Journal of Medical Screening最新文献

{"title":"Breast cancer mortality during the COVID-19 pandemic.","authors":"Camilla Mattiuzzi, Giuseppe Lippi","doi":"10.1177/09691413241278129","DOIUrl":"10.1177/09691413241278129","url":null,"abstract":"<p><p>Several lines of evidence suggest that breast cancer screening and treatment may have been compromised during the early phase of the COVID-19 pandemic. Using data from the US Centers for Disease Control and Prevention (CDC) WONDER database, we estimated the age-adjusted mortality rates for female breast cancer between 2018 and 2023. We found that the age-adjusted death rate for breast cancer decreased gradually from 2018 to 2019 and 2020. This downward trend reversed in 2021, with an increase in breast cancer mortality, which then declined further in 2022 and 2023. These findings indicate that breast cancer mortality may have increased slightly in 2021, possibly as a result of limited access to screening and timely treatment during the first phase of the COVID-19 pandemic, although the age-adjusted mortality rate continued to decline in the following two years.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"100-101"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women's experience of the information provided along with invitation to participate in BreastScreen Norway.","authors":"Nataliia Moshina, Marie Burns Bergan, Åsne Sørlien Holen, Gunhild Mangerud, Solveig Hofvind","doi":"10.1177/09691413241280791","DOIUrl":"10.1177/09691413241280791","url":null,"abstract":"<p><p>ObjectivesTo explore how women aged 50-69 invited to BreastScreen Norway perceived the information provided along with the invitation letter, as well as time spent on reading this information.MethodsAn anonymous questionnaire was sent, as a paper-based form along with a physical invitation letter, or as a link to a digital form in a digital invitation letter, to 84,543 women invited to BreastScreen Norway in 2022. The paper-based forms were handed in upon screening attendance. The women were invited to screening by physical or digital invitation including an information leaflet describing benefits and harms, or a link to similar information on a webpage. The questionnaire assessed women's perception of the information and time spent on reading it. Responses were presented by screening invitation type (physical/digital).ResultsA total of 9.9% (8355/84,543) of the women responded to the questionnaire. Among women invited by a physical letter, information about the screening examination and about benefits and harms was considered sufficient by 90% (4338/4797) and 89% (4246/4790), respectively, and 92% (4246/4790) reported the information to be sufficient to make an informed decision on participation. Among those invited digitally, the percentages were 83% (2788/3379), 78% (2618/3369), and 88% (2962/3370), respectively. About 59% (4807/8169) spent <5 min reading the information.ConclusionsMost of the respondents perceived the information received upon invitation to BreastScreen Norway sufficient to make an informed decision on participation and used <5 min to read the information. The results should be interpreted with caution due to the low response rate.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"85-92"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving access to cervical cancer screening: The impact of a Saturday pap smear clinic.","authors":"Brittany Strelow, Joy Stevens, Stephanie Fink, Kristin Cole, Danielle O'Laughlin","doi":"10.1177/09691413241281653","DOIUrl":"10.1177/09691413241281653","url":null,"abstract":"<p><p>IntroductionThe implementation of cervical cancer screening and human papillomavirus (HPV) vaccination has significantly reduced cervical cancer rates. However, it remains the fourth most common cancer among women globally. Barriers to screening include personal, health system, and insurance factors.MethodsTo address these barriers, a \"Saturday Pap smear Clinic\" was established to increase accessibility. The study included female patients aged 21 to 65 from Southeast Minnesota, USA, who attended the clinic from September 2021 to April 2023.ResultsA total of 357 women attended the Saturday clinic, with a median age of 44 years; 70.6% were White. Abnormal Pap smear results were found in 13.8% of attendees, with 7.8% testing positive for HPV. Additional health maintenance was addressed. The majority of patients had a physician primary care provider (58.3%), followed by residents (26.3%), and nurse practitioner/physician associates (15.4%).DiscussionThe clinic demonstrated a high fill rate of 86.15%, indicating demand for non-traditional appointment times. Despite this, disparities in access were noted, with primarily White and English-speaking women utilizing the clinic. The clinic showed improved outcomes compared to national screening rates, highlighting the importance of timely preventative care.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"102-105"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective cohort study investigating factors affecting recommendation for continued low-dose computed tomography lung cancer screening in the national lung cancer screening trial.","authors":"Brandon Buck, Annette Yates, Jessica Bui, Amanda McCoy, Lauren Wisnieski","doi":"10.1177/09691413251342740","DOIUrl":"https://doi.org/10.1177/09691413251342740","url":null,"abstract":"<p><p>ObjectiveTo analyze trends in recommending continuation of lung cancer screening across different risk factors and demographic groups using data from the National Lung Screening Trial (NLST).MethodsThis retrospective cohort study utilized de-identified NLST data from August 2002 to April 2004 and follow-up data collected through December 31, 2009, with 24,924 participants. Multivariable logistic regression was performed to assess the odds of continued low-dose computed tomography (LDCT) screening based on variables such as alcohol consumption, age, sex, race, ethnicity, education, diagnosis of chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, or pneumonia, occupational history, family history of lung cancer, and a previous cancer diagnosis for another type of cancer. Participants receiving chest X-rays, a previous diagnosis of lung cancer, or those with incomplete data were excluded from the analysis.ResultsParticipants who consumed five or more alcoholic drinks per day (OR = 2.19), identified as Asian (OR = 3.59) or Native American, Alaskan Native, or Pacific Islander (OR = 2.37), and multiracial participants (OR = 2.15) had significantly higher odds of the reporting radiologist to recommend continued screening compared to Caucasians, while Black participants had lower odds (OR = 0.85). Factors such as family history of lung cancer or respiratory diseases like chronic bronchitis, COPD, and emphysema reduced the odds of the reporting radiologist recommending continued screening.ConclusionsThe study highlights differences in lung cancer screening recommendations among demographic groups at the time the NLST data were collected. Given the evolving guidelines and practices for LDCT screening, further research is needed to understand how these patterns compare to current trends. It is noted that global lung cancer screening programs vary in their approach, offering comparisons with lung cancer prevention worldwide.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"9691413251342740"},"PeriodicalIF":2.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of COVID-19 pandemic on breast cancer screening: A 6-year cohort study.","authors":"Pin-Yang Huang, Rui-Bin Huang, Li-Ying Chen, Hsiu-Jung Wang, Ka-Wai Tam","doi":"10.1177/09691413251338456","DOIUrl":"https://doi.org/10.1177/09691413251338456","url":null,"abstract":"<p><p>ObjectiveBreast cancer screening facilitates the early detection of breast cancer and can reduce mortality among women. However, during the COVID-19 pandemic, regular screening was postponed or interrupted. This study investigated the effect of the pandemic on breast cancer screening and diagnosis rates.MethodsThis single-center, retrospective cohort study enrolled women aged 40-69 years. Mammography was performed at our hospital or in outreach screening vehicles. Follow-up rate, time to follow-up, time to diagnosis, cancer detection rate (CDR), positive predictive value (PPV), and cancer staging were compared between pre-pandemic (2017-2019) and pandemic (2020-2022) periods.ResultsA similar number of participants were screened during the pandemic (N = 77,901) and pre-pandemic periods (N = 75,403). However, mobile screening significantly increased from 89.4% to 94.9% during the pandemic. Education level, rate of self-examination of breasts, and the proportion of participants with a family history of breast cancer were higher during the pandemic than in the pre-pandemic period. Time to follow-up and time to diagnosis were significantly shorter during the pandemic than in the pre-pandemic period. No significant differences were observed in PPV, CDR, cancer staging, and rate of invasive carcinoma between the two periods.ConclusionDuring the pandemic, participants were more likely to promptly return for follow-up. The use of outreach screening vehicles and increased awareness for individuals with low education levels are crucial for maintaining screening volumes in the pandemic recovery period. Outreach screening strategies may serve as an alternative in a future pandemic crisis.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"9691413251338456"},"PeriodicalIF":2.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent cancer screening participation and associated factors among Canadian women: Insights from a cross-sectional study.","authors":"Kazeem Adefemi, John C Knight, Yun Zhu, Peizhong Peter Wang","doi":"10.1177/09691413251333223","DOIUrl":"https://doi.org/10.1177/09691413251333223","url":null,"abstract":"<p><p>ObjectivesColorectal, breast, and cervical cancers are leading causes of morbidity and mortality among Canadian women. While organized screening programs aim to reduce this burden, participation rates remain suboptimal, particularly for colorectal cancer screening. This study examined factors associated with colorectal cancer screening uptake among women participating in breast and cervical cancer screening ('screen-aware\" women), investigated patterns of concurrent participation across all three programs, and identified associated factors.MethodsCross-sectional data from the 2017 Canadian Community Health Survey were analyzed for women aged 50-69 eligible for breast cancer (mammography), cervical cancer (Pap smear), and colorectal cancer (fecal and/or endoscopy tests) screening (<i>n</i> = 10,426). Multivariable logistic regression evaluated factors associated with colorectal cancer screening among \"screen-aware\" women. Multinomial logistic regression assessed factors related to full (all three), partial (any two), single, or non-participation across screening programs, using \"no screening\" as the reference.ResultsAlthough the majority of women (87%) participated in at least one screening program, only 27% reported full participation. Colorectal cancer screening (53.7%) lagged behind breast and cervical cancer screening (∼64%). Among \"screen-aware\" women, older age (adjusted odds ratio 1.50, 95% confidence interval 1.31-1.71), higher income, self-rated health as \"great\" (adjusted odds ratio 1.31, 95% confidence interval 1.05-1.63), and having a regular healthcare provider (adjusted odds ratio 3.29, 95% confidence interval 2.45-4.40) were associated with higher colorectal cancer screening participation. Having multiple chronic conditions reduced colorectal cancer screening likelihood (adjusted odds ratio 0.72, 95% confidence interval 0.55-0.94). Higher income, self-rated health, having a regular healthcare provider, and physical activity increased the odds of full screening participation, while smoking and Asian identity reduced the odds.ConclusionsColorectal cancer screening uptake remains low among Canadian women, even those participating in other cancer screenings. Socioeconomic, health-related, and systemic factors influence concurrent screening participation. Tailored interventions addressing identified barriers and promoting equitable access to screening are crucial for improving cancer prevention efforts.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"9691413251333223"},"PeriodicalIF":2.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial problems caused by abdominal aortic aneurysm surveillance: A cross-sectional survey.","authors":"Jane Hughes, Elizabeth Lumley, Alan Elstone, Jo Hall, Jonathan Michaels, Akhtar Nasim, Steve Radley, Phil Shackley, Niall MacGregor Smith, Gerry Stansby, Emily Wood, Alicia O'Cathain","doi":"10.1177/09691413251333967","DOIUrl":"https://doi.org/10.1177/09691413251333967","url":null,"abstract":"<p><p>ObjectivePeople with abdominal aortic aneurysms (AAA) are at risk of aneurysm rupture, which is immediately life-threatening. People diagnosed with AAA that are a sub-threshold size for intervention undergo regular ultrasound surveillance in England. However, surveillance may cause psychosocial problems such as anxiety. We aimed to use an AAA-specific measure of quality of life to identify the characteristics of people in surveillance with AAA-related psychosocial problems.SettingIn the National Health Service (NHS) in England, all men are screened for AAA aged 65. They undergo annual surveillance if a small AAA is detected (3-4.4 cm) and three-monthly surveillance if a medium AAA is detected (4.5-5.4 cm). Men with larger AAAs are referred to vascular services.MethodsA postal survey of men in AAA surveillance from five regional screening centres was conducted using the e-PAQ-AAA quality of life measure which included the Psychological Consequences of Screening Questionnaire.ResultsThe response rate was 64% (734/1156). The majority of men reported no AAA-related anxiety or impact on daily living, and no screening-related psychological consequences. However, 11% (29/257) of men in three-monthly surveillance reported having AAA-related anxiety most or all of the time. Men with higher levels of anxiety and physical, emotional or social consequences of surveillance tended to be younger, from more socially deprived communities, have poorer physical health, and have relatively larger and faster-growing AAAs.ConclusionsPsychosocial problems related to AAA surveillance were not common but did affect a minority of men significantly. An intervention would be beneficial in helping men in AAA surveillance to manage such problems.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"9691413251333967"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced disease at presentation for Canadian patients with colorectal cancer despite provincial screening programs: A call to action.","authors":"Kieran Purich, Courtney Streu, Sunita Ghosh, Ram V Anantha, Clarence Wong, Daniel Schiller","doi":"10.1177/09691413251332588","DOIUrl":"https://doi.org/10.1177/09691413251332588","url":null,"abstract":"<p><p>ObjectiveWe sought to evaluate the presentation and outcomes of patients with a diagnosis of colorectal cancer (CRC) at an academic Canadian center to identify strategies to improve the existing screening system for CRC.SettingRoyal Alexandra Hospital, Edmonton, Alberta, Canada.MethodsWe performed a prospective cohort study. Data collected included: patient demographics, presentation, treatment, and outcomes 1 year after study completion.ResultsOne hundred consecutive patients were included with a median age of 68 years (SD = 13.3). Most (58%) participants were male and 25% had a first-degree family history of CRC. Only 26% of CRC presentations were identified through screening. Of the screened patients, 81% had stage 0-2 disease, all underwent surgery and there were no deaths in this group 1 year after recruitment.In contrast, 74% of patients presented with symptoms, including bleeding (26%), anemia (22%), and obstruction (19%). Thirty-six (49%) received elective surgery, 33 (45%) underwent emergency surgery, and 5 (7%) did not receive surgery. One year after recruitment, 21 patients (28%) in this group were deceased. Within the symptomatic cohort, 55% of patients were outside the age range recommended for screening, 22% did not have a family physician, and 50% had not been offered regular screening.ConclusionsDespite an established screening program, a significant proportion of patients diagnosed with CRC at our center were not diagnosed via screening. Patients presenting with symptoms were more likely to have advanced disease, require more urgent surgeries, and experience worse outcomes compared to their screened counterparts. The current provincial approach to screening for CRC needs to be improved.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"9691413251332588"},"PeriodicalIF":2.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-attendance to mammographic screening after a false positive screening result.","authors":"Marthe Larsen, Nataliia Moshina, Åsne Sørlien Holen, Marie Burns Bergan, Solveig Hofvind","doi":"10.1177/09691413251329671","DOIUrl":"https://doi.org/10.1177/09691413251329671","url":null,"abstract":"<p><p>ObjectiveAttendance as well as re-attendance is important for an effective screening program for breast cancer. We aimed to evaluate re-attendance among women with a false positive versus negative screening result in BreastScreen Norway.MethodsThe study sample included 3,990,388 screening examinations performed between 1996 and 2021 among women with an invitation to the subsequent screening examination available, that is, women eligible for re-attendance in the period 1998-2023. Mixed logistic regression was used to analyze the association between screening results, including negative versus any false positive, and negative versus false positive with or without a needle biopsy, and attendance in the subsequent screening round. We adjusted for screening history and age.ResultsCrude attendance rates in the subsequent screening round were 90.8% for those with a negative result and 88.3% for those with a false positive result. The adjusted odds ratio (OR) for re-attendance after a false positive result was 0.91 (95% CI: 0.87-0.93) using a negative screening result as the reference. Also using negative screening result as the reference, adjusted OR for re-attendance among those with a false positive screening result without a needle biopsy was 0.93 (95% CI: 0.91-0.96) while it was 0.85 (95% CI: 0.82-0.87) for those with a false positive result including a biopsy.ConclusionsWomen invited to BreastScreen Norway re-attended screening less often after a false positive compared to a negative result. The benefits of regular attendance should be communicated to women targeted for breast cancer screening.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"9691413251329671"},"PeriodicalIF":2.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying optimum implementation for human papillomavirus self-sampling in underserved communities: A systematic review.","authors":"Olivia Mackay, Kate Joanna Lifford, Anahat Kalra, Denitza Williams","doi":"10.1177/09691413241274312","DOIUrl":"10.1177/09691413241274312","url":null,"abstract":"<p><strong>Objective: </strong>To review the existing evidence to identify the optimum methods for implementing human papillomavirus self-sampling to increase screening uptake for underserved groups.</p><p><strong>Setting: </strong>Specific groups are less likely to participate in cervical screening. These include individuals from low socioeconomic status groups, ethnic minority groups, younger age groups (25-29), older age groups (≥50), with a physical disability, with a learning disability and with an LGBTQ+ identity. The advent of human papillomavirus self-sampling for cervical screening presents an opportunity to promote equitable access to screening. Implementation for human papillomavirus self-sampling can vary, for example, opt-out or opt-in approaches. However, it is unclear which of these is the best method of offering human papillomavirus self-sampling to underserved groups.</p><p><strong>Methods: </strong>Six databases were searched through May 2023. Studies comparing cervico-vaginal human papillomavirus self-sampling provision using different implementation strategies with the standard screening pathway in underserved groups were identified. A narrative synthesis was conducted.</p><p><strong>Results: </strong>In total, 4574 studies were identified; 25 studies were included, of which 22 were from high-income countries. Greater uptake was found for offering human papillomavirus self-sampling compared to standard clinician-based sampling. Directly mailing human papillomavirus self-sampling kits to participants resulted in higher uptake of screening than using an 'opt-in' approach or standard recall in low socioeconomic status and ethnic minority groups, and older women. Strategies that used community health workers or educational materials increased uptake in ethnic minority and low socioeconomic status groups.</p><p><strong>Conclusions: </strong>Directly mailing human papillomavirus self-sampling kits to low socioeconomic status groups, ethnic minority groups and older women has the potential to increase uptake of human papillomavirus self-sampling. Using community health workers to offer human papillomavirus self-sampling should be considered for ethnic minority and low socioeconomic status groups. Further research exploring the preferences of younger women is needed.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":" ","pages":"2-18"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114472","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}