Igiene e sanita pubblica最新文献

{"title":"First major Clade IIb mpox outbreak in Africa: Narrative review of Sierra Leone's 2025 epidemic.","authors":"André Izacar Gaël Bita, Agbor Nyenty Agbornkwai, Eneigheo Emmanuel Achuondou","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The mpox outbreaks observed in 2025 highlighted significant shifts in transmission dynamics, viral clades, and public health responses, particularly in Africa. In contrast, Sierra Leone experienced its largest mpox outbreak that year-Africa's first major Clade IIb epidemic-which ran from 10 January to 17 December 2025. It involved 5,442 confirmed cases among 7,110 suspected cases, a case fatality rate of 1.1%, and 22,536 contacts identified. A public health emergency was declared on 13 January 2025. Transmission peaked in epidemiological week 20 (May 2025) with 654 confirmed cases. The burden was highest in Western Area Urban (55.4%, 3,014 cases), Western Area Rural (19.9%), and Bombali (6.1%). Cases predominantly affected young adults aged 20-39 years (median age 26) and males (52.5%). Key affected groups included sex workers, children under 15 years (6.5%), and pregnant women (1.6%). High population density in Freetown, limited resources, weak coordination, misinformation, and surveillance gaps facilitated spread. Genomic evidence revealed undetected Clade IIb (hMPXV-1 lineage, including G.1) circulating for ~3 months from Nigeria. Environmental contamination affected 13.5% of healthcare surfaces. Symptoms included rash, fever, headache, lymphadenopathy, sore throat, and pain; 28.9% of cases were hospitalized, often delayed by stigma and fear. Among those screened for HIV co-infection (23.6%), 82% of deaths occurred in co-infected individuals. The National Public Health Agency (NPHA) implemented seven response pillars: case management and isolation, infection prevention and control (IPC), risk communication, targeted vaccination (186,470 doses administered from 267,000 received), coordination, surveillance, and research. The outbreak ended after 42 consecutive case-free days, underscoring the importance of early surveillance and genomic monitoring to prevent sustained urban transmission.</p>","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"99 2","pages":"51-62"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240819","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":"When AI Extinguishes Expertise Artificial intelligence, expert intuition, and the future of training in healthcare organisations.","authors":"Giuseppe Zanini","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The pervasive adoption of Generative Artificial Intelligence tools in professional settings raises a question that those responsible for training can no longer avoid: what happens to expert intuition - that form of embodied, tacit knowledge built through years of practice and error - when the most cognitively demanding tasks are systematically delegated to a machine? This article argues that the risk is not technical but formative: it concerns the mechanism through which deep professional competence is constructed, with concrete implications for the design of professional development pathways in healthcare organisations.</p>","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"99 2","pages":"46-50"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240782","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":"Every Second Counts: The School Nurse as a Health Educator - A Cross Sectional Observational Study.","authors":"Chiara Gatti, Stefano Marcelli, Gloria D'Angelo, Cinzia Borgognoni, Elena Torresi","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Background Schools are key environments for children's daily lives, where urgent events such as syncope, hypoglycemia, seizures, and minor trauma can occur. In Italy, the absence of school nurses and the lack of mandatory first aid training for all teachers place initial emergency management largely on educational staff, whose preparation is variable. Enhancing first aid culture and readiness is therefore essential for prevention, early recognition, and timely response. Aim To assess the training level and preparedness of teachers-from nursery to lower secondary school-in managing pediatric urgent and emergency situations within school settings. Material and Methods A multicenter, descriptive, cross sectional observational study was conducted (April-October 2025) using a structured questionnaire integrating two validated instruments. Participants were recruited from nursery, kindergarten, primary, and lower secondary schools in the Marche region (Italy). Data were summarized as proportions with 95% CIs (Clopper-Pearson). Associations were tested with chi square (exact tests as needed), with effect size via Cramér's V. Significance α=0.05. Correct CPR sequence knowledge was estimated as prevalence. Results The sample included nursery (n=8), kindergarten (n=12), primary (n=23), and lower secondary (n=24) teachers, mostly aged 26-50 years; 64.2% held a university degree. While 91% reported first aid knowledge and 88% had attended at least one course, only 7.5% felt genuinely prepared; 64.2% felt insecure and 28.4% unprepared, and ~90% requested further practical training. Scenario items revealed procedural gaps: only 55.2% prioritized assessing consciousness in an injured/unconscious student; 71.6% would avoid manipulating a sprained ankle; responses on bleeding were split (direct pressure 52.2% vs gentle tamponing 46.3%). Diabetes knowledge was stronger (e.g., insulin via injection 95.5%; insulin does not raise glucose 92.5%), yet uncertainty remained for managing acute episodes on site. On epilepsy, misconceptions were largely rejected, but causal attributions mixed genetics (47.8%) and emotional factors (41.8%). Practical first aid sequencing showed fragmentation; only ~33% (95% CI 22-45%) knew the correct CPR sequence. Training was strongly associated with perceived preparedness (χ²(2)=22.95; p&lt;0.001; V=0.59), age and seniority with lower confidence (V=0.66 and 0.61, respectively), and perception moderately with correct CPR sequence (p=0.003; V≈0.42). Training alone did not correlate with correct CPR sequencing (p=0.366). Discussion Current training reduces outright unpreparedness but often leaves teachers in a state of operational insecurity. Confidence and competence-especially CPR sequencing-appear to require hands on practice, realistic simulations, and regular refreshers rather than single-course exposure. Conclusions Teachers show acceptable theoretical awareness in selected areas but significant practical uncertainties in first a","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"99 2","pages":"78-93"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240767","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":"Clinical Risk Management in Long-Term Healthcare Facilities (LTHFs) in Northern Italy: Empirical Evidence from the Lombardy Region.","authors":"Carmen Tereanu, Antonio Antonelli, Giacomo Crotti, Davide Molteni, Anna Paiano, Cristina Curioni, Elena De Giosa, Giovanni Maifredi, Ada Ferrari, Paolo Valdisolo, Enrico Burato","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Background Quality and patient safety policies in Italy are constantly evolving. Given the rapidly aging population and the increased vulnerability, it is essential to consistently ensure high levels of attention to quality and risk assessment in long-term healthcare facilities, providing medical and social care to elderly residents or to adults with disabilities (LTHFs). Objective The objective was to identify critical issues that persist in (LTHFs) in Lombardy despite the prevention and containment strategies currently in place or ongoing, and to identify areas for improvement. Materials and Methods The cross-sectional study was based on a questionnaire developed and applied by the Risk Managers of the eight Local Agencies for Health Protection, in the LTHFs in their respective geographical areas. Descriptive, correlation, and factorial analyses were performed. Results and discussion The response rate was 82% (674 LTHFs). Results for 2022 indicate that only 43.8% of the LTHFs had designated a Risk Manager, while 67.2% had established an Incident Reporting System. No incidents were reported in half of the LTHFs. Overall, the number of reported incidents varied greatly (mean: 13.8 ± 38.9). While data protection and ethical-behavioural risks were mapped in more than 80% of the LTHFs, risks concerning internal or external communication (53.5%), litigation (47.8%) and reputation (41.1%) were mapped in fewer LTHFs. The level of implementation of the Ministerial Recommendations applicable to LTHFs ranged from 94.6% for fall prevention, to 43.8% for prevention of violence against staff, to 43.4% for prevention of transfusion reactions caused by AB0 incompatibility, and to 34.3% for prevention of suicide in the facility. Most LTHFs implemented a range of risk prevention strategies, but those concerning the use of benzodiazepines (50.7%), the prevention of antibiotic resistance (47.8%), the antibiotic consumption (42.6%), and the provision of personalized packaging for safety and medication adherence (28.6%) were implemented in less than half of the LTHFs. The formal appointment of a Risk Manager was significantly correlated with the level of implementation of best practices related to risk management, quality of care, and communication. The psychometric properties of the questionnaire were acceptable for a model with 46 items grouped into 5 distinct domains: &quot;General risk mapping&quot;; &quot;Main Ministerial Recommendations&quot;; &quot;Risk management strategies&quot;; &quot;Particular events and special medications&quot; and &quot;Quality and communication.&quot; Therefore, the authors encourage its widespread application in other LTHFs. Conclusion The study highlights both positive aspects and critical issues concerning risk management in LTHFs in the Lombardy region as well as opportunities for improvement. The collaboration between the Regional Centre for Management of Clinical Risk and Patient Safety, the Risk Managers of the Local Age","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"99 2","pages":"63-77"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240810","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":"Measuring care complexity: a retrospective cross-sectional observational study - CardioMEO PediCARE (Ancona, Italy)","authors":"Alessia Galli, Ludovica Mazzieri, Chiara Gatti, Fabienne Yvonne Pallua, Andrea Crognaletti, Alessandra Montini, Elisa Andreoli, Gilda Pelusi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The increasing clinical complexity of pediatric patients, combined with global nursing workforce shortages, requires reliable tools to measure nursing care complexity and support evidence-based staffing decisions. In highly specialized settings such as pediatric cardiovascular units, patient acuity and cognitive nursing workload are particularly demanding. However, data on validated tools for assessing care complexity in pediatric contexts remain limited.</p><p><strong>Objective: </strong>To measure nursing care complexity in pediatric cardiovascular patients and to identify clinical and organizational factors associated with higher complexity levels using validated pediatric acuity tools.</p><p><strong>Material and methods: </strong>A retrospective cross-sectional observational study was conducted on 313 patient records from the Pediatric and Congenital Cardiac Surgery and Cardiology Unit and the Pediatric Intensive Care Unit of a tertiary university hospital in Italy (January-December 2022). Nursing care complexity was assessed using the CAMEO II tool for intensive care and the Inpatient CAMEO tool for ward settings. Descriptive statistics were performed. Associations between complexity and categorical variables were analyzed using chi-square tests. Simple and multiple linear regression analyses were conducted to identify predictors of baseline complexity (T0). Statistical significance was set at p 0.05.</p><p><strong>Results: </strong>All patients admitted to the intensive care unit showed medium nursing care complexity. In the inpatient cardiac unit, 27% of patients had low complexity and 73% had medium complexity; no high-complexity cases were observed. Younger age was significantly associated with higher complexity (B = -0.29, p 0.001). Urgent admission (B = 6.73, p 0.001) and longer hospital stay (B = 0.37, p 0.001) were also significant predictors. Organizational variables, including day of the week and work shift, were not significantly associated with complexity. The regression model explained 46% of the variance in baseline complexity scores (adjusted R² = 0.451).</p><p><strong>Discussion and conclusions: </strong>In pediatric cardiovascular settings, nursing care complexity is primarily driven by patient-related clinical factors rather than organizational variables. Younger and urgently admitted patients with longer hospital stays require higher cognitive nursing workload. The systematic implementation of validated acuity tools such as CAMEO II and Inpatient CAMEO may support evidence-based workforce planning, optimize nurse-to-patient ratios according to patient acuity, and enhance quality and safety of care. These findings are particularly relevant in the context of healthcare resource constraints and contribute to improving organizational decision-making in specialized pediatric settings.</p>","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"99 2","pages":"94-109"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240741","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":"Advanced age and comorbidities as risk factors for mortality in COVID-19 patients treated with Home Oxygen Therapy (HOT) in a Northern Italy Local Health Authority.","authors":"Beatrice Canavera, Tiziana Cena, Rossana Monciino, Maddalena Galante, Roberta Giacometti, Luca Rabbiosi, Valerio Antognoli, Fabiola Formica, Antonietta Barbieri","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>COVID-19, which stands for Coronavirus Disease 2019, is a highly transmissible viral infection, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [1]. Its rapid dissemination prompted the World Health Organization (WHO) to officially declare it a global pandemic on March 11, 2020 [2]. It was later recognized as one of the most significant global health and socioeconomic crisis of modern times, leading to 776.8 million confirmed cases and over 7 million confirmed deaths [2, 3].</p>","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"99 1","pages":"36-45"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357780","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 alliance of barriers in digital natives and the \"Born to Read\" project: a public health challenge.","authors":"Gloria D'Angelo, Stefano Marcelli, Laura Olimpi, Mara Esposto, Daniela Stracci, Serena Calvaresi, Chiara Gatti, Alessia Bejani","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Media exposure has caused profound changes in family life, and because children's brains are extremely plastic in the early stages of development, the risks and benefits of any environmental stimulus are amplified (1,2,3). Therefore, the World Health Organisation (WHO) and the American Academy of Paediatrics (AAP) have implemented official recommendations on screen use, prohibiting exposure for children under one year of age and stating that children under five years of age should not spend more than one hour per day on screen-based activities (4,5). Although digital technology offers numerous advantages, from enhancing our capabilities to providing rapid access to large amounts of information, as is the case with distance learning, for example, it is also important to consider its possible negative effects.</p>","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"99 1","pages":"19-35"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357883","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":"Knowledges of MDSR and challenges to reduce maternal death in Sierra Leone: Lessons learned from MDSR meetings review, Tonkolili health district.","authors":"André Izacar Gaël Bita, Samuel Sankoh, Eneigheo Emmanuel Achuondou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Sierra Leone has one of the highest maternal and under-five mortality rates in the world. Maternal death reviews can reduce maternal mortality. In Sierra Leone, the national Maternal Death Surveillance, and responses (MDSR) was developed in 2015 and introduced (implementation) in 2016. This study exploring the knowledge and perceptions of MDSR, challenges to reduce the cause of maternal deaths in Tonkolili Health district, Sierra Leone.</p><p><strong>Materials and methods: </strong>It was a qualitative evaluation among MDSR review meeting members in Tonkolili health district. We used individual interviews and focus groups for audio recorded. We stopped to collect the data with the saturation. The audios records were transcript to word text and, systematic coding and thematic analysis done by using NVIVO software version 15.</p><p><strong>Results: </strong>We conducted 30 interviews and 3 focus groups with 16 (40% female) participants of MDSR review meeting members in Tonkolili health district on July 2025. MDSR's start in Tonkolili lack consensus, with estimates from 2015, aligning with national rollout in 2015-2016. Participants understand MDSR as a continuous, collaborative system to identify, review, notify, and respond to maternal deaths (pregnancy to 42 days postpartum) to prevent future ones, addressing gaps, three delays, and accountability without blame. Viewed as well-designed, non-judgmental, and action oriented, MDSR fosters team collaboration, learning from mistakes, and clinical knowledge improvement. Postpartum Hemorrhage (PPH) was cited as top cause of maternal death, follow by, Hypertensive disorders, infections/sepsis, unsafe abortions, obstructed labor, non-obstetric issues and first delay (seeking care) from cultural barriers; referral/transport issues. As challenges, we noted, logistical (equipment/supply shortages, blood bank delays, poor referrals/vehicles); human resources (training gaps, low attendance, overburdened staff); community (awareness lacks, traditional birth attendance home deliveries) and systemic challenges (communication, documentation, politicization, blame culture).</p><p><strong>Conclusions: </strong>To enhance MDSR implementation, ensure comprehensive support through resource provision, capacity building, community engagement, timely processes, motivation, infrastructure, policy reforms, and a blame-free culture.</p>","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"99 1","pages":"4-18"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357742","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":"Public health professional perspective of rules and regulations pertaining to road safety traffic.","authors":"K Narmatha, R Diwakar, K Saranya, P Paintamilselvi, Dominic Savio Yogesh Manickam","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Road traffic accidents (RTAs) are a major public health concern, particularly among young adults. This study assessed road safety awareness, attitudes, and behaviors among medical students in Chennai, India.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 320 undergraduate medical students and their interns. Data were collected using a semi-structured questionnaire and analyzed using SPSS version 22.0. Logistic regression was used to identify the associations between demographic variables and outcomes.</p><p><strong>Results: </strong>Overall, 66.9% of the participants demonstrated good knowledge of road safety, 77.2% exhibited good behavior, and 52.2% held positive attitudes. Sex significantly influenced both knowledge (females: adjusted OR = 0.42, 95% CI: 0.23-0.77, p = 0.005) and attitudes (females: OR = 1.84, 95% CI: 1.06-3.19, p = 0.030). Formal road safety education was associated with better behavior (OR = 0.54, 95% CI: 0.32-0.92, p = 0.023).</p><p><strong>Conclusion: </strong>Although knowledge and self-reported behavior were relatively high, positive attitudes were less prevalent. Gender and formal education significantly impacted road safety awareness and adherence. These findings highlight the need for targeted interventions to improve road safety practices among healthcare professionals.</p>","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"98 6","pages":"343-356"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357653","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":"Amplify your academic influence: proven tactics for elevating your h-index.","authors":"B Prithiga, V Aravinth, Elizebth Chaly Preetha, Malar Indhu, Thampy Parvathi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>One of the most important metrics for evaluating a researcher's performance is the h-index, which assesses productivity as well as citation effect. Emphasizing the significance of quality over quantity, the paper analyses the importance of publishing in high-impact journals and collaborating with influential researchers. It highlights the role of self-citation judiciously and advocates for active engagement in scholarly networks and conferences. Furthermore, it discusses the impact of open-access publications and the advantages of promoting research through social media and academic platforms. Researchers can greatly increase their exposure and intellectual impact in their field by putting these strategies into practice.</p>","PeriodicalId":73329,"journal":{"name":"Igiene e sanita pubblica","volume":"98 6","pages":"366-372"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357624","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}