feeding, and feeding frequency were associated to underweight. The maternal perception of infant weight was inaccurate for both underweight (mothers overestimate the weight) and overweight/obese (mothers underestimate the weight) infants.</p><p><strong>Discussion: </strong>The main maternal perception influencing infant nutritional status was inaccurate weight perception. Mothers demonstrated limited knowledge and negative feeding practices with non-recommended feeding practices among Mexican mothers. Longer maternal sleep duration (> 8 h/night) was associated with underweight infants.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"87-94"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639873","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":"Participant Perspectives on a Community Health Worker Intervention to Reduce Infant Mortality: A Mixed Methods Assessment of the Bronx Healthy Start Partnership.","authors":"Elisa M Fisher, Alma Idehen, Luisa Cárdenas, David W Lounsbury, Foram Jasani, Caryn R R Rodgers, Mayssa Gregoire, Rebecca Williams, Linda Weiss, A Hal Strelnick","doi":"10.1007/s10995-024-04014-1","DOIUrl":"10.1007/s10995-024-04014-1","url":null,"abstract":"<p><strong>Introduction: </strong>Healthy Start is an initiative to reduce infant mortality and improve birth equity throughout the US, in large part by deploying community health workers (CHWs) to conduct home visits and provide educational and emotional support to new and expectant parents.</p><p><strong>Methods: </strong>A mixed-methods assessment of the Bronx Healthy Start Partnership (BxHSP) was conducted as part of a quality improvement initiative to understand client perspectives regarding the impact of BxHSP on short- and intermediate-term outcomes that affect long-term well-being. Phone interviews (n = 16) and online surveys (n = 62) were conducted in English and Spanish with BxHSP participants in 2020 and 2022. The interview sample was selected purposefully; interview participants were eligible if they gave birth prior to mid-March 2020 and had received at least one CHW home visit. All individuals with open BxHSP cases (n = 379) were invited to complete the survey.</p><p><strong>Results: </strong>Findings suggest that BxHSP CHWs can provide vital psychosocial, material, and educational resources that help engaged participants feel supported as new parents and develop knowledge and skills related to infant care. Results further suggest that these short-term outcomes contribute to lower stress, increased self-efficacy, and health-promoting infant care practices, enabling participants to feel more confident and capable as new parents.</p><p><strong>Discussion: </strong>Findings underscore how programs like BxHSP can help address gaps in resources and improve health and well-being for pregnant and postpartum participants. Limitations include possible selection, recall, and/or social desirability biases as response rates were low and data were self-reported and retrospective. Limitations were addressed in part through triangulation of qualitative and quantitative data.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"4-11"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689283","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}