Medicina Del Lavoro最新文献

{"title":"Quantitative Assessment of Asbestos Fibers in Abdominal Organs: A Scoping Review.","authors":"Yohama Caraballo-Arias, Francesco Roccuzzo, Francesca Graziosi, Nataliia Danilevskaia, Samantha Rota, Carlotta Zunarellli, Paola Caffaro, Paolo Boffetta, Mattia Bonetti, Francesco Saverio Violante","doi":"10.23749/mdl.v114i6.14946","DOIUrl":"10.23749/mdl.v114i6.14946","url":null,"abstract":"<p><strong>Background: </strong>Quantification of asbestos fibers has been mainly performed in the lung but rarely in other organs. However, this may be relevant to understanding better translocation pathways and the oncogenic effects of asbestos on the human body. Electron microscopy is the best technology available to assess the type of fiber, dimensions, and distribution of asbestos fibers in different tissues and as a biomarker of cumulative dose.</p><p><strong>Objectives: </strong>This scoping review aims to summarize the findings of the studies in which asbestos fibers have been quantified by electron microscopy, occasionally associated with X-ray microanalysis, in normal and pathological tissue of ten abdominal organs.</p><p><strong>Methods: </strong>A scoping review has been performed by searching articles that quantified asbestos fibers in abdominal organs by electron microscopy (Scanning- SEM or Transmission- TEM).</p><p><strong>Results: </strong>The 12 selected studies included 204 cases, and 325 samples were analyzed. The colon and rectum, kidney, bladder, and abdominal lymph nodes were the organs with at least ten samples available with quantification of asbestos fibers. Asbestos fibers were detected in all the abdominal organs considered: the highest value (152,32 million fibers per gram of dry tissue) was found in the colon and was identified using STEM with EDS.</p><p><strong>Conclusion: </strong>The studies included were heterogeneous in terms of exposure and cases, type of samples, as well as analytical techniques, therefore we cannot confirm a specific pattern of distribution in any organ, based on the low homogeneity of the exposure status. The colon is the organ in which the number of fibers is the highest, probably because of exposure arising from both internal distribution of inhaled fibers and ingestion. Additional studies of the number of asbestos fibers in abdominal organs should be made to achieve better representativity.</p>","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 6","pages":"e2023048"},"PeriodicalIF":2.4,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499997","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":"Cross-Sectional Study of the Psychological Well-Being of Healthcare Workers in a Large European University Hospital after the COVID-19 Initial Wave.","authors":"Emma Sala, Emilio Paraggio, Maria Angela Abrami, Cesare Tomasi, Emanuela Tomasini, Emanuele Sansone, Stefano Barlati, Antonio Vita, Giuseppe De Palma","doi":"10.23749/mdl.v114i6.14849","DOIUrl":"10.23749/mdl.v114i6.14849","url":null,"abstract":"<p><strong>Background: </strong>The SARS-CoV-2 pandemic greatly impacted healthcare workers (HCWs) dedicated to caring for COVID-19 patients. The study was conducted in a large European hospital to study the psychological distress of HCWs engaged in COVID-19 wards in the early phase of the pandemic.</p><p><strong>Methods: </strong>A questionnaire was sent to 1229 HCWs aimed at collecting the following information: 1) sociodemographic data; 2) depression, anxiety, and stress scales (DASS-21); 3) event impact scale (IES-R); 4) perceived stress scale (PSS); and 5) work interface analysis. The responses were collected through Google® forms and then statistically analyzed. Regardless of the outcome of the questionnaire, all subjects were offered psychological support voluntarily.</p><p><strong>Results: </strong>Approximately two-thirds of the workers reported no symptoms according to the DASS-21 scales, while the IES-R and PSS scales showed 36% and 43%, respectively. There were no statistically significant differences in the levels of depression investigated through the different scales in the various occupational categories. Symptoms of anxiety, stress, and depression were more pronounced in women, while the highest stress levels were observed in the younger age groups. The highest scores were observed on the DAS-21 scales of anxiety and IES-R but not on the others. Only 51 workers, most of them with previous SARS-CoV-2 infection, sought clinical psychological counseling, and more than half received subsequent psychological support.</p><p><strong>Conclusions: </strong>Our results agree with most of the literature data that anxiety, depression, and stress are associated with gender (female), age (18-44 vs. over 55), and having cared for patients with COVID-19.</p>","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 6","pages":"e2023051"},"PeriodicalIF":2.7,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499993","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":"COVID-19 in Workplace Settings: Lessons Learned for Occupational Medicine in the UK.","authors":"Raymond Agius","doi":"10.23749/mdl.v114i6.15461","DOIUrl":"10.23749/mdl.v114i6.15461","url":null,"abstract":"<p><p>This paper addresses lessons learned from the COVID-19 pandemic from a UK Occupational Medicine perspective to permit comparison with other national accounts. In spite of good prior research and statute, the necessary resources to protect workers' health were seriously lacking when the pandemic struck. Weak public health guidance, which did not recognise dominant airborne transmission, was applied to workplaces, leaving workers and others unprotected, especially in respect to Respiratory Protective Equipment (RPE). The Health and Safety Executive (HSE) as regulator was lacking, for example, in not producing guidance to protect HealthCare Workers (HCW) who were amongst the most at risk. The UK COVID-19 Public Inquiry should address shortcomings such as these, but recommendations must be accompanied by robust means to ensure appropriate implementation. These should range from substantial measures to improve indoor air quality, to a permanent pandemic management organization with adequate resources. The enforcing authority has to be obliged to publish more specific workplace guidance than the public health authorities. Occupational medicine as a discipline needs to be better prepared, and hence to assert its responsibility towards high standards of workers' health protection. Future research has to include investigating the best means of mitigation against airborne infection and the management of post-acute covid sequelae.</p>","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 6","pages":"e2023055"},"PeriodicalIF":2.7,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499991","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":"Learning from the Experience of the COVID-19 Pandemic: A New Paradigm for Occupational Biohazard Assessment and Management.","authors":"Paolo Durando, Alborz Rahmani, Alfredo Montecucco, Guglielmo Dini","doi":"10.23749/mdl.v114i6.15452","DOIUrl":"10.23749/mdl.v114i6.15452","url":null,"abstract":"<p><p>The COVID-19 pandemic has affected workplaces in many different aspects. In this scenario, Occupational Physicians played a crucial role in assessing and managing the risk of SARS-CoV-2 infection and associated diseases to guarantee workers' health and the safety of workplaces. However, the pandemic experience has drawn attention to several critical issues in overall biohazard prevention and management strategies, originating from important knowledge gaps in our scientific understanding. An extensive analysis of the relevant hurdles that have emerged in our medical field can bring valuable lessons for the post pandemic future, not only in preparation for possible new pathogens with pandemic potential but also with principles and concepts applicable to managing all biological agents. In particular, a paradigm shift is needed to properly approach occupational diseases caused by infective agents, accurately define the \"case\", assess exposure and possible causal relationship with work appropriately, and effectively manage the specific risk through implementing appropriate preventive and protective measures. In this framework, the Occupational Physician should expand his contribution based on his unique expertise and specific competencies, confirming his role as the go-to consultant in all occupational health matters, but also in a multidisciplinary approach, considering different scientific expertise and evidence.</p>","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 6","pages":"e2023056"},"PeriodicalIF":2.7,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499995","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":"Workplace Bullying in Italy: A Systematic Review and Meta-Analysis.","authors":"Corrado Colaprico, Daniela Grima, David Shaholli, Ilaria Imperiale, Giuseppe La Torre","doi":"10.23749/mdl.v114i6.14673","DOIUrl":"10.23749/mdl.v114i6.14673","url":null,"abstract":"<p><strong>Background: </strong>Within any work environment, employees may be affected by \"workplace bullying\", a form of violent and repeated social behavior towards subordinates and colleagues. This review aimed to investigate the prevalence of bullied workers in Italy, the causes of the phenomenon, and the consequences at physical, psychological, and organizational levels.</p><p><strong>Methods: </strong>We included observational studies and systematic reviews examining the prevalence of bullied workers and the causes and consequences in Italian workplaces. Data extraction and analysis were performed on all included studies. The research strategy included three electronic databases (PubMed, Scopus, and Web of Science). A comprehensive search was done to retrieve articles based on a PRISMA-compliant protocol registered in PROSPERO: CRD 42023394635.</p><p><strong>Results: </strong>One hundred eighty-four articles were retrieved, and once duplicates and irrelevant articles were removed, 42 useful articles were reviewed. The mean pooled prevalence, calculated based on workers complaining of mistreatment, was 6.7% (SD: 4,09) and increased significantly to 17.0% (SD: 12.88) when considering only healthcare workplaces. Causes include how impaired mental health and high workload reinforce the possibility of being bullied in the workplace, resulting in a worsening of the worker's quality of life (physical and psychological) and the work organization with increased absenteeism and job changes.</p><p><strong>Conclusions: </strong>Workplace bullying is a very present phenomenon within workplaces in Italy. In light of this, it is necessary to put prevention plans in place and find solutions to maintain optimal organizational well-being in the work environment.</p>","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 6","pages":"e2023049"},"PeriodicalIF":2.7,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499998","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":"Occupational Risk Factors for Laryngeal Cancer in Tunisia: A Case Control Study.","authors":"Asma Gaddour, Aicha Brahem, Hiba Mosbah, Chaima Sridi, Maroua Saidane, Mouna Belakhdher, Asma Chouchene, Imen Kacem, Maher Maoua, Houda Kalboussi, Olfa El Maalel, Souheil Chatti, Wassim Kermani, Mrizek Najib","doi":"10.23749/mdl.v114i6.14588","DOIUrl":"10.23749/mdl.v114i6.14588","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use and alcohol consumption are the primary risk factors for laryngeal cancer (LC). In most populations, occupational exposures are likely to play a minor role in laryngeal carcinogenesis. We aimed to investigate the association between occupational exposure and laryngeal cancer.</p><p><strong>Methods: </strong>It is a case-control study that included 140 cases diagnosed between January 2013 and December 2016 and 140 controls matched by sex, age, alcohol consumption, and tobacco consumption.</p><p><strong>Results: </strong>Significantly increased risks were found amongst workers of the building sector (OR=4.621; 95% CI [1.826-11.693]) and the mechanical industry sector (OR=5.074; 95% CI [1.425-18.072]). Significant association of laryngeal cancer with various carcinogens was observed such as asbestos (p=0.009; OR=3.68; 95% CI [1.29-10.46]), paint vapors (p=0.005; OR=3.35; 95% CI [1.37-8.16]), solvents (p=0.001; OR=3.29: 95% CI [1.61-6.68]) and cement dust (p=0.003; OR=3.19: 95% CI [1.43-7.12]). After binary logistic regression, cement dust was independently correlated with LC (p=0.042; OR=3.93; 95% CI [1.04-14.78]. The administration sector was associated with decreased risk (p=0.001; OR=0.07; 95% CI [0.03-0.15]) as well as the health sector (p=0.001; OR=0.098; 95% CI [0.02-0.43]).</p><p><strong>Conclusions: </strong>Our results supported the role of occupational factors in developing LC. Further studies enabling an in-depth analysis of occupational exposures are necessary to provide a clearer definition of the etiological associations between single agents and circumstances of exposure and the genesis of LC.</p>","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 6","pages":"e2023047"},"PeriodicalIF":2.7,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499996","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":"From Pandemic to World Instability and War Crimes: Lessons Learned in a Turbulent Socio-Political Landscape.","authors":"Antonio Mutti","doi":"10.23749/mdl.v114i6.15436","DOIUrl":"10.23749/mdl.v114i6.15436","url":null,"abstract":"","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 6","pages":"e2023052"},"PeriodicalIF":2.7,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499994","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":"Mesothelioma Risk Among Maritime Workers According to Job Title: Data From the Italian Mesothelioma Register (ReNaM).","authors":"Luigi Vimercati, Domenica Cavone, Omero Negrisolo, Floriana Pentimone, Luigi De Maria, Antonio Caputi, Stefania Sponselli, Giuseppe Delvecchio, Francesco Cafaro, Elisabetta Chellini, Alessandra Binazzi, Davide Di Marzio, Carolina Mensi, Dario Consonni, Enrica Migliore, Carol Brentisci, Andrea Martini, Corrado Negro, Flavia D'Agostin, Iolanda Grappasonni, Cristiana Pascucci, Lucia Benfatto, Davide Malacarne, Veronica Casotto, Vera Comiati, Cinzia Storchi, Lucia Mangone, Stefano Murano, Lucia Rossin, Federico Tallarigo, Filomena Vitale, Marina Verardo, Silvia Eccher, Gabriella Madeo, Tommaso Staniscia, Francesco Carrozza, Ilaria Cozzi, Elisa Romeo, Paola Pelullo, Michele Labianca, Massimo Melis, Giuseppe Cascone, Giovanni Maria Ferri, Gabriella Serio","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The study describes the 466 cases of malignant mesotheliomas (MM) collected by the National Mesothelioma Register (ReNaM) in Italy in the period 1993-2018 relating to subjects with exclusive asbestos exposure in merchant or military navy. The cases among maritime workers represent 1.8% of the total cases with defined exposure registred in the ReNaM, of which 212 cases (45.4%) among merchant maritime workers and 254 cases (54.5%) among navy. The distribution by site of mesothelioma showed 453 (97.2%) MM cases of the pleura, 11 (2.3%) of the peritoneum and 2 (0.4%) of the tunica vaginalis of the testis. With regard to occupational exposure, it was classified as certain in 318 (68.2%) cases, probable in 69 (14.8%) cases and possible in 79 (16.9%) cases. Among the 23 classified jobs, the highest percentages of certain exposures are among naval engineers, motor mechanics, machine captains and sailors. Machine crew accounted for 49.3% of the cases, deck crew for 27.6%. All cases began exposure on board between 1926 and 1988. Seamen were exposed to asbestos while at sea by virtue of living onboard ships and from continual release of asbestos fibers due to the motion of a vessel. Epidemiological surveillance through the ReNaM has allowed us to verify among cases in the maritime, navy and merchant marine sectors, that in the past, subjects were exposed regardless of the ship's department where have provided service therefore all these cases must be considered as occupational diseases.</p>","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 5","pages":"e2023038"},"PeriodicalIF":2.7,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159164","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":"Serum Specific Antibodies Do Not Seem to Have an Additional Role in the Diagnosis of Hypersensitivity Pneumonitis.","authors":"Baris Demirkol, Celal Satici, Elif Tanriverdi, Ramazan Eren, Elif Altundas Hatman, Hande Aytul Yardimci, Halide Nur Urer, Kursad Nuri Baydili, Erdogan Cetinkaya","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>We aimed to investigate the contribution of serum IgG testing to the history of exposure in the diagnosis of fibrotic hypersensitivity pneumonitis.</p><p><strong>Methods: </strong>A single-center, retrospective, cross-sectional study including 63 patients pathologically diagnosed with fibrotic hypersensitivity pneumonitis in line with the guidelines of the American Thoracic Society. Descriptive statistics were presented and Kappa statistic was performed to evaluate the compatibility between panel and the history of exposure.</p><p><strong>Results: </strong>The median age was 63 (22-81) years and 34 (54%) were male. Forty-six patients (73%) had a positive history of exposure. Thirty-nine patients (61.9%) had a positive HP/Avian panel. The most common exposure agent was mold (34.9%), followed by parakeet (31.7%). The antibody detected the most was penicillium chrysogenum lgG (36.5%), followed by aspergillus fumigatus (31.8%). There was no compatibility between HP/Avian panel and history of exposure (kappa coefficient= 0.18, p= 0.14). When the exposure was only assessed based on the history, 4 (6.35%) patients were diagnosed as fibrotic hypersensitivity pneumonitis with low confidence, 6 (9.52%) with moderate confidence, 11 (17.46%) with high confidence and 42 (66.67%) with definite confidence; whereas 4 (6.35%) patients were diagnosed as fibrotic hypersensitivity pneumonitis with low confidence, 6 (9.52%) with moderate confidence, 9 (14.29%) patients with high confidence and 44 (69.84%) patients with definite confidence if exposure was evaluated with history and/or panel.</p><p><strong>Conclusions: </strong>Serum specific precipitating antibody panel does not seem to provide additional value to the history of exposure in the diagnosis of fibrotic hypersensitivity pneumonitis.</p>","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 5","pages":"e2023042"},"PeriodicalIF":2.7,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159080","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":"Moldy Hazelnut Husk and Shell Related Hypersensitivity Pneumonitis: A Possible Novel Occupational Causative Agent.","authors":"Ozlem Kar Kurt, Neslihan Akanil Fener, Erdogan Cetinkaya","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Hypersensitivity pneumonitis (HP) is a complex immune-mediated interstitial lung disease (ILD) triggered by inhalation exposure to environmental or occupational antigens in genetically susceptible individuals. Novel exposure sources and antigens are frequently identified. However, the causative agent remains unidentified in nearly half of HP cases. Early diagnosis for nonfibrotic-HP and quitting the exposure may prevent the disease progression to fibrotic forms and related complications. Here, we present two cases of HP associated with mold exposure in hazelnut husks, leaves, and shells in hazelnut agriculture.</p>","PeriodicalId":49833,"journal":{"name":"Medicina Del Lavoro","volume":"114 5","pages":"e2023041"},"PeriodicalIF":2.7,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159165","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}