International Journal of Transgenderism最新文献

{"title":"Special Issue of International Journal of Transgenderism Trans pregnancy: Fertility, reproduction and body autonomy","authors":"","doi":"10.1080/15532739.2019.1676499","DOIUrl":"https://doi.org/10.1080/15532739.2019.1676499","url":null,"abstract":"","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":"20 1","pages":"471 - 471"},"PeriodicalIF":0.0,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87592608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland.","authors":"Jamie Howell,&nbsp;Rebecca Maguire","doi":"10.1080/15532739.2019.1658145","DOIUrl":"10.1080/15532739.2019.1658145","url":null,"abstract":"<p><p><b>Background:</b> While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group. <b>Aims:</b> This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables. <b>Methods</b>: 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions. <b>Results:</b> Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors. <b>Discussion:</b> The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.</p>","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":"20 4","pages":"421-433"},"PeriodicalIF":0.0,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/15532739.2019.1658145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38441041","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":"The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics.","authors":"Annie Pullen Sansfaçon,&nbsp;Julia Temple-Newhook,&nbsp;Frank Suerich-Gulick,&nbsp;Stephen Feder,&nbsp;Margaret L Lawson,&nbsp;Jennifer Ducharme,&nbsp;Shuvo Ghosh,&nbsp;Cindy Holmes","doi":"10.1080/15532739.2019.1652129","DOIUrl":"https://doi.org/10.1080/15532739.2019.1652129","url":null,"abstract":"<p><p><b><i>Background</i>:</b> Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate. <b><i>Aims:</i></b> This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions. <b><i>Methods</i>:</b> The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17 years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery. <b><i>Results:</i></b> Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions. <b><i>Discussion</i></b> : The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.</p>","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":"20 4","pages":"371-387"},"PeriodicalIF":0.0,"publicationDate":"2019-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/15532739.2019.1652129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38440162","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":"What about the family in youth gender diversity? A literature review.","authors":"Jason J Westwater,&nbsp;Elizabeth A Riley,&nbsp;Gregory M Peterson","doi":"10.1080/15532739.2019.1652130","DOIUrl":"https://doi.org/10.1080/15532739.2019.1652130","url":null,"abstract":"<p><p><b>Background:</b> Previous research has suggested that gender diversity affects everyone in the family, with positive mental health and global outcomes for gender diverse youth reliant on receiving adequate family support and validation. Although the individual mental health, treatment and outcomes for gender diverse youth have received recent research attention, much less is known about a family perspective. Hence, a review of the literature exploring youth gender diversity from a family perspective is warranted. <b>Aims:</b> To systematically identify, appraise and summarize all published literature primarily exploring gender diversity in young people under the age of 18 years, as well as selected literature pertaining to a family understanding. <b>Methods:</b> Six electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO, SCOPUS, Web of Science) were searched for relevant literature pertaining to youth under the age of 18 years. <b>Results:</b> Research evidence was consistently found to support the beneficial effects of a supportive family system for youth experiencing gender diversity, and a systemic understanding and approach for professionals. Conversely, lack of family support was found to lead to poorer mental health and adverse life outcomes. Few articles explored the experience of siblings under the age of 18 years. <b>Discussion:</b> This literature review is the first to critically evaluate and summarize all published studies which adopted a family understanding of youth gender diversity. The review highlighted a lack of current research and the need for further targeted research, which utilizes a systemic clinical approach to guide support for gender diverse youth and family members.</p>","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":"20 4","pages":"351-370"},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/15532739.2019.1652130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38440161","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":"Clinician and client perspectives regarding transgender health: a North Queensland focus.","authors":"Audrey Heng, Clare Heal, Jennifer Banks, Robyn Preston","doi":"10.1080/15532739.2019.1650408","DOIUrl":"10.1080/15532739.2019.1650408","url":null,"abstract":"<p><p><b><i>Background:</i></b> Healthcare encounters are important in ensuring safe access to medical or surgical care for transgender people. Previous literature suggests many transgender people have had negative encounters with healthcare professionals. In Australia, there is limited research about this population and their healthcare, and less from regional locations. <b><i>Aims:</i></b> This study primarily aimed to explore both transgender client and clinician perspectives and experiences of healthcare interactions. A secondary aim was to investigate increased presentations to sexual health clinics in North Queensland by people wishing to transition. <b><i>Methods:</i></b> Semi-structured, in-depth interviews were used to gather data from 23 participants. Interview transcripts were inductively analyzed and themes developed. Results: Four themes emerged relating to healthcare encounters and the regional setting of North Queensland. These showed that support from family and peers is important for transgender mental health and wellbeing, and that person-centered clinicians who acknowledge a holistic approach to transgender care also form part of the support network for transgender individuals particularly in the regional setting. The internet was found to play a significant role in this study's findings. <b><i>Discussion:</i></b> A collaborative holistic approach to transgender healthcare should be taken by client and clinician to best support the transgender individual during transition. The establishment of Australian guidelines and online peer support groups would facilitate this approach, particularly in rural or regional areas where specialist services are limited.</p>","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":"20 4","pages":"434-446"},"PeriodicalIF":0.0,"publicationDate":"2019-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913600/pdf/WIJT_20_1650408.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38441043","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":"Whole-incarceration-setting approaches to supporting and upholding the rights and health of incarcerated transgender people.","authors":"Annette Brömdal,&nbsp;Kirsty A Clark,&nbsp;Jaclyn M W Hughto,&nbsp;Joseph Debattista,&nbsp;Tania M Phillips,&nbsp;Amy B Mullens,&nbsp;Jeff Gow,&nbsp;Kirstie Daken","doi":"10.1080/15532739.2019.1651684","DOIUrl":"10.1080/15532739.2019.1651684","url":null,"abstract":"Transgender people incarcerated1 around the world remain a “vulnerable group,” and continue to experience significant mistreatment, human rights violations, and erasure of their gender identity, co...","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":"20 4","pages":"341-350"},"PeriodicalIF":0.0,"publicationDate":"2019-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/15532739.2019.1651684","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38440160","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":"Transforming the paradigm of nonbinary transgender health: A field in transition.","authors":"Joz Motmans,&nbsp;Timo O Nieder,&nbsp;Walter Pierre Bouman","doi":"10.1080/15532739.2019.1640514","DOIUrl":"10.1080/15532739.2019.1640514","url":null,"abstract":"It is exactly a decade ago that Sexual and Relationship Therapy published a special issue entitled “Gender Variance and Transgender Identity”, which was guest edited by Walter Bockting, former Editor-in-Chief of International Journal of Transgenderism (IJT). In his editorial Bockting wrote “[this issue] is comprised of a collection of articles that reflect a transition in this growing field from a disease-based to an identity-based model of transgender health. The disease-based model assumes that normative gender identity development has been compromised and that the associated distress can be alleviated by establishing congruence between sex, gender identity and gender role, if necessary through hormonal and surgical sex reassignment. The identity-based model assumes that gender variance is merely an example of human diversity and that the distress transgender individuals might experience results from social stigma attached to gender variance. The latter model views transgender people as having an experience, identity and sexuality distinct from those of both non-transgender women and men. This paradigm shift forms the context for nine peer reviewed articles... .” (Bockting, 2009). This special issue consists of more than double the amount of contributions than a decade ago, and concerns the area of nonbinary and genderqueer transgender health. Clearly a reflection of progress, progression and promise, albeit at a moderate pace. There is nevertheless reason for optimism. The multidimensionality and heterogeneity of gender identities and the idea that one’s gender identity can be a mix of both being a man and a woman, being somehow beyond the gender binary, or something completely else is increasingly acknowledged and recognized (Bockting, 2008; Harrison, Grant, & Herman, 2012; Herdt, 1993; K€ ohler, Eyssel, & Nieder, 2018; Kuper, Nussbaum, & Mustanski, 2012; Richards, Bouman, & Barker, 2018). In the last decade in particular, there is growing evidence that in fact there is a sizable group of people who do not identify as binary trans. In parallel, language regarding gender identities has shifted and continues to evolve (Bouman et al., 2017), and although we will use the adjective nonbinary in this editorial to refer to people who identify between, outside and beyond the gender binary, we acknowledge that this is a reductionist approach and does not do justice to the realities of nuanced gender identity categories. We are also aware that the term nonbinary may well change in academic and legal discourse, especially once the terminology chapter of the 8 version of the WPATH Standard of Care has been completed and published. In terms of the prevalence of nonbinary identities then, Harrison, Grant, and Herman (2012) found that 13% of trans respondents (N1⁄4 6436) in their US sample preferred a different identity than: male/man, female/ woman, or part time as one gender, part time an another in their community based survey; of the 860 written respons","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":" ","pages":"119-125"},"PeriodicalIF":0.0,"publicationDate":"2019-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/15532739.2019.1640514","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38540948","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":"The terminology of identities between, outside and beyond the gender binary - A systematic review.","authors":"Nat Thorne,&nbsp;Andrew Kam-Tuck Yip,&nbsp;Walter Pierre Bouman,&nbsp;Ellen Marshall,&nbsp;Jon Arcelus","doi":"10.1080/15532739.2019.1640654","DOIUrl":"10.1080/15532739.2019.1640654","url":null,"abstract":"<p><p><b>Background:</b> Recently, a multitude of terms have emerged, especially within North America and Western Europe, which describe identities that are not experienced within the culturally accepted binary structure of gender which prevails within those cultures. As yet, there is no clear single umbrella term to describe such identities and a mixture of words have been used in scholarly work to date. <b>Aims:</b> To explore the origins and track the emergence of newer terms and definitions for identities between, outside and beyond the gender binary, to outline current trends in descriptors within scholarly work and to suggest a term which is wide enough to encompass all identities. <b>Methods:</b> A comprehensive systematic review was made, following the PRISMA guidelines. Several relevant key terms were used to search Web of Science, ScienceDirect, PubMed, and the <i>International Journal of Transgenderism</i>. The descriptions each title gives for identities outside of the binary are extracted for analysis. <b>Results:</b> Several terms have been used over the years to describe identities outside of the binary. \"Non-binary\" and \"genderqueer\" are currently mostly used as umbrella terms. However, \"gender diverse\" is emerging as a more suitable wide-ranging inclusive term for non-male and non-female identities. <b>Discussion:</b> Identity outside of \"male\" and \"female\" is an emerging concept which currently has several identifiers and little academic agreement on which is the most pertinent. The two leading descriptors are \"non-binary\" and \"genderqueer.\" Gender diverse is emerging as a new term which has the aim of including all other terms outside of male and female within it and this article suggests the increase in its use to describe gender identities outside of the binary.</p>","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":" ","pages":"138-154"},"PeriodicalIF":0.0,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/15532739.2019.1640654","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38540952","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":"Hormonal contraceptive choices in a clinic-based series of transgender adolescents and young adults.","authors":"Rula V Kanj,&nbsp;Lee Ann E Conard,&nbsp;Sarah D Corathers,&nbsp;Gylynthia E Trotman","doi":"10.1080/15532739.2019.1631929","DOIUrl":"https://doi.org/10.1080/15532739.2019.1631929","url":null,"abstract":"<p><p><b>Aims:</b> To describe the use of hormonal contraceptives for menstrual management and/or pregnancy prevention in a clinic-based series of transgender adolescents and young adults who were assigned female at birth (transmasculine identity). <b>Methods:</b> We performed a chart review of post-menarchal transgender assigned-female-at-birth (AFAB) patients, age 10-25 years, seen at CCHMC Transgender Health Clinic for at least 2 visits between July 1, 2013 and September 17, 2016, and who were not on a puberty suppression method. We collected data including choice of hormonal contraceptive and indication (menstrual suppression, pregnancy prevention, or both), duration of use, initiation of sexual activity, reported sexual partners, and use of gender-affirming hormone therapy (i.e., testosterone). We present simple descriptive statistics. <b>Results:</b> A total of 231 patients met inclusion criteria, with ages from 11 to 25 years. Of those, 135 (59%) were using a hormonal contraceptive method. Most patients (67%) used hormonal contraception for the indication of menstrual suppression. Most commonly used method was depot medroxyprogesterone (DMPA) (49 patients), followed by combined oral contraceptives (COC) and norethindrone (progestin-only pill, POP) (34 patients each). Thirteen patients used 52 mg levonorgestrel IUD (LNG-IUD). Of the total sample (<i>n</i> = 231), 82 (36%) reported sexual activity, 35 of whom (43% of sexually active patients) reported sexual intercourse with assigned-male-at-birth (AMAB) partners and/or penile-vaginal intercourse. Among 35 patients at risk for pregnancy, only 21 (60%) were using hormonal contraception. Over half (54%) of sexually active patients taking testosterone discontinued their hormonal contraceptive method once they stopped having menses. <b>Discussion:</b> Within a sample of transgender AFAB adolescents, half of whom were taking testosterone, a variety of contraceptives were used, including depot medroxyprogesterone, combined oral contraceptives, and levonorgestrel IUD. Among those taking testosterone, many patients discontinued contraception once they stopped having menses.</p>","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":"20 4","pages":"413-420"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/15532739.2019.1631929","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38441042","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":"Mental health and quality of life in non-binary transgender adults: a case control study.","authors":"Bethany A Jones, Walter Pierre Bouman, Emma Haycraft, Jon Arcelus","doi":"10.1080/15532739.2019.1630346","DOIUrl":"10.1080/15532739.2019.1630346","url":null,"abstract":"<p><p><b>Background:</b> The social challenges that non-binary people experience, due in part to social intolerance and the lack of validation of non-binary gender identities, may affect the mental health and quality of life of this population. However, studies that have distinguished between non-binary and binary transgender identities are lacking. <b>Aim:</b> To compare the mental health and quality of life of a community sample of non-binary transgender adults with controls (binary transgender people and cisgender people) matched on sex assigned at birth. <b>Method:</b> A total of 526 participants were included. Ninety-seven were classified as non-binary and were compared with two control groups: 91 people classified as binary and 338 cisgender people. Only transgender people not on gender affirming hormone treatment or who had not undergone gender affirming surgery were included. Participants were invited to complete an online survey that included mental health and quality of life measures. <b>Results:</b> Non-binary people reported significantly better mental health than binary transgender people, but worse than cisgender people. Overall, there were no significant differences in quality of life between non-binary and binary transgender participants assigned male at birth and transgender females, but non-binary assigned males at birth had better scores on the psychological and social domains of quality of life than transgender males. Quality of life was better across all domains in cisgender people than transgender groups. <b>Conclusion:</b> There is an inequality with regard to mental health and quality of life between non-binary (and binary) transgender people and the cisgender population that needs to be addressed. The better mental health scores in non-binary people may reflect lower levels of body dissatisfaction among the non-binary population. Mental health problems and poor quality of life are likely to have social causes and hence legislative measures and broader government-led inclusive directives should be put in place to recognize and to validate non-binary identifying people.</p>","PeriodicalId":56012,"journal":{"name":"International Journal of Transgenderism","volume":" ","pages":"251-262"},"PeriodicalIF":0.0,"publicationDate":"2019-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830991/pdf/WIJT_20_1630346.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38442173","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}