Social Science & Medicine最新文献

{"title":"“We know what to do for you, but we can't do it:” How actionability is coordinated and contested in genomics research","authors":"E. Carolina Mayes","doi":"10.1016/j.socscimed.2025.118088","DOIUrl":"10.1016/j.socscimed.2025.118088","url":null,"abstract":"<div><div>Over the last few decades, an influential movement has emerged in genomics research advocating for the return of “actionable” findings to research participants. This movement argues that actionable findings constitute clinically significant information that can be used to inform preventive care, and that research projects may therefore have a responsibility to disclose such findings. Using a document analysis of institutional and expert guidance, this article traces how the notion of actionability became a predominant justification for the disclosure of research findings, and explores how this guidance has failed to account for local and structural coordination of actionability. The paper presents two case studies of US-based research projects, Geisinger Health System's MyCode Initiative and the National Institutes of Health's All of Us Research Program, to characterize how the disclosure of actionable findings has been implemented in research programs, and to reveal how a decontextualized approach to actionability threatens to undermine the promised clinical utility of genomic findings and exacerbate inequalities in healthcare access. As research projects increasingly adopt clinical actionability as a stand-in for clinical utility, exchanging evidence of improved health outcomes with opportunities for preventive interventions, coordination of the responsibilities and resources for realizing actionability is essential. This analysis indicates the possible consequences of contested actionability, and points to the need for further investigation of how actionable findings are implemented in practice.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118088"},"PeriodicalIF":4.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“No peace in my heart”: Exploring psychosocial problems experienced by women in relation to water insecurity and inadequate sanitation in an informal settlement, Kenya","authors":"Joan J. Kimutai ,&nbsp;Crick Lund ,&nbsp;Wilkister N. Moturi ,&nbsp;Seble Shewangizaw ,&nbsp;Charlotte Hanlon","doi":"10.1016/j.socscimed.2025.118118","DOIUrl":"10.1016/j.socscimed.2025.118118","url":null,"abstract":"<div><h3>Background</h3><div>Social determinants of mental health are recognized as significant contributors to the disproportionate burden of depression and anxiety experienced by women worldwide.</div><div>This study aimed to explore psychosocial problems experienced by women in relation to water insecurity and inadequate sanitation in an informal settlement in Kenya.</div></div><div><h3>Methods</h3><div>We conducted a qualitative study employing a phenomenological approach. The study setting was Kaptembwo, an informal settlement in Kenya. Data collection was conducted from March 28, 2023 to April 24, 2023. Twenty-one in-depth interviews were carried out in Swahili with women of reproductive age (18–49 years) selected through purposive sampling and snowballing. Women were approached as they accessed the common water point and sanitation facility at their households and invited to participate. Marrianne Hennik's thematic analysis approach was used to examine patterns, themes, and meanings of data.</div></div><div><h3>Results</h3><div>The key themes that emerged were stresses and social tension; bodily concerns and relational impacts; emotional consequences; and coping strategies. Unreliable and inadequate water and sanitation brought myriad stresses, led to stigma, and threatened social harmony as women struggled to maintain the health and dignity of their families. Women experienced infections and expressed bodily concerns including backpain, urinary problems and vaginal discharge, that fueled discord within their intimate relationships. Emotional consequences included stress, anxiety, shame, discomfort, frustration, embarrassment, and depression. Coping strategies reported by women included attempts to restore social relationships or seek social solutions to gender-based violence, with limited uptake of formal psychosocial care. Women's accounts supported conceptualization of psychosocial problems as a syndemic arising from interconnections between infections, gender disadvantage and environment.</div></div><div><h3>Conclusion</h3><div>Future research should focus on longitudinal and ethnographic observational studies to track evolving experiences of women and investigate the hypothesis that psychosocial problems in women in this informal settlement are the best conceptualized as a syndemic.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118118"},"PeriodicalIF":4.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of war exposures, post-migration living difficulties and social support with (complex) PTSD: a cohort study of Ukrainian refugees resettled in Denmark","authors":"Karen-Inge Karstoft ,&nbsp;Ludvig Daae Bjørndal ,&nbsp;Anne Agathe Pedersen ,&nbsp;Nataliia Korchakova ,&nbsp;Séamus A. Power ,&nbsp;Thomas A. Morton ,&nbsp;Vibeke J. Koushede ,&nbsp;Marie H. Thøgersen ,&nbsp;Brian J. Hall","doi":"10.1016/j.socscimed.2025.118080","DOIUrl":"10.1016/j.socscimed.2025.118080","url":null,"abstract":"<div><h3>Background</h3><div>The war in Ukraine has forced millions of Ukrainians to flee their country, many after exposure to actions of war. Previous research found that both war exposures (WE) and post-migration living difficulties (PMLD) are associated with risk of PTSD. In the current study, we test associations between WE, PMLD and PTSD/Complex PTSD (CPTSD). Further, we test if the associations are moderated by social support.</div></div><div><h3>Methods</h3><div>In a representative prospective cohort study of adult Ukrainians arriving in Denmark in the first year after Russia's full-scale invasion (N = 4,229), we test associations between WE, PMLD, and (C)PTSD using multinomial logistic regression analysis. Interaction terms were added to assess if associations were moderated by SS.</div></div><div><h3>Results</h3><div>Prevalence of PTSD and CPTSD was 12.1 % and 12.2 %, respectively. We found statistically significant associations between family-related PMLD, health-related PMLD, and general PMLD and CPTSD (AORs from 1.25 to 1.56), and between health-related PMLD and family-related PMLD and PTSD (AORs from 1.18 to 1.35). WE were associated with PTSD (AOR (CI): 1.15 (1.07–1.25)), but not CPTSD (AOR (CI): 1.05 (0.97–1.13)). Social support was associated with CPTSD (AOR (CI): 0.69 (0.60–0.78)) but not PTSD (AOR (CI):0.94(0.83–1.07)). Interaction terms were significant only for PTSD, where social support attenuated the negative association between PMLD and PTSD.</div></div><div><h3>Conclusion</h3><div>PMLDs are important risk factors for post-trauma psychopathology in war refugees. Social support mitigates the negative association between PMLDs for PTSD, while low social support is an independent risk factor for CPTSD. Attention should be paid to refugees’ daily life challenges and social support networks.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118080"},"PeriodicalIF":4.9,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ageing in place or stuck in place: A critical qualitative study on older adults’ independence across six municipalities in Norway","authors":"Linda Aimée Hartford Kvæl","doi":"10.1016/j.socscimed.2025.118098","DOIUrl":"10.1016/j.socscimed.2025.118098","url":null,"abstract":"<div><div>The concept of ageing in place (AIP) has garnered substantial international attention, especially with the global rise in the ageing population. Despite extensive research and policy support, the practical complexities of implementing AIP policy, particularly in diverse living situations, places, social contexts and evolving family structures, remain unclear. The purpose of this study was to critically examine the key factors influencing experiences of AIP among older individuals, family caregivers and municipal health and social care employees across six diverse Norwegian municipalities. This qualitative study utilised an explorative interpretative design, involving focus group interviews with municipal employees (N = 36) and semi-structured individual interviews with older persons (N = 17) and family caregivers (N = 18). The municipalities varied in several key dimensions, including population size, geographic extent, centrality, demographics and the economy. The reflexive thematic analysis identified four themes: i) Ageing-Related Preparation: Balancing Personal and Municipal Responsibility, ii) Access to Proper Services: Aligning the Person-Environment Fit, iii) Family Caregiving: Bridging the Gap between Services and Actual Needs, and iv) Transitional Housing: Supporting Aging in Place with Dignity. Together, these themes highlight the need to promote 'independence literacy' for older adults, ensuring they have the necessary knowledge, access, and support to live independently and maintain their quality of life while AIP. The findings urge a re-evaluation of local factors shaping safe and proper person–environment fit, emphasising access to proper services, caregiver support, housing options, resource allocation and the enhancement of skilled healthcare staff to optimise safe AIP. The findings may be relevant for policy makers, municipal leaders and health service employees in developing equitable AIP policies tailored to the local context.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"375 ","pages":"Article 118098"},"PeriodicalIF":4.9,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a cancer diagnosis on educational, employment, health-related quality of life, and social outcomes among young adults: A matched cohort study of 401 cancer survivors aged 15–24 in England","authors":"R. Mattock ,&nbsp;A. Martin ,&nbsp;A.E. Beckett ,&nbsp;O.C. Lindner ,&nbsp;D. Stark ,&nbsp;R.M. Taylor","doi":"10.1016/j.socscimed.2025.118078","DOIUrl":"10.1016/j.socscimed.2025.118078","url":null,"abstract":"<div><h3>Background</h3><div>Globally, cancer incidence is rising fastest among young people. Existing literature on acute health shocks, including cancer diagnoses, focuses on older working-aged adults.</div></div><div><h3>Methods</h3><div>Matched cohort study involving 401 young cancer survivors (aged 15–24) in the BRIGHTLIGHT study and 765 UK Household Longitudinal Study controls without cancer between 2013 and 2018. Participants were matched on sex, age, ethnicity, index of multiple deprivation (IMD) quintile, non-cancer health conditions, and follow-up duration. Regression models assessed economic, educational, social, health-related quality of life (HRQoL), and mental health outcomes at 6(T1), 12–18(T2), and 24–36 months (T3) post-diagnosis.</div></div><div><h3>Results</h3><div>Compared to matched controls, those with cancer were: less likely to be in employment, education, or training at T1 (OR = 2.03, p &lt; 0.001) but not at T3 (OR = 0.96, p = 0.18), because transitioning from unemployment or economic inactivity into education was more common (24 % vs 3 % between T1 and T3); less likely to live in parental households at T1 (OR = 0.54, p &lt; 0.001) and T3 (OR = 0.59, p &lt; 0.001); and more likely to experience relationship breakdown (23 % vs 12 % between T1 and T3). Differences in mental health and HRQoL declined over time (mean difference compared to matched controls: T1: −0.07, p &lt; 0.001; T2 and T3: −0.01 p ≥ 0.55). Economic outcomes, mental health and HRQoL utility scores were persistently worse among more severe cancer cases.</div></div><div><h3>Conclusions</h3><div>Despite having initially poorer health and economic outcomes, cancer survivors in this cohort caught up with their peers within 3 years. Linked clinical data showed those with more severe diagnoses were affected most, indicating scope for improved psychosocial and economic support.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118078"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cost of being a legal patient: Judicial use of rape defendants' and victims’ psychiatric records in South Korea","authors":"Joohyun Park","doi":"10.1016/j.socscimed.2025.118108","DOIUrl":"10.1016/j.socscimed.2025.118108","url":null,"abstract":"<div><div>Mental health evidence in courts can either support or undermine the trustworthiness and accuracy of each party's claims. When defendants and victims of sex crimes against women present their medical evidence, how are their claims impacted differently? This paper examines the court's interpretation of defendants' and victims' psychiatric records in 821 South Korean court cases involving rape (2013–2023). The findings show that a defendant's credibility is discussed as a potential mitigating factor in determining their responsibility and treatability. In contrast, a victim's credibility is debated at the risk of dismissing the entire case, determining the occurrence of the crime and new harm. This structural imbalance is exacerbated when rape trials turn into false accusation trials, in which rape victims must use their psychiatric evidence to invalidate their own rape allegations. The paper highlights the asymmetrical cost of being a patient to speak up in court and discusses the consequences of diagnosis with the term <em>legal patient</em>.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118108"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disability stigma resistance by parents at the intersection of psychosocial and structural levels","authors":"Alice Scavarda ,&nbsp;Graham Scambler","doi":"10.1016/j.socscimed.2025.118097","DOIUrl":"10.1016/j.socscimed.2025.118097","url":null,"abstract":"<div><div>In this paper we define and argue for the salience of the concept of ‘project stigma’ in the context of long-term illness and disability. In the opening section we briefly review the literature on long-term illness and disability as ‘personal tragedy’ and go on to discuss critiques of this limited and limiting narrative from disability theorists and, belatedly, medical sociologists. This prepares the ground for conceptual innovation around the notion of project stigma. This, in turn, is explored using a qualitative study of 63 parents of children with Down Syndrome and Autism conducted in North-West Italy. The paper closes by outlining and commending a programme of research arising out of a series of ideal types of modes of stigma resistance and its enactment that highlights important but neglected issues of stigma resistance at both psychosocial and structural levels.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118097"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Working the boundaries of ‘whining’ – how patients and care professionals make sense of informal complaining practices","authors":"Jelmer Brüggemann ,&nbsp;Ann-Charlotte Nedlund ,&nbsp;Lisa Guntram","doi":"10.1016/j.socscimed.2025.118112","DOIUrl":"10.1016/j.socscimed.2025.118112","url":null,"abstract":"<div><div>This study investigates informal complaining in healthcare settings, that is, the kind of patient complaints that are expressed verbally to professionals in care encounters. In healthcare policies and the complaints literature, informal complaints receive little attention and are rarely studied as a distinct phenomenon. Building on the sociology of complaint, research on the good and bad patient, and scholarship on boundary work, we analyse focus groups with care professionals and interviews with patients in Sweden to study how these actors make sense of patients' informal complaining practices. We highlight the discursive work that patients and care professionals do around the boundaries of ‘whining’ – our analytic term to capture informal complaining practices that are demarcated as <em>to-be-avoided</em>. We argue that there are three dimensions to this work: they negotiate the <em>validity</em> and <em>temporality</em> of complaining and do so in relation to an <em>identity</em> of the ‘complainer’. Our analysis highlights the complexities of these negotiations and shows how informal complaining oftentimes is framed as a risky practice by patients and a problem by care professionals. These normative complexities get muddled further through their contrast to healthcare political discourses which emphasise complaints as valuable knowledge and patients as active subjects. Our study suggests that it is necessary for future research, complaint policies, and person-centred care to engage with the difficult and at times unwanted parts of informal complaining practices.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118112"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of sex on the incidence of colorectal cancer: considering the influence of gender mechanisms","authors":"Amalia Martinez ,&nbsp;Nadine Hamieh ,&nbsp;Hélène Colineaux ,&nbsp;Michelle Kelly-Irving ,&nbsp;Pascale Grosclaude ,&nbsp;Emmanuel Wiernik ,&nbsp;Cyrille Delpierre ,&nbsp;Sébastien Lamy","doi":"10.1016/j.socscimed.2025.118058","DOIUrl":"10.1016/j.socscimed.2025.118058","url":null,"abstract":"<div><h3>Context</h3><div>Differences in colorectal cancer (CRC) incidence between men and women are documented, but the role of gender mechanisms in explaining these disparities remains underexplored. CRC, the third deadliest cancer worldwide, is often analyzed through “biological” sex differences, without a clear distinction between innate and socially acquired factors. Gender mechanisms, including social roles, behaviors, and access to healthcare, may significantly influence CRC risk.</div></div><div><h3>Objective</h3><div>This study quantifies the proportion of the effect of gender mechanisms on the relationship between sex assigned at birth and CRC incidence, adopting a social epidemiology approach.</div></div><div><h3>Method</h3><div>Using data from the CONSTANCES cohort and the French National Health Insurance database (SNDS), we identified relevant covariates with a Directed Acyclic Graph (DAG). Mediation analyses estimated the contribution of socioeconomic, behavioral, anthropometric and medical factors as gender-related mechanisms.</div></div><div><h3>Results</h3><div>Men have a higher risk of CRC compared to women (OR: 1.54 [1.33; 1.79]). Men exhibit lower cultural capital, higher social and economic capital, more frequent risk behaviors, and higher BMI. Gender mechanisms account for 30 % of the association between sex assigned at birth and CRC incidence, in the imputed data, and up to 50 % in the complete cases. Among the gender mechanisms, BMI emerged as the main mediator.</div></div><div><h3>Conclusion</h3><div>This study reveals that gender-based health inequalities in CRC incidence are partially explained by differences in exposure to social and behavioral risk factors. These findings underscore the importance of integrating gender dynamics into public health strategies for CRC prevention and intervention, focusing on addressing gender-based risk factor exposure.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118058"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping fertility trajectories: An endarkened narrative inquiry of Black women's fertility experiences and pathways through infertility treatment","authors":"Isabel Morgan ,&nbsp;Christine Tucker ,&nbsp;Aunchalee E.L. Palmquist ,&nbsp;Stephanie Baker ,&nbsp;Larissa Jennings Mayo-Wilson ,&nbsp;Chantel L. Martin ,&nbsp;Natalie Hernandez ,&nbsp;Lasha Clarke","doi":"10.1016/j.socscimed.2025.118082","DOIUrl":"10.1016/j.socscimed.2025.118082","url":null,"abstract":"<div><div>While existing literature has documented barriers and facilitators to Black women’s access to infertility treatment, scholars have a limited understanding of the experiences of Black women who have initiated medically assisted reproduction (MAR), including medicated timed intercourse, intrauterine insemination, and in vitro fertilization. Informed by Black feminism and reproductive justice, this endarkened narrative inquiry leveraged data from the Fertility Equity Study at Morehouse School of Medicine to characterize 41 Black women’s infertility treatment outcomes and examine their trajectories through fertility care and infertility treatment. Our analysis provides greater nuance and understanding to Black women’s experiences navigating systems of care to address challenges related to conceiving or maintaining a pregnancy. The results indicate a lack of fertility benefits and out-of-pocket expenses as significant barriers at each stage of the treatment pathway. There is a need for legislation that mandates private and public (e.g., Medicaid) health insurance coverage for fertility treatments and associated costs, inclusive of medication, genetic screening (and other ancillary testing), and donor gametes. Additionally, integration of culturally congruent providers (including mental health practitioners), addressing reproductive health conditions, and providing fertility awareness counseling throughout the life course may optimize Black women’s fertility care and MAR experiences.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118082"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}