Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil最新文献

{"title":"Reviewed article: Rodrigues HTB, Garcia MT. Perceptions of Family Health Strategy doctors and nurses on the promotion of adequate and healthy eating practices in light of the Dietary Guidelines: qualitative study, 2022. Epidemiol Serv Saude. 2025:34;e20240456.","authors":"Juliana Bicalho","doi":"10.1590/S2237-96222025v34e20240456.a","DOIUrl":"10.1590/S2237-96222025v34e20240456.a","url":null,"abstract":"","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20240456.a"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in healthcare professionals' perception of self-efficacy for providing dietary advice after completing a massive open online course: an uncontrolled community trial in 64 Brazilian municipalities, 2022-2024.","authors":"Vanessa Del Castillo Silva Couto, Adhara Brandão Lima Vanhoz, Kamila Tiemann Gabe, Cleyton Zanardo de Oliveira, Patrícia Constante Jaime","doi":"10.1590/S2237-96222025v34e20240330.en","DOIUrl":"10.1590/S2237-96222025v34e20240330.en","url":null,"abstract":"<p><strong>Objective: </strong>To assess the change in the perception of self-efficacy of Primary Health Care professionals to provide dietary advice using the Protocols based on the Brazilian Dietary Guidelines for Individual Dietary Advice, after completing a massive online open course (MOOC).</p><p><strong>Methods: </strong>Uncontrolled community trial. The study population comprises degree-holding healthcare professionals working in Primary Health Care in 64 small municipalities in Brazil. The intervention was a massive online open course. The outcome was assessed by a validated scale that measures the perception of self-efficacy to provide dietary advice based on the Protocols based on the Brazilian Dietary Guidelines. The mean score was calculated before and after the intervention and the change in score was tested with paired t-test (p-value<0.05).</p><p><strong>Results: </strong>Among the 1,201 health professionals, the average self-efficacy score increased from 23.71 to 37.31 after the intervention (p-value<0.001), an increase that was significant in all professional categories.</p><p><strong>Conclusion: </strong>The massive online open course increased the perception of self-efficacy of Primary Health Care professionals to provide individual dietary advice based on the Protocols based on the Brazilian Dietary Guidelines.</p>","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20240330"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of Family Health Strategy doctors and nurses on the promotion of adequate and healthy eating practices in light of the Dietary Guidelines, Santa Bárbara d'Oeste, 2022: qualitative study.","authors":"Hariane Thaine Bueno Rodrigues, Mariana Tarricone Garcia","doi":"10.1590/S2237-96222025v34e20240456.en","DOIUrl":"10.1590/S2237-96222025v34e20240456.en","url":null,"abstract":"<p><strong>Objective: </strong>To explore the perception of doctors and nurses from the Family Health Strategy in the municipality of Santa Bárbara d'Oeste/State of São Paulo regarding the promotion of adequate and healthy eating practices, in light of the Dietary Guidelines for the Brazilian Population.</p><p><strong>Methods: </strong>All doctors and nurses from the Family Health Teams were interviewed and the interviews were transcribed for content analysis. The thematic categories for analysis were defined a priori, having the Dietary Guidelines as a guide. The findings were discussed considering the Health Promotion framework.</p><p><strong>Results: </strong>Doctors (n=11) and nurses (n=9) were mostly female, between 36 and 45 years old and with 1 to 5 years of experience in the Family Health Strategy. Perceptions about their knowledge about food and health, autonomy in food choices, nutritional reductionism, convenience and cost appeared as challenges and were shown to be misaligned with the Dietary Guidelines. However, their perceptions about the consumption of ultra-processed foods and commensality were more in line with the Guidelines.</p><p><strong>Conclusion: </strong>Professionals perceive limitations in their knowledge about food and nutrition and the difficulties in carrying out actions to promote adequate and healthy eating, focusing on specific nutrients and restrictive prescriptions. The perception of the consumption of ultra-processed products as something harmful and the recognition of the influence of the context in which eating occurs on eating practices were observed. Despite the perception of obstacles to adequate and healthy eating as highlighted in the Dietary Guidelines, no strategies were suggested to overcome them.</p>","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20240456"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial analysis of granting of social welfare benefits to people with gastrointestinal Chagas disease in Brazil, 2004-2016: a time series study.","authors":"Jean Ezequiel Limongi, Keile Aparecida Resende Santos, Izabela Lima Perissato, Rivaldo Mauro Faria","doi":"10.1590/S2237-96222025v34e20240622.en","DOIUrl":"10.1590/S2237-96222025v34e20240622.en","url":null,"abstract":"<p><strong>Objective: </strong>To analyze patterns of spatial association in the granting of social welfare benefits to individuals with gastrointestinal Chagas disease in Brazil in the period 2004-2016.</p><p><strong>Methods: </strong>This was a time series analysis, using secondary data provided by the Ministry of Labor and Employment. The analyses were performed using global and local Moran indices spatial autocorrelation techniques.</p><p><strong>Results: </strong>In all, 4,661 benefits were granted, mainly to residents of urban areas (n=3,285, 70.5%), males (n=2,819, 60.5%) and with average age of 49.5±9.3 years. The main benefits granted were social welfare due to temporary incapacity (n=3,754, 80.5%), retirement due to permanent incapacity (n=581, 12.5%) and assistance support for people with disabilities (n=320, 6.9%). The most significant values ​​found for the global Moran index were for the variables \"benefits to individuals aged ≥60 years old\" (0.673; p-value 0.001) and \"benefits granted in urban areas\" (0.666; p-value 0.001). Health macro-regions in the states of Minas Gerais, Goiás and Bahia stood out, forming high-high clusters in the local Moran index analysis when benefit granting was analyzed according to sex, area of ​​residence, type of benefit granted and age.</p><p><strong>Conclusion: </strong>The concentration of benefit granting in Minas Gerais, Goiás and Bahia is a result of the intense transmission of the disease in these areas in past decades. Longitudinal monitoring of the population chronically affected by Chagas disease, mainly by Primary Care teams, can reduce the impact of the disease on social support and social security.</p>","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20240622"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urban canine leishmaniasis in an Amazonian municipality: a cross-sectional study of prevalence, distribution and phlebotomine fauna during the dry season, Brazil, 2023.","authors":"Adriana Sousa Tapajós, Luciana Pinto Oliveira, Andréa Helena Martins Amaral, Clístenes Pamplona Catete, Walter Souza Santos, Lourdes Maria Garcez","doi":"10.1590/S2237-96222025v34e20240130.en","DOIUrl":"10.1590/S2237-96222025v34e20240130.en","url":null,"abstract":"<p><strong>Objective: </strong>To describe the prevalence and distribution of canine leishmaniasis and the phlebotomine fauna across the five urban neighborhoods of the Cachoeira do Piriá Amazonian municipality, Pará state, Brazil, during the dry season.</p><p><strong>Methods: </strong>Dogs were sampled for five hours in each neighborhood, with blood and conjunctival swab specimens (from June 13 to 15, 2023). Samples were tested using polymerase chain reaction targeting the heat shock protein 70-234 gene. Risk areas (kernel) and phlebotomine fauna were investigated (from 1 to 7/10/2023).</p><p><strong>Results: </strong>A total of 93/864 (11%) animals were included. The prevalence of canine leishmaniasis was 65% (60/93). Positivity rates varied among neighborhoods (p-value 0.001), with major clusters in the Northwest and Southeast urban areas, encompassing three neighborhoods. Lutzomyia antunesi (2) and Lutzomyia evandroi (11) were found in four neighborhoods.</p><p><strong>Conclusion: </strong>High prevalence of canine leishmaniasis and a potential phlebotomine vector (Lutzomyia antunesi) were identified during the Amazonian summer in the urban area of Cachoeira do Piriá, where three neighborhoods were prioritized for surveillance.</p>","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20240130"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to multiple recommendations of the Dietary Guidelines for the Brazilian Population (Guia Alimentar para a População Brasileira) and associated factors among adolescents: a cross-sectional study with data from the National Students' Health Survey, 2019.","authors":"Diôgo Vale, Maria Eduarda da Costa Andrade, Natalie Marinho Dantas","doi":"10.1590/S2237-96222025v34e20240404.en","DOIUrl":"10.1590/S2237-96222025v34e20240404.en","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the prevalence of adherence to multiple recommendations of the Dietary Guidelines for the Brazilian Population among school adolescents in Brazil in 2019 and its associations with sociodemographic and behavioral factors.</p><p><strong>Methods: </strong>Cross-sectional study with micro data from the 2019 National Students' Health Survey. The dependent variable was adherence to multiple Guidelines recommendations, based on dietary practices markers. The independent variables were sex, race/skin color, maternal education, area of ​​residence, geographic region, school administration, territory of residence, use of laxative measures, formulas for weight loss or weight gain, body satisfaction and self-perception of health. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated by Poisson regression.</p><p><strong>Results: </strong>The prevalence of better adherence to multiple Guidelines recommendations among Brazilian adolescents was 0.4% (95%CI 0.3; 0.4). This adherence to the recommendations showed a higher rate with factors such as: living in rural areas (PR 1.91; 95%CI 1.16; 3.13), in the Northeast region (PR 1.92; 95%CI 1.10; 3.35 and the Midwest region (PR 2.29; 95%CI 1.28; 4.09), in areas outside the capitals (PR 1.33; 95%CI 1.01; 1.77), declaring oneself very satisfied with one's body (PR 2.72; 95%CI 1.20; 6.20) and considering oneself as having a very good health (PR 3.87; 95%CI 1.12; 13.43) or poor health (PR 6.11; 95%CI 1.20; 31.12).</p><p><strong>Conclusion: </strong>The prevalence of adherence to multiple Guidelines recommendations among adolescents is very low and the factors associated with better adherence are characterized by less urbanized areas and, above all, with positive perceptions about one's body and health.</p>","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20240404"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 on the incidence of visceral leishmaniasis in children and adolescents in the Northeast region, 2007-2022: time series study.","authors":"Pedro Henrique Ferreira Dos Santos, Bruna Rykelly Ramos Dos Santos, Karol Fireman de Farias","doi":"10.1590/S2237-96222025v34e20240382.en","DOIUrl":"10.1590/S2237-96222025v34e20240382.en","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of COVID-19 on the incidence of visceral leishmaniasis in children and adolescents living in the Northeast region of Brazil.</p><p><strong>Methods: </strong>Time series study with data from the Notifiable Diseases Information System, from the study of population estimates by municipality, age and sex from 2000 to 2021, and from the Brazilian Institute of Geography and Statistics. An analysis of the temporal trends of the incidence rate was performed using the Joinpoint software, calculating the average annual percentage variation (AAPV) and its 95% confidence intervals (95%CI). The percentage variation in incidence rates from 2020 to 2022 was also calculated to check whether they were below or above what was expected for the year and territory.</p><p><strong>Results: </strong>From 2007 to 2022, 13,890 new cases of visceral leishmaniasis were reported in children and adolescents in Northeast Brazil. Changes in trends were identified with the addition of the years of the COVID-19 pandemic, from 2020 to 2022, in the Northeast: AAPV (2007-2019) 0.44; 95%CI -2.23; 3.18; AAPV (2007-2022) -7.95; 95%CI -13.63; -1.88), Pernambuco: AAPV (2007-2019) 6.77; 95%CI 2.04; 11.71; AAPV (2007-2022) -1.40; 95%CI -8.75; 6.53 and Alagoas: AAPV (2007-2019) 11.51; 95%CI 4.90; 18.53; AAPV (2007-2022) -1.33; 95%CI -14.89; 14.40).</p><p><strong>Conclusion: </strong>The Northeast and its states where changes in temporal trends were observed after the COVID-19 pandemic are priorities for the intensification of actions to combat and control the disease.</p>","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20240382"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate change: a priority agenda for health services.","authors":"Everton Nunes da Silva, Jorge Otávio Maia Barreto, Maria Auxiliadora Parreiras Martins, Wildo Navegantes de Araújo, Taís Freire Galvão","doi":"10.1590/S2237-96222025v34e20252001.en","DOIUrl":"10.1590/S2237-96222025v34e20252001.en","url":null,"abstract":"","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20252001"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the Food Guide for the Brazilian Population as a training instrument for intersectoral actions: perceptions of professionals in a Brazilian metropolis.","authors":"Vanessa Fernandes Davies, Luiza Navarro de Azevedo, Roberta Camila de Lima Pinheiro, Larissa Galastri Baraldi","doi":"10.1590/S2237-96222025v34e20240397.en","DOIUrl":"10.1590/S2237-96222025v34e20240397.en","url":null,"abstract":"<p><strong>Objective: </strong>To analyze perceptions arising from an educational intervention based on the Food Guide for the Brazilian Population, aimed at health, education and social services professionals who work with children.</p><p><strong>Methods: </strong>This was a qualitative study conducted with nine professional training course participants, using semi-structured interviews. The interviews took place one year after the training, on an online platform, with average duration of 30 minutes. The interview was validated previously, including questions to explore perceptions about the training course, the applicability of the Food Guide and challenges faced. Thematic analysis was performed in stages: familiarization with the data, direct labeling, data extraction and organization into matrices, development of preliminary themes and review to define final themes.</p><p><strong>Results: </strong>The interviews were conducted with nine female professionals. Based on analysis of the data, the following themes were defined: Training and professional enhancement; Reflections produced by the Guide; and Intersectoral integration and collaboration.</p><p><strong>Conclusions: </strong>The Food Guide for the Brazilian Population promoted reflections on challenges in implementing actions to prevent childhood obesity.</p>","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20240397"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 case fatality ratio and survival among hospitalized adults in Goiás, 2020: a cohort study.","authors":"Moara Alves Santa Bárbara Borges, Ana Laura de Sene Amâncio Zara, Lísia Gomes Martins de Moura Tomich, Adriana Oliveira Guilarde, Cacilda Pedrosa de Oliveira, Deborah Lopes Mota Carvajal, Marina Mascarenhas Roriz Pedrosa, Paulo Sérgio Sucasas da Costa, Marília Dalva Turchi","doi":"10.1590/S2237-96222025v34e20240053.en","DOIUrl":"10.1590/S2237-96222025v34e20240053.en","url":null,"abstract":"<p><strong>Objective: </strong>To describe clinical-epidemiological and therapeutic aspects and to estimate case fatality ratio and risk factors for lower in-hospital survival due to COVID-19.</p><p><strong>Methods: </strong>This is a retrospective cohort study conducted in the state of Goiás, Brazil, in 2020, with data obtained from the Influenza Epidemiological Surveillance Information System and through a review of clinical records and hospital. Relative risk for in-hospital death was estimated and Poisson multiple regression and Cox regression analyses were performed. Survival functions were compared using the log-rank test and represented by Kaplan-Meier curves.</p><p><strong>Results: </strong>The sample consisted of 651 adults, whose median age was 59 years, 57.0% were admitted to public hospitals, 61.1% had severe acute respiratory syndrome on admission and 72.0% had at least one comorbidity, the most frequent being hypertension , diabetes and obesity. The overall case fatality ratio was 17.5% (95% confidence interval, 95%CI 14.7; 20.6), with no significant difference between public and private hospitals. The case fatality ratio was higher in the ≥60 years age group (prevalence ratio, PR 1.26; 95%CI 1.01; 1.58), in hypertensive patients (PR 1.41; 95%CI 1.14; 1 .74) and in those undergoing intensive care (PR 2.68; 95%CI 1.13; 6.32) and mechanical ventilation (PR 11.15; 95%CI 5.53; 22.46). The median time between hospital admission and death was 10 days (interquartile range, 6-18). Survival was lower in the ≥60 years age group (adjusted hazard ratio, HR 1.93; 95%CI 1.26; 2.95) and in those undergoing mechanical ventilation (HR 10.13; 95%CI 6.03; 17. 02).</p><p><strong>Conclusion: </strong>Factors related to comorbidities and severity were independent predictors of shorter in-hospital survival among patients with COVID-19.</p>","PeriodicalId":520611,"journal":{"name":"Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil","volume":"34 ","pages":"e20240053"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}