Diabetes epidemiology and management最新文献

{"title":"Factors influencing adherence towards oral hypoglycaemic agents- A cross-sectional study among patients with Type II Diabetes Mellitus","authors":"Abhilash P ,&nbsp;Delisha Josvita Dsouza ,&nbsp;Sradha S ,&nbsp;Nandakumar UP ,&nbsp;Shuaib Ahmed MA ,&nbsp;Reshma Kolar ,&nbsp;Sharad Chand","doi":"10.1016/j.deman.2023.100163","DOIUrl":"10.1016/j.deman.2023.100163","url":null,"abstract":"<div><h3>Aims</h3><p>The present study was conducted to assess the level of medication adherence and factors affecting adherence among Type-2 Diabetes Mellitus (T2DM) patients.</p></div><div><h3>Methods</h3><p>A prospective cross-sectional study was carried out among T2DM patients who were presented to the outpatient department of general medicine. A well-designed data collection form was used to gather information pertaining to various socio-demographic and medical variables. A previously validated and translated 8-item self-reported questionnaire was used to assess the level of medication adherence. Data was analysed using SPSS Version 29.0.</p></div><div><h3>Results</h3><p>Among the total 369 subjects enrolled, a majority were found to be males, and the mean age of the population was observed as 56.84 ± 11.32. A total of 125 (33.8%) subjects were found to be within the category of high adherence, 161 (43.6%) subjects were found to have moderate level of adherence and 83 (22.4%) had low level of adherence. On analysis, various medical variables were found to have a statistically significant association with medication adherence.</p></div><div><h3>Conclusion</h3><p>The findings of the present study would form the basis for all the future implications including education intervention programmes to improve the level of adherence towards anti-diabetic medications, which ultimately results in better health outcomes.</p></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"12 ","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43544546","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":"Bullous diabeticorum","authors":"Rawan Alharbi,&nbsp;Ibtihal Abdulaal","doi":"10.1016/j.deman.2023.100152","DOIUrl":"https://doi.org/10.1016/j.deman.2023.100152","url":null,"abstract":"<div><p>Bullous Diabeticorum is a skin condition that occurs rarely in diabetic patients. It is a specific type of skin lesions characterized by non-inflammatory blisters that heals spontaneously. It is usually found in long standing diabetic patients with poor glycemic control, although the relationship between BD and blood glucose level in diabetic patients remains unclear. It frequently goes undiagnosed because it resembles other vesicobullous illnesses. Few published articles reported such cases. This case report describes a rare case of Saudi female patient presented to the clinic with a well demarcated erythematic fluid-filled lesion. Based on medical history and clinical examination diagnosis of diabetic bullae was made. We present this case to shed light on the rare occurrence of Bullous Diabeticorum in diabetic patients, to highlight the role of interprofessional team in its management and to improve the patients’ outcome.</p></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"12 ","pages":"Article 100152"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49765971","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":"Prevalence of nonalcoholic fatty liver disease in type 2 diabetes mellitus patients from the Eastern region of India","authors":"Anirban Sinha ,&nbsp;Biswabandhu Bankura","doi":"10.1016/j.deman.2023.100161","DOIUrl":"10.1016/j.deman.2023.100161","url":null,"abstract":"<div><h3>Objective</h3><p>The risk of nonalcoholic fatty liver disease (NAFLD) is increased significantly in individuals having Type 2 diabetes mellitus (T2DM) and the presence of T2DM enormously drives NAFLD progression. However, in clinical practice, it is overlooked despite the significant clinical effects of NAFLD in T2DM. Our study aimed to estimate the prevalence of NAFLD in T2DM patients from the eastern region of India.</p></div><div><h3>Methods</h3><p>This cross-sectional study assessed 132 T2DM patients for NAFLD. Anthropometry and lipid estimations were done in all the individuals. Hepatic fibrosis was diagnosed by transient elastography (TE) using a TOUCH 502 Fiber Scanner using M‑probe. A fibrosis score ≥ 11 kgpascals (kPa) was used to define advanced fibrosis (F3).</p></div><div><h3>Results</h3><p>Overall prevalence of NAFLD in T2DM patients was 57% (75/132 subjects) and the prevalence is higher in males (54.6%). Results showed that approximately 26% of patients with NAFLD will develop into NASH, among them 37.3% developed mild to moderate steatosis and 26.6% developed severe steatosis.</p></div><div><h3>Conclusion</h3><p>The prevalence of NAFLD is high in the eastern region of India, need for early diagnosis and treatment of NAFLD in T2DM. The use of TE with other serum markers can be helpful for the diagnosis of advanced fibrosis.</p></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"12 ","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43847580","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":"The impact of diabetes on sarcopenia in community-dwelling older adults in India: key findings from the longitudinal ageing study in India (LASI)","authors":"Sayani Das","doi":"10.1016/j.deman.2023.100158","DOIUrl":"10.1016/j.deman.2023.100158","url":null,"abstract":"<div><h3>Background</h3><p>Diabetes has become a major public health issue in India, and understanding its impact on skeletal muscle health is crucial for addressing the elevated risk of sarcopenia among individuals with diabetes. While the association between diabetes and sarcopenia has been extensively studied worldwide, there is a notable lack of research focusing on this relationship within the Indian community-dwelling geriatric population. Therefore, this study aimed to explore the influence of diabetes on sarcopenia among older adults living in community settings in India.</p></div><div><h3>Methodology</h3><p>The study used data from the Longitudinal Aging Study in India (LASI), Wave 1 (2017–18). It was focused on older adults aged 60 years and above living in community settings in India, including both males and females. This study followed the Asian Working Group on Sarcopenia (2019) guidelines, utilizing a screening tool that assessed sarcopenia through muscle (handgrip) strength, physical performance, and appendicular skeletal muscle mass (ASM). The presence of diabetes was determined through a self-reported approach, where participants disclosed their diabetes diagnosis as provided by healthcare professionals. To examine the association between diabetes and sarcopenia, the study utilized logistic regression analysis to calculate the adjusted odds ratio (AOR) and corresponding 95% confidence interval (CI).</p></div><div><h3>Results</h3><p>Present study included 27,241 individuals, with sarcopenia prevalent in 27.0% of participants. 3.4% had both sarcopenia and diabetes, 23.5% had sarcopenia only, 11.7% had diabetes only, and 61.3% had neither. After adjusting for confounding variables, participants with diabetes had a significantly higher odds ratio of 1.14 (95% CI 1.06–1.26, <em>p</em> &lt; 0.001) for sarcopenia.</p></div><div><h3>Conclusions</h3><p>The study established that diabetes is a risk factor for sarcopenia in older adults living in India. Early identification and management are essential to mitigate sarcopenia, emphasizing the importance of addressing both conditions in healthcare.</p></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"12 ","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48735290","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":"Characteristics of people with optimally-managed type 1 diabetes","authors":"Gijsbert Stoet ,&nbsp;Richard IG Holt","doi":"10.1016/j.deman.2023.100153","DOIUrl":"10.1016/j.deman.2023.100153","url":null,"abstract":"<div><h3>Objective</h3><p>The aim is to describe the characteristics of people with type 1 diabetes who are meeting all seven glycemic targets set by international consensus.</p></div><div><h3>Research Design &amp; Methods</h3><p>We analyzed continuous glucose monitoring (CGM) data from 497 participants (aged 18-70 yrs). Time-in-range, time above and below range, co-efficient of variability, and glucose management indicator (GMI) were combined with demographic data, insulin delivery, and exercise.</p></div><div><h3>Results</h3><p>While 68% of participants achieved a GMI below 7% (53 mmol/mol), 39% met all seven glycemic targets. Older people and those of White ethnicity were more likely to meet these targets. Men and women were equally likely to meet all targets, although men were more likely to experience hypoglycemia while women were more likely to experience hyperglycemia. Hybrid-closed loop (HCL) system users were more likely to meet all targets than people using a standard pump or multiple daily injections.</p></div><div><h3>Conclusions</h3><p>Only 56% of those with a GMI below 7% (53 mmol/mol) met all seven targets, illustrating how glycemic management involves more than GMI/HbA_1c lowering alone, which has implications for estimates of optimally managed participants in the wider population of people with type 1 diabetes. Demographic inequalities were prevalent. Using a HCL system clearly facilitated the achievement of glycemic targets.</p></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"12 ","pages":"Article 100153"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43923721","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":"Endocrinologists’ use of patient-reported outcome measures in the care of people with diabetes: A qualitative study","authors":"B.K. Nielsen ,&nbsp;M.D. Terkildsen ,&nbsp;A.L. Jensen ,&nbsp;M.Z. Pedersen ,&nbsp;M.R. Hollesen ,&nbsp;K. Lomborg","doi":"10.1016/j.deman.2023.100159","DOIUrl":"10.1016/j.deman.2023.100159","url":null,"abstract":"<div><h3>Aims</h3><p>DiabetesFlex Care is a patient-reported outcome (PRO)-based telehealth service for adults with type 1 diabetes, intended to enable patient perspectives in consultations. The study aimed to explore endocrinologists' experiences of using PRO to support dialog in diabetes consultations.</p></div><div><h3>Methods</h3><p>Thematic analysis was conducted on data from participant observations and semi-structured interviews with 13 endocrinologists engaging in DiabetesFlex consultations at a Danish hospital-based diabetes clinic.</p></div><div><h3>Results</h3><p>Two themes were extracted: 'Perceiving PRO as ambiguous information' and 'Integrating PRO in the care for people with diabetes'. Endocrinologists perceived PRO as situational information with variable quality and validity, depending on patient competencies and commitment. Therefore, endocrinologists used different approaches to integrate PRO in their efforts to improve care for the individual patient. The study also showed that patients’ PRO-responses were rarely discussed among endocrinologists.</p></div><div><h3>Conclusion</h3><p>Endocrinologists experienced both potentials and challenges in using PRO to support diabetes consultations. To optimize DiabetesFlex Care and similar PRO-based diabetes consultations, a culture should be built up where clinicians share experiences to improve the quality and solve PRO-related problems in consultations.</p></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"12 ","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43191252","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":"Metabolic consequences of alterations in gut microbiota induced by antidiabetic medications","authors":"Venkata Chaithanya ,&nbsp;Janardanan Kumar ,&nbsp;Kakithakara Vajravelu Leela ,&nbsp;Matcha Angelin ,&nbsp;Abhishek Satheesan ,&nbsp;Ria Murugesan","doi":"10.1016/j.deman.2023.100180","DOIUrl":"https://doi.org/10.1016/j.deman.2023.100180","url":null,"abstract":"<div><p>The mutualistic relationship between human health and gut microbiota has gained growing attention as a result of its far-reaching consequences. Diabetes medications, essential for managing type 2 diabetes, which regulate glucose metabolism, have shown effects that go beyond glycemic control by receiving attention for their possible influence on gut microbiota. Notably, metformin, a cornerstone therapy, has received a lot of attention for its ability to influence the gut microbiota. Metformin administration has been linked to changes in the abundance of specific bacterial taxa, including an uprise in beneficial microbes like <em>Akkermansia muciniphila</em>. These modifications have been linked to increased insulin sensitivity and better metabolic outcomes. Other classes of diabetes drugs, in addition to metformin, have shown potential effects on the gut microbiota. SGLT-2 inhibitors, for example, may contribute to changes in gut microbial communities, which could explain their cardiovascular and metabolic benefits. However, the processes underlying these interactions, are complicated and not entirely understood. Direct interactions between the gut microbiota and drug, changes in intestinal permeability, and modulation of bile acid metabolism are all possible mechanisms. Individual differences and genetic factors complicate the relationship even more. Understanding the intricate interplay between diabetes drugs and gut microbiota holds promise for developing personalized diabetes management approaches. Taking advantage of these interactions could lead to novel therapeutic strategies that improve drug efficacy and overall metabolic health. More studies are required to determine the exact mechanisms underlying these effects and to capitalize on their potential for improved patient outcomes. This review provides a concise overview of the effects of diabetes medications on gut microbiota composition and its importance.</p></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"13 ","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666970623000598/pdfft?md5=a6f9c3f9c66218d87de1a61a5edc4f00&pid=1-s2.0-S2666970623000598-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92096551","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":"Similar incidence of stroke with SGLT2 inhibitors and GLP-1 receptor agonists in real-world cohort studies among patients with type 2 diabetes","authors":"André J. Scheen","doi":"10.1016/j.deman.2023.100179","DOIUrl":"https://doi.org/10.1016/j.deman.2023.100179","url":null,"abstract":"<div><h3>Background</h3><p>Stroke represents a major burden in patients with type 2 diabetes. Yet, this cerebrovascular complication has been less well studied than coronary artery disease and heart failure. Some cardiovascular outcome data suggested that sodium-glucose cotransporter 2 inhibitors (SGLT2is) exert a less pronounced protection against stroke compared with glucagon peptide-1 receptor agonists (GLP-1RAs) despite similar efficacy regarding major cardiovascular events (MACE-3 points). However, this conclusion was derived from indirect comparisons of placebo- controlled trials (RCTs).</p></div><div><h3>Methods</h3><p>The present comprehensive review analyses the effects of SGLT2is versus GLP-1RAs on nonfatal and fatal/nonfatal strokes in real-life studies carried out worldwide.</p></div><div><h3>Results</h3><p>A large majority of retrospective observational cohort studies (19 out of 21) failed to find any significant difference in the risk of stroke between the two pharmacological classes, independently of the presence of established cardiovascular disease. Available, yet limited, findings suggested that SGLT2is could be more efficacious against haemorrhagic than ischaemic strokes, in patients at risk for atrial fibrillation or with chronic kidney disease.</p></div><div><h3>Conclusion</h3><p>In contrast to what was reported in RCTs, most observational studies showed similar incidence of stroke in SGLT2i users versus GLP-1RA users. Because both indirect comparisons of RCTs and retrospective cohort studies have limitations, a head-to-head RCT comparing the effects on stroke of an SGLT2i versus a GLP-1RA is needed to draw any definite conclusion.</p></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"13 ","pages":"Article 100179"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67739978","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":"Once-Weekly Insulin Icodec vs Once-Daily Insulin Glargine U100 for type 2 diabetes in insulin naive patients: a systemic review and meta-analysis","authors":"Faiza Zakaria, Ahmed Kunwer Naveed, Mushood Ahmed, Rameen Rao, Areeba Shaikh, Anusha Abdul Muqeet Farid, Tehreem Ali, Muhammad Hasanain","doi":"10.1016/j.deman.2023.100181","DOIUrl":"https://doi.org/10.1016/j.deman.2023.100181","url":null,"abstract":": Insulin Therapy is essential for managing diabetes, but difficulties such as daily injections and hypoglycemia risk hinder patient compliance. Recent advancements have brought basal insulin analogs such as insulin icodec and insulin glargine U100 so in this study we aimed to assess the efficacy and safety of Once-Weekly Insulin icodec and Once-Daily insulin glargine-U100 in Insulin-Naive type 2 diabetic patients (T2DM). : The PRISMA guidelines were followed in conducting this meta-analysis. An electronic search was conducted utilizing databases such as PubMed, Google Scholar, OvidSP, and the Cochrane Database of Controlled Studies (CENTRAL). The analysis findings were combined using a random-effects model. Continuous outcomes were expressed as mean difference (MD), whereas dichotomous outcomes were represented as odds ratios (ORs) with 95% confidence intervals (95% CIs). : 3 randomized control trials (RCTs) comprising 1436 patients were included in our analysis. Pooled analysis showed a significant difference in improved time with glucose range (%TIR) between icodec group and glargine U100 (MD=4.89; 95% CI= 2.95 to 6.82; P=<0.00001; I2=0%), reduction in HbA1c (MD=-0.19; 95% CI= -0.30 to -0.08; P=0.0009; I2=0%), risk of hypoglycemia alert (OR=1.47; 95% CI=1.18-1.84; P=0.0006; I2=0%). There was no significant difference in pooled analysis for fasting plasma glucose levels, severe hypoglycemia, and any adverse effects or hyperactivity events. : Our systematic review and meta-analysis provided evidence that favored Once-Weekly Insulin Icodec over Once-Daily Insulin Glargine U100 for patients with T2DM.","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"165 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135389060","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":"Hypoglycemia avoidance behaviour in active Qatari adults with type 1 diabetes under blood glucose monitoring device","authors":"Georges Jabbour,&nbsp;Souhail Hermassi","doi":"10.1016/j.deman.2023.100176","DOIUrl":"10.1016/j.deman.2023.100176","url":null,"abstract":"<div><h3>Aims</h3><p>The present study aimed to explore the relationship between fear of hypoglycemia and exercise management strategies in active Qatari adults with T1D during the COVID-19 pandemic, and to explore the potential role of continuous glucose monitoring (CGM) devices in promoting safe physical activity practices.</p></div><div><h3>Methods</h3><p>Participants completed the Hypoglycemia Fear Survey (HFS) questionnaire and the International Physical Activity Questionnaire (IPAQ). Out of the 102 participants, 41 were considered \"active\" and under CGM and were included in the analysis.</p></div><div><h3>Results</h3><p>Multiple linear regression analysis revealed a significant positive correlation between the behavior dimension of the HFS scores and both vigorous physical activity and MET-minutes per week (<em>R</em>² adj. = 0.055; β = 0.56; <em>p</em> = 0.05 and <em>R</em>² adj. = 0.039; β = 0.38; <em>p</em> = 0.04). The results showed a significant positive association between HbA1c levels and the behavior dimension of the HFS (<em>R</em> = 0.39, <em>p</em> = 0.005), as well as between the number of episodes of severe hypoglycemia and the behavior dimension (<em>R</em> = 0.46, <em>p</em> = 0.042).</p></div><div><h3>Conclusion</h3><p>These findings highlight the need for effective strategies to manage fear of hypoglycemia and promote physical activity in individuals with T1D. The use of CGM devices may provide added safety to physical activity practices by reducing the risk of hypoglycemia.</p></div>","PeriodicalId":72796,"journal":{"name":"Diabetes epidemiology and management","volume":"13 ","pages":"Article 100176"},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44817312","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}