Clara Sancho-Domingo, José Luis Carballo, Ainhoa Coloma-Carmona, Daniel J Buysse
{"title":"Psychometric adaptation of the Spanish version of the Brief Pittsburgh Sleep Quality Index in adolescents.","authors":"Clara Sancho-Domingo, José Luis Carballo, Ainhoa Coloma-Carmona, Daniel J Buysse","doi":"10.1093/jpepsy/jsae046","DOIUrl":"10.1093/jpepsy/jsae046","url":null,"abstract":"<p><strong>Objective: </strong>Good sleep quality is essential for adolescent health, yet sleep difficulties persist in this age group. The 6-item Brief Pittsburgh Sleep Quality Index (B-PSQI) was recently developed to improve sleep quality assessment, however, its validity in adolescents remains unexplored. This study examined the B-PSQI's psychometric properties in Spanish adolescents and adapted the scoring method to age-specific sleep recommendations.</p><p><strong>Methods: </strong>A cross-sectional study involving 1,065 adolescents (15-17 years; 56.8% female) was conducted in public high schools. Sleep quality was measured using the B-PSQI, the Insomnia Severity Index (ISI), the short Patient-Reported Outcomes Measurement Information System (PROMIS), and the Epworth Sleepiness Scale (ESS). Additionally, depression and anxiety were assessed using the Depression, Anxiety, and Stress Scales. Reliability, validity, and measurement invariance were analyzed.</p><p><strong>Results: </strong>The B-PSQI global scores were 4.5 (SD = 1.9) for the original scoring method and 5.4 (SD = 2.8) for the age-adjusted. The age-adjusted B-PSQI showed satisfactory reliability (ω = 0.84) and concurrent, convergent, and discriminant validity (ISI rS = 0.67; PROMIS rS = 0.71; anxiety rS = 0.40; depression rS = 0.42; ESS rS = 0.29). Adequacy for one-factor structure (χ2(4) = 53.9; CFI = 0.97; TLI = 0.92; RMSEA = 0.108; SRMR = 0.05) and invariance across sexes were supported. Both B-PSQI scoring methods showed similar psychometric properties, but the original yielded a higher percentage of poor sleepers (43.1%; cutoff ≥5) than the age-adjusted version (41.9%; cutoff ≥6).</p><p><strong>Conclusions: </strong>Findings suggest that the B-PSQI is a valid and reliable measure to assess adolescent sleep quality. Its scoring can be adjusted to provide age-specific criteria for good sleep. The B-PSQI has potential utility for screening sleep problems and facilitating overall health promotion in adolescents.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"596-604"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421473","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}
Rui Wu, Rebecca M Puhl, Leah M Lessard, Gary D Foster, Michelle I Cardel
{"title":"Exploring the interplay of weight-based teasing and sociodemographic factors in adolescent weight bias internalization.","authors":"Rui Wu, Rebecca M Puhl, Leah M Lessard, Gary D Foster, Michelle I Cardel","doi":"10.1093/jpepsy/jsae042","DOIUrl":"10.1093/jpepsy/jsae042","url":null,"abstract":"<p><strong>Objective: </strong>Research has highlighted the potential adverse effects of weight bias internalization (WBI) on adolescents, but there has been little examination of WBI and sources of weight teasing (family, peers, or both) or across racial/ethnic diversity of adolescents. We aimed to examine the relationship between WBI and sources of weight teasing across sociodemographic characteristics and weight status in a diverse community sample of adolescents.</p><p><strong>Methods: </strong>Data were collected from a U.S. sample of 1859 adolescents aged 10-17 years (59% female; 43% White, 27% Black or African American, and 25% Latino). An online questionnaire was used to assess participants' experiences of weight teasing from family members, peers, or both, and their weight status, weight-related goals, WBI, and sociodemographic characteristics.</p><p><strong>Results: </strong>Adolescents experiencing weight teasing from both family and peers reported the highest levels of WBI, while those reporting no teasing exhibited the lowest levels. These patterns were observed across sex, race/ethnicity, weight status, and weight goals, and persisted after controlling for depressive symptoms. Notably, family influences played a salient role, with adolescents reporting higher WBI if teased by family only compared to teasing from peers only. Sex and racial differences were also observed in adolescents' experiences with weight-based teasing.</p><p><strong>Conclusion: </strong>Our study reveals associations between adolescent weight-based teasing, WBI, and sociodemographic factors. Weight-based teasing, whether from family and peers or from family only, was associated with increased WBI. Interventions targeting weight stigma in youth should not be limited to peer-focused efforts, but should also emphasize supportive family communication.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"547-558"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297067","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: Intervention research in pediatric rare diseases.","authors":"Laurianne Buron, Leandra Desjardins","doi":"10.1093/jpepsy/jsae051","DOIUrl":"10.1093/jpepsy/jsae051","url":null,"abstract":"","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"536-537"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318584","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}
Katherine M Knauft, Angela J Jacques-Tiura, April Idalski Carcone, Meredyth Evans, Jill Weissberg-Benchell, Colleen Buggs-Saxton, Claudia Boucher-Berry, Jennifer L Miller, Tina Drossos, Bassem Dekelbab, Deborah A Ellis
{"title":"The moderating role of diabetes distress on the effect of a randomized eHealth intervention on glycemic control in Black adolescents with type 1 diabetes.","authors":"Katherine M Knauft, Angela J Jacques-Tiura, April Idalski Carcone, Meredyth Evans, Jill Weissberg-Benchell, Colleen Buggs-Saxton, Claudia Boucher-Berry, Jennifer L Miller, Tina Drossos, Bassem Dekelbab, Deborah A Ellis","doi":"10.1093/jpepsy/jsae033","DOIUrl":"10.1093/jpepsy/jsae033","url":null,"abstract":"<p><strong>Objective: </strong>Due to systemic inequities, Black adolescents with type 1 diabetes are more likely to have suboptimal glycemic control and high rates of diabetes distress, but tailored interventions for this population are lacking. In primary outcomes of a randomized clinical trial, a family-based eHealth intervention improved glycemic control in Black adolescents with type 1 diabetes and elevated depressive symptoms. The present study is a secondary analysis of these clinical trial data examining the moderating effect of diabetes distress on the efficacy of the intervention.</p><p><strong>Methods: </strong>Using secondary data from a multicenter randomized clinical trial (Clinicaltrials.gov [NCT03168867]), caregiver-adolescent dyads were randomly assigned to either up to three sessions of an eHealth parenting intervention (n = 75) or a standard medical care control group (n = 74). Black adolescents (10 years, 0 months to 14 years, 11 months old) with type 1 diabetes and a caregiver willing to participate were eligible. Adolescents reported their diabetes distress at baseline, and hemoglobin A1c (HbA1c) data were collected at baseline, 6-, 13-, and 18-month follow-up.</p><p><strong>Results: </strong>No between-group contrasts emerged in a linear mixed-effects regression (p's > .09). Within-group contrasts emerged such that adolescents assigned to the intervention who reported high diabetes distress had lower HbA1c at the 18-month follow-up relative to baseline (p = .004); the 18-month decrease in HbA1c was -1.03%.</p><p><strong>Conclusions: </strong>Black adolescents with type 1 diabetes and high levels of diabetes distress showed significant decreases in HbA1c following a family-based eHealth intervention, suggesting diabetes distress may be a key moderator of intervention efficacy within this population.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"538-546"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077187","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}
Michelle L Townsend, Karlen R Barr, Caitlin E Miller, Gillian Sanzone
{"title":"Self-harm and suicidal behaviors in children: perspectives of mental health clinicians.","authors":"Michelle L Townsend, Karlen R Barr, Caitlin E Miller, Gillian Sanzone","doi":"10.1093/jpepsy/jsae044","DOIUrl":"10.1093/jpepsy/jsae044","url":null,"abstract":"<p><strong>Objective: </strong>Presentations for self-harm and suicidal behaviors are increasing in children and young people, although less is known about these presentations in children aged 12 years and under. This study aims to understand how mental health clinicians in public health services conceptualize, identify and respond to self-harm and suicidal behaviors in children.</p><p><strong>Methods: </strong>26 mental health clinicians provided their perspectives through interviews or focus groups. Participant responses were analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>Mental health clinicians described how self-harm and suicidal behaviors may present differently in children compared with adolescents, particularly with the methods used. Using developmentally appropriate language and including parents or carers when screening for self-harm and suicidal behaviors was recommended by clinicians. The inclusion of parents or carers throughout the treatment process was important for clinicians, including helping parents understand their child's behavior and manage their own distress. Clinicians also highlighted the benefit of collaborating with schools to support children, yet noted primary school staff require training in responding to child self-harm and suicidal behavior. The limited services available for children 12 years and under including emergency care services, was identified as a problem.</p><p><strong>Conclusions: </strong>Findings highlight the importance of timely assessment and interventions which include mental health and medical clinicians, parents, carers, and school staff to support children with self-harm and suicidal behaviors.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"571-579"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318587","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}
Eloïse J Fairbank, James Borenstein-Laurie, Nicole M Alberts, Carsten Wrosch
{"title":"Optimism, pessimism, and physical health among youth: a scoping review.","authors":"Eloïse J Fairbank, James Borenstein-Laurie, Nicole M Alberts, Carsten Wrosch","doi":"10.1093/jpepsy/jsae045","DOIUrl":"10.1093/jpepsy/jsae045","url":null,"abstract":"<p><strong>Objective: </strong>High levels of optimism (and low levels of pessimism) are associated with improved physical health in adults. However, relatively less is known about these relations in youth. The present study aimed to review the literature investigating optimism, pessimism, and physical health in children and adolescents from populations with and without health conditions.</p><p><strong>Methods: </strong>We conducted a scoping review up until February 2024. Studies were included if they sampled youth (average age ≤18 years) and treated optimism or pessimism as predictors of health behaviors or outcomes. Data on study and sample characteristics, health outcome, optimism construct, and findings were extracted from eligible papers and results were synthesized.</p><p><strong>Results: </strong>Sixty studies were retained. Most studies were conducted in North America, with adolescents, and used cross-sectional designs and self-reported measures of health. Measures of optimism and pessimism differed across studies. Roughly one-third of studies sampled medical populations. Health categories included substance use, diet and physical activity, sexual health practices, medical adherence, other health behaviors, cardiometabolic health, subjective health/health-related quality of life, pain, sleep, and oral health. Generally, we observed adaptive associations between optimism and health. Higher optimism and lower pessimism were most consistently associated with lower rates of substance use and lower cardiometabolic risk.</p><p><strong>Conclusions: </strong>The presence of optimism or the absence of pessimism appears to be associated with various adaptive health outcomes among youth with and without health conditions. Developmental, methodological, and clinical considerations for future research are discussed, such as conducting longitudinal studies with objective measures of health and psychometrically validated instruments.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"580-595"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327986","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}
Irune García, Oscar Martínez, Imanol Amayra, Monika Salgueiro, Alicia Aurora Rodríguez, Juan Francisco López-Paz
{"title":"Effects of a neuropsychosocial teleassistance intervention on social cognition and health-related quality of life of pediatric patients with neuromuscular diseases.","authors":"Irune García, Oscar Martínez, Imanol Amayra, Monika Salgueiro, Alicia Aurora Rodríguez, Juan Francisco López-Paz","doi":"10.1093/jpepsy/jsae013","DOIUrl":"10.1093/jpepsy/jsae013","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine the effects of a neuropsychosocial teleassistance group-based intervention on improving social cognitive functioning and health-related quality of life (HRQoL) in pediatric neuromuscular diseases (NMD).</p><p><strong>Methods: </strong>Thirty-five pediatric patients with NMD were assigned to the neuropsychosocial intervention program (n = 20) or waiting list control condition (n = 15). The intervention group received an integrative approach that combines training in social cognition with cognitive behavioral therapy. All participants completed a neuropsychological and clinical assessment at baseline and follow-up, which included tests of social cognition, both for emotion recognition and theory of mind, and HRQoL. Repeated-measures multivariate analysis of covariance was used to determine the effects of the teleassistance program.</p><p><strong>Results: </strong>Group × Time interactions revealed significant improvements in the intervention group as compared with the control group for different social cognition's indicators (AR NEPSY-II: p = .003, η2p = .24; TM NEPSY: p < .001, η2p = .35; Verbal task: p < .001, η2p = .35; Happé's Strange Stories: p = .049, η2p = .11) and HRQoL (Psychosocial health: p = .012, η2p = .18; Emotional functioning: p = .037, η2p = 0.13; Social functioning: p = .006, η2p = .21; Total: p = .013, η2p = .17), showing medium to large effects.</p><p><strong>Conclusions: </strong>Patients receiving the neuropsychosocial intervention showed improvements in their social cognition performance and psychosocial HRQoL, providing evidence about the positive effects of the program in pediatric patients with NMD. This should be considered in further research and interventions in this field.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"525-535"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140060844","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}
Brittany D Lancaster, Tristen Hefner, Calissa J Leslie-Miller, Kody Sexton, Dana M Bakula, Jason Van Allen, Christopher C Cushing, Crystal S Lim, David M Janicke, Elissa Jelalian, Katie Dayani, Ann M Davis
{"title":"Systematic review and meta analysis of psychological interventions to prevent or treat pediatric chronic disease in rural communities.","authors":"Brittany D Lancaster, Tristen Hefner, Calissa J Leslie-Miller, Kody Sexton, Dana M Bakula, Jason Van Allen, Christopher C Cushing, Crystal S Lim, David M Janicke, Elissa Jelalian, Katie Dayani, Ann M Davis","doi":"10.1093/jpepsy/jsae054","DOIUrl":"https://doi.org/10.1093/jpepsy/jsae054","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this systematic review and meta-analysis was to examine the effectiveness of psychological interventions at improving physical or mental health outcomes for youth living in rural communities who have, or are at-risk for, any chronic medical condition in comparison to control interventions conducted in rural communities.</p><p><strong>Methods: </strong>Following prospective registration (OSF.IO/7TDQJ), 7 databases were searched through July 1, 2023. Studies were included if they were a randomized control trial of a psychological intervention conducted with youth living in a rural area who had, or were at-risk for, a chronic medical condition. Risk of bias was assessed with the Cochrane risk of bias version 2 tool. A qualitative synthesis and meta-analysis were conducted.</p><p><strong>Results: </strong>15 studies met inclusion criteria. Obesity studies (n = 13) primarily focused on body mass index metrics, with limited significant findings across studies. Asthma treatment interventions (n = 2) showed no impact on hospitalizations. 3 studies evaluated mental health outcomes with no significant group differences observed. We meta-analytically analyzed 9 studies that evaluated body mass index z-scores and identified an overall null effect (Hedge's g = 0.01, 95% CI [-0.07, 0.09], p = .85).</p><p><strong>Conclusions: </strong>Most included studies focused on pediatric obesity, and there was a limited range of health outcomes reported. Compared to controls, minimal significant improvements in health outcomes were identified for psychological interventions for youth living in rural communities. Future efforts may benefit from situating this work more systematically within a health disparities framework with a focus on understanding mechanisms of disparities and translating this work into interventions and policy changes.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564845","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":"Correction to: Pandemic-Related Social Disruption and Well-Being in Pediatric Gastrointestinal Diseases.","authors":"","doi":"10.1093/jpepsy/jsae017","DOIUrl":"10.1093/jpepsy/jsae017","url":null,"abstract":"","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"524"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140060842","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":"The rehabilitation treatment beliefs questionnaire-revised: assessing adolescents' treatment beliefs.","authors":"Gloria Metzner, Manuela Glattacker","doi":"10.1093/jpepsy/jsae037","DOIUrl":"10.1093/jpepsy/jsae037","url":null,"abstract":"<p><strong>Objective: </strong>While there are several studies on children's and adolescents' beliefs about illness and medication treatment, there is limited research on their treatment beliefs in the context of rehabilitation. The Rehabilitation Treatment Beliefs Questionnaire (RTBQ) was the first instrument available to assess pediatric patients' rehabilitation-related treatment beliefs. However, the RTBQ had some limitations that we aimed to address in this study: We revised the content of the RTBQ to include previously unaddressed dimensions of rehabilitation-related treatment beliefs, and we thoroughly tested its psychometric properties based on a sizeable, multicenter sample of adolescents with different chronic diseases.</p><p><strong>Methods: </strong>Across 11 pediatric rehabilitation clinics throughout Germany, eligible patients aged 12-18 years with any chronic physical or mental health condition were invited to participate in an online survey. Psychometric evaluation included item analysis, exploratory factor analysis, internal consistency and construct validity.</p><p><strong>Results: </strong>The sample comprised N = 294 adolescents (M = 14.2 years) with various chronic conditions. Psychometric testing demonstrated a coherent factor structure with 6 interpretable scales covering process and outcome expectations, expectations of one's own role in the treatment process, structural expectations, concerns, and emotions, the latter three representing previously unaddressed dimensions of rehabilitation-related treatment beliefs. Internal consistency was acceptable to good. Construct validity analyses showed mostly hypotheses-consistent correlations with related constructs.</p><p><strong>Conclusions: </strong>The revised RTBQ provides a psychometrically well-tested, adolescent-specific, and disease-generic instrument that captures multiple dimensions of rehabilitation-related treatment beliefs. Practical implications include identifying adolescents' beliefs about rehabilitation treatment in order to actively involve them in their illness management.</p>","PeriodicalId":48372,"journal":{"name":"Journal of Pediatric Psychology","volume":" ","pages":"501-511"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094553","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}