Journal of Pediatric Psychology最新文献

{"title":"Mental and physical health differences between youth infected and uninfected by SARS-CoV-2: data from 2021 to 2023.","authors":"Linda Jones Herbert, Audrey Thurm, Maureen Monaghan, James E Bost, Max T Wolff, Mallory C Kader, Karyl Barron, Gina Montealegre Sanchez, Roberta L DeBiasi","doi":"10.1093/jpepsy/jsag024","DOIUrl":"10.1093/jpepsy/jsag024","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic had a profound impact on children's well-being. This study examines the mental and physical health of youth infected with SARS-CoV-2 in comparison to uninfected youth and infected youths' functioning across pandemic waves.</p><p><strong>Methods: </strong>Baseline parent-proxy and self-report questionnaire data from SARS-CoV-2-infected and uninfected youth were collected as part of a multisite, prospective, longitudinal observational study to evaluate clinical manifestations of SARS-CoV-2 infection in youth. Measures included the Developmental Profile-4, PROMIS scales, and the CoRonavIruS health Impact Survey.</p><p><strong>Results: </strong>Data on 684 infected and 147 uninfected youth (median age = 8.9 years) were analyzed. There was no difference between groups regarding developmental concerns. When controlling for age/gender, caregivers of infected youth reported worse youth global health, physical functioning, cognitive functioning, pain interference, fatigue, and sleep disturbance compared to caregivers of uninfected youth, ps < .05. Infected youth reported worse fatigue and sleep disturbance compared to uninfected youth, ps < .05. Anxiety, depressive symptoms, and peer relationships did not differ between groups. Infected youth categorized as \"at risk\" were more likely to be female, older, have a pre-existing condition, were infected during the wild-type SARS-CoV-2 wave, or were infected more than 90 days prior to baseline.</p><p><strong>Conclusions: </strong>Baseline data from a large cohort study indicate that the physical functioning of youth infected with SARS-CoV-2 was worse than that of uninfected youth, but mental health concerns were comparable. Data may reflect the direct impact of SARS-CoV-2 on physical health and the overall impact of the COVID-19 pandemic on all youths' mental health.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov Identifier: NCT04830852.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"659-669"},"PeriodicalIF":2.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community health workers as providers of pediatric behavioral healthcare: a scoping review and call to action for pediatric psychologists.","authors":"Erin M Rodríguez, Jendayi Dillard-Cooke, Spencer Westcott, Hadi Fareed, Ricardo Garay","doi":"10.1093/jpepsy/jsag051","DOIUrl":"https://doi.org/10.1093/jpepsy/jsag051","url":null,"abstract":"<p><strong>Objective: </strong>Community health workers (CHWs) are uniquely positioned to provide community-based, culturally responsive, and accessible healthcare to pediatric populations. We conducted a scoping review of the literature to describe how CHWs have been involved in pediatric health intervention research in the United States.</p><p><strong>Methods: </strong>We searched the databases PubMed, PsycInfo, Medline, CINAHL, and Medic Latina for peer-reviewed intervention studies published in English from 2003 to 2025. Additional inclusion criteria were that CHWs were involved in some aspect of intervention delivery; the intervention impacted a child's physical, behavioral, or mental health concern or behavior; the study provided quantitative outcome data, and the intervention was implemented in the United States. We extracted information on (1) the characteristics of interventions CHWs have delivered, (2) the extent to which CHWs are providing interventions with psychotherapeutic content, (3) the training and supervision received by CHWs, and (4) the match between intervention components and CHW roles/competencies.</p><p><strong>Results: </strong>We identified 11,361 articles from our search, of which 151 articles met inclusion criteria. Interventions addressed a range of pediatric health conditions and prevention/promotion outcomes, and 35 interventions included psychotherapeutic components. Most studies provided minimal information about CHW training and supervision, and CHWs' roles in most studies were limited to providing health education and outreach, despite the wide range of competencies CHWs have in providing care.</p><p><strong>Conclusions: </strong>We call for pediatric psychologists to advocate for CHWs as members of multidisciplinary healthcare teams and collaborate with CHWs in research and practice for children and families.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward brain-based predictors of chronic post-surgical pain after gender-affirming surgery in adolescents and young adults: a neuroimaging perspective.","authors":"Caitlin Curry, Emma Costello, Ziyan Wu, Christine B Sieberg","doi":"10.1093/jpepsy/jsag055","DOIUrl":"https://doi.org/10.1093/jpepsy/jsag055","url":null,"abstract":"<p><p>Chronic pain, pain lasting for at least 3 months, can be highly disruptive to an individual's quality of life. Chronic pain is likely a product of neurological, psychological, and sociological influences. One group that may be at heightened risk is transgender and gender diverse (TGD) adolescents and young adults (AYAs). This topical review aims to highlight the factors that may influence pain development in TGD AYAs, paying special attention to one form of chronic pain, chronic post-surgical pain (CPSP). Furthermore, this article aims to highlight the need for mechanistic research that could elucidate the pain-related mechanisms in TGD AYAs and CPSP, proposing neuroimaging as one potential way to accomplish this.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing new approaches to mental health care for individuals with congenital heart disease: a tri-national qualitative study exploring health professionals' views and experiences.","authors":"Julia Baenziger, Madeleine Pidcock, Emily Jones, Jennifer Reiter-Purtill, Daniel Tobler, Nadine A Kasparian","doi":"10.1093/jpepsy/jsag044","DOIUrl":"https://doi.org/10.1093/jpepsy/jsag044","url":null,"abstract":"<p><strong>Objective: </strong>Increasingly, hospitals are recognizing the need to address the high mental health care needs of individuals with chronic illness, including congenital heart disease (CHD). This qualitative study explored health professionals' views on integrated mental health care in CHD.</p><p><strong>Methods: </strong>Individual, semi-structured interviews were conducted with health professionals from diverse disciplines at five CHD centers in the United States, Australia, and Switzerland. Each center had a distinct model of mental healthcare integration and a unique healthcare ecosystem. The Consolidated Framework for Implementation Research was used to guide study design and analysis. Verbatim transcriptions were analyzed thematically using MAX Qualitative Data Analysis (MAXQDA) software.</p><p><strong>Results: </strong>Health professionals representing medicine, psychology, nursing, social work, education, and healthcare administration participated (N = 46, 58% response rate, 72% women, M = 15.5 ± 8.0 years of professional experience, interview duration: M = 47.9 ± 18.8 min). Five key themes were identified: (1) high need and demand for mental health care among individuals with CHD and their families; (2) multiple, inter-related barriers to care, including stigma and socioeconomic factors; (3) barriers to mental healthcare integration for CHD centers, including understaffing, time and fiscal constraints, and lack of clear referral pathways; (4) strategies to promote integration, including interdisciplinary teamwork and regular communication with mental health professionals embedded in cardiac care; and (5) facilitators of access to care, including routine mental health screening, multiple entry points across the medical trajectory, a preventive focus, and skills-based staff training.</p><p><strong>Conclusions: </strong>Results highlight the need for innovative implementation strategies to accelerate access to integrated mental healthcare for individuals with CHD across the lifespan.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth hormone deficiency, bullying victimization, and associations with treatment status: a pediatric case-control study.","authors":"Zumrut Kocabey Sutcu, Yasin Caliskan, Emel Hatun Aytaç Kaplan","doi":"10.1093/jpepsy/jsag022","DOIUrl":"10.1093/jpepsy/jsag022","url":null,"abstract":"<p><strong>Objective: </strong>Short stature affects approximately 3% of children and often leads to psychosocial challenges, including peer bullying. While growth hormone therapy effectively treats physical aspects of growth hormone deficiency, its protective effects against bullying victimization remain understudied.</p><p><strong>Methods: </strong>This case-control study included 317 children aged 9-18 years: 108 newly diagnosed with growth hormone deficiency (untreated), 103 receiving growth hormone treatment (≥1 year), and 106 healthy controls. Participants completed the Olweus Bully/Victim Questionnaire, Rosenberg Self-Esteem Scale, Revised Child Anxiety and Depression Scale, and Strengths and Difficulties Questionnaire. Demographic and clinical data were collected through standardized interviews and medical records.</p><p><strong>Results: </strong>Bullying victimization rates differed significantly among groups (p = .005). Newly diagnosed children showed the highest victimization rate (34.3%), followed by treated children (24.3%) and controls (15.1%). Treated children demonstrated significantly lower depressive affect scores (1.17 ± 0.95) compared to newly diagnosed children (2.2 ± 1.19, p = .001) and higher prosocial behavior scores (8.06 ± 2.09 vs. 7.08 ± 2.27, p = .001). Among treated children, bullying victims showed significantly compromised psychological functioning compared to non-victims, including lower self-esteem (27.52 ± 6.0 vs. 31.12 ± 5.44, p = .005) and higher anxiety-depression scores (48.88 ± 19.78 vs. 35.13 ± 23.81, p = .008).</p><p><strong>Conclusions: </strong>Growth hormone therapy is associated with reduced peer bullying victimization in children with growth hormone deficiency. The stepwise pattern observed across treatment groups suggests that treatment status relates to psychosocial outcomes extending beyond physical growth. These findings support early diagnosis and comprehensive care approaches addressing both endocrine and psychosocial aspects of growth hormone deficiency.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"612-620"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Improving the assessment of pediatric-to-adult healthcare transition.","authors":"Katherine E Weaver, Sayward Harrison","doi":"10.1093/jpepsy/jsag020","DOIUrl":"10.1093/jpepsy/jsag020","url":null,"abstract":"","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"552-553"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Story-based interventions for chronic health conditions in youth: a systematic review and narrative synthesis.","authors":"Emily L Rappolt, Eunji Cho, Molly L Tanenbaum, Allison Myers, Shelagh A Mulvaney","doi":"10.1093/jpepsy/jsag014","DOIUrl":"10.1093/jpepsy/jsag014","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review the literature on the implementation and effectiveness of story-based interventions for youth with chronic conditions to improve health-related outcomes.</p><p><strong>Methods: </strong>The protocol for this review was registered with PROSPERO: CRD42024550328. A comprehensive search was conducted across PubMed, CINHAL, EMBASE, and Web of Science. Databases were searched from inception to June 2024. Studies were included if the intervention was story-based, the sample had a mean or median age between 11 and 25, and participants had a chronic condition. Studies were limited to quantitative and mixed methods. Three reviewers independently screened abstracts and full text for eligibility. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Effect sizes were extracted or calculated. Reported qualitative findings were narratively synthesized.</p><p><strong>Results: </strong>Of the 3,797 articles screened, 7 articles met the inclusion criteria. Considerable variation existed across studies in intervention goals, components, and outcomes assessed. Notable impacts were related to improvement in distress and depressive symptoms. Intervention strategies ranged from autobiographical writing to digital formats such as video narratives and online participatory community sites. Interventions demonstrated mixed impact in improving health-related outcomes with effect sizes ranging from -0.54 to 5.50.</p><p><strong>Conclusion: </strong>Story-based interventions focused on youth with chronic illness provide promising means to elicit relevant experiences and impact health outcomes. The knowledge base is in a formative stage and characterized by multicomponent interventions with research designs that do not support strong causal inference. Further research is warranted to replicate outcomes and understand active intervention components.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"579-592"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility, satisfaction, and preliminary results of a coping skills training program for parents of children with cancer.","authors":"Oz Hamtzani, Michael J Dolgin, Talma Kushnir","doi":"10.1093/jpepsy/jsag015","DOIUrl":"10.1093/jpepsy/jsag015","url":null,"abstract":"<p><strong>Objective: </strong>While parents of children with cancer experience increased levels of emotional distress, considerable variability in adjustment and distress is evident. The current study aimed to examine the feasibility, acceptability, and satisfaction of a semi-structured intervention protocol based on a three-factor theoretical model of coping and distress using a single-arm study design. The intervention focused on reducing the use of avoidance-focused coping techniques, expanding the repertoire of problem-, and emotion-focused coping techniques, and increasing flexibility in applying these techniques.</p><p><strong>Methods: </strong>A sample of 22 mothers and 10 fathers (N = 32) of children undergoing active cancer treatment were recruited from a pediatric hematology-oncology department. The manualized intervention protocol consisted of six 1-hr sessions. Parents completed standardized measures at three time points: baseline, post-intervention, and 6-week follow-up. Parents also completed an acceptability measure and four brief open-ended questions evaluating their satisfaction and experience with the intervention.</p><p><strong>Results: </strong>Of 48 eligible parents who were approached, 32 agreed to participate in the intervention (enrollment rate = 66.67%) and of these, 25 completed the intervention (retention rate = 78.13%), supporting the intervention's feasibility. Parents who completed the intervention provided positive feedback and high satisfaction ratings. Descriptive patterns across pre-, post-, and follow-up assessments reflected expected directions of change in coping and distress measures.</p><p><strong>Conclusions: </strong>These results support the feasibility and acceptability of a theory-driven intervention based on a three-dimensional model of parental coping and distress. Although preliminary descriptive changes were observed across assessment points, these should not be interpreted as evidence of efficacy. Larger controlled trials are necessary to rigorously evaluate the intervention's effectiveness.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"568-578"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritizing mentors in a peer-to-peer support program for young adult transplant recipients: a qualitative account of mentors' experience to inform success and sustainability.","authors":"Samantha J Anthony, Enid K Selkirk, Jia Lin, Faye Ajmera, Megan Liang, Mirna Seifert-Hansen, Simon Urschel, Stephanie Soto, Suzanne Boucher, Anna Gold, Jennifer N Stinson, Sara Ahola Kohut","doi":"10.1093/jpepsy/jsag021","DOIUrl":"10.1093/jpepsy/jsag021","url":null,"abstract":"<p><strong>Objective: </strong>The iPeer2Peer© (iP2P©) program is an online peer mentorship program that has been successfully used for adolescents and young adults with chronic illness. This paper explores the experiences of young adult thoracic transplant recipients who acted as peer mentors in the iP2P© program. Objectives are to comprehensively understand the iP2P© mentor experience and identify recommendations for program refinement and sustainability.</p><p><strong>Methods: </strong>A qualitative description approach was used. Mentors, ages 18-25 years, were heart or lung transplant recipients who had successfully transitioned to adult care and self-managed their condition. Paired mentor-mentee dyads engaged in 5-10 video or phone calls and exchanged text messages over a 15-week period. Following program completion, a focus group with follow-up interviews and in-depth interviews was conducted. Thematic data analysis led to theme development through an iterative process with consensus among team members.</p><p><strong>Results: </strong>A total of nine participants completed mentor training and were matched with at least one mentee. Mentors (89% female) were aged 21.2 ± 2.2 years (range 18-24 years). Seven had received a heart transplant, two had received a lung transplant, and their mean time post-transplant was 8.5 ± 5.2 years. Qualitative findings illuminated three themes: (1) Gaining connection and support through shared experiences, (2) Carrying the responsibility of providing impactful mentorship, and (3) Nurturing reflection and positive self-growth through helping mentees.</p><p><strong>Conclusions: </strong>This study provides novel insights into how mentorship programs can be designed to balance the emotional and logistical demands of mentorship while maximizing its mutual benefits for mentors and mentees.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"601-611"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The transition from pediatric to adult healthcare in spina bifida: an interview-based measure.","authors":"Grayson N Holmbeck, Tessa K Kritikos, Olivia E Clark, Allison D Payne, Taylor Morgan Dattilo, Colleen F Bechtel Driscoll, Taylor L Hilderbrand, Monique M Ridosh, Colleen Stiles-Shields","doi":"10.1093/jpepsy/jsaf107","DOIUrl":"10.1093/jpepsy/jsaf107","url":null,"abstract":"<p><strong>Objective: </strong>This study presents a novel interview and coding system to assess the transition from pediatric to adult healthcare in individuals with spina bifida (SB). Inter-rater reliability, descriptive data, and demographic and condition severity correlates are reported.</p><p><strong>Methods: </strong>Young adults with SB, aged 19-26 at Time 6 (n = 86) of a longitudinal study, completed the Transition to Adult Healthcare in Young Adults with Spina Bifida Interview which assessed: (1) the transition status (pediatric vs. adult) of primary care providers, (2) the transition status of specialist providers, (3) transition-related discussions and meetings with health professionals, (4) subjective reports of transition status, and (5) self-reports of how medical complications/emotional problems are managed during the transition.</p><p><strong>Results: </strong>Findings revealed high levels of inter-rater reliability. A large percentage (30%-48%) reported having specialty providers who were pediatric-oriented. Half reported that they had not had a transition-related discussion or were advised not to begin the transition process. Roughly half reported that they had not transitioned or were still in the planning phase. Most reported that they could make their own decisions regarding medical complications, but felt less able to assess the urgency of a complication, the need for action, or how to prevent a complication. Shunt status was associated with several transition status indicators.</p><p><strong>Conclusions: </strong>This study supports the use of an interview-based measure in young adults with SB. Findings revealed that a large percentage of young adults aged 19-26 had not transitioned to adult healthcare and felt ill-equipped to manage health complications.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"539-551"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}