Public health challenges最新文献

{"title":"Toward Equitable Health Care: Bridging the Gap in the Health of Incarcerated Individuals in Africa.","authors":"Praise Oyedepo Okunlola, Abdulhammed Opeyemi Babatunde, David Mobolaji Akoki, Opeyemi Temitope Ilori, Victor Oluwafemi Femi-Lawal, Favour Mofiyinfoluwa Abiona, Samuel Tobi Tundealao","doi":"10.1002/puh2.70020","DOIUrl":"10.1002/puh2.70020","url":null,"abstract":"<p><p>The situation of correctional facilities in African countries represents a critical threat to health due to overcrowding, poor living conditions, and limited access to medical services. With over 3000 facilities and nearly a million incarcerated individuals, the prevalence of health conditions such as HIV/AIDS, mental health disorders, and tuberculosis is alarmingly high. These conditions are exacerbated by physical and psychological abuse and inadequate healthcare infrastructure. Despite these challenges, the health needs of incarcerated individuals in Africa remain largely neglected. This article provides a review of the health status of incarcerated individuals in Africa, drawing on limited available data. Lessons from developed countries highlight the potential for effective interventions through structured healthcare programs and policies. Recommendations include adopting the World Health Organization (WHO) prison health framework, improving judicial efficiency to reduce overcrowding, ensuring healthcare is managed by health ministries, and establishing rehabilitation centers. These measures are crucial for integrating incarcerated individuals back into society and achieving equitable health coverage in Africa.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70020"},"PeriodicalIF":0.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268136","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 and Barriers to Human Papillomavirus Vaccination and Cervical Cancer Screenings: A Survey Study of Underserved Populations in North Texas.","authors":"Sofia Eva Olsson, Sameep Shah, Erin Haase, Kelly Pagidas","doi":"10.1002/puh2.70018","DOIUrl":"10.1002/puh2.70018","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV) is a common cause of cervical cancer along with several other neoplasms. With the availability of HPV vaccination and cervical cancer screenings, it is more likely for cervical cancers to be prevented or caught early in their course. However, there are disparities and barriers preventing all individuals from obtaining proper preventative care.</p><p><strong>Methods: </strong>An online survey analyzing compliance, barriers, and subjective perceptions of HPV vaccination and cervical cancer screening was distributed via flyers. These were placed in the half of zip codes with lowest median income in Fort Worth, Texas.</p><p><strong>Results: </strong>Respondents with non-White race, income of $40,000 or less, and a maximum education of high school or less were 4.24, 3.2, and 1.2 times more likely to have incomplete HPV vaccination, respectively. Respondents with an income of $40,000 or less and a maximum education of high school were 3.2 and 2.6 times more likely to be overdue for cervical cancer screening, respectively. The most common barrier for HPV vaccination was lack of knowledge, and for cervical cancer screening, it was cost. Most respondents felt as though cervical cancer screening allows for early cancer detection and decreased mortality but also endorsed feelings of pain, embarrassment, and fear of the test.</p><p><strong>Conclusions: </strong>HPV vaccine and cervical cancer screening non-compliance is likely multifactorial, including lack of knowledge and cost. Interventions such as increased access to pediatric care and increased opportunities for free preventative healthcare may be helpful in both reducing stigma and improving access to care.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70018"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268134","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":"Towards Understanding Contemporary Gambling Advertising in Sub-Saharan Africa.","authors":"Emmanuel Badu","doi":"10.1002/puh2.70017","DOIUrl":"10.1002/puh2.70017","url":null,"abstract":"<p><p>Gambling advertising has become ubiquitous in sub-Saharan Africa influencing social norms and attitudes towards gambling. The delay or failure of governments to effectively regulate gambling advertising poses a significant threat to public health. This article provides contemporary insights into gambling advertising, its forms, mechanics and influence on gambling behaviour. It provides contextual understanding to policy-makers, health advocates and public health actors, including a call to action for effective regulation. With sub-Saharan Africa becoming important to the gambling industry for market growth and profits, there is the need for public health actors to instigate advocacy for strong regulations and enforcement of gambling advertising.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70017"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268137","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":"Burnout Among Labor and Birth Providers in Northern Tanzania: A Mixed-Methods Study.","authors":"Virginie Marchand, Melissa H Watt, Linda M Minja, Mariam L Barabara, Olivia R Hanson, Janeth Mlay, Maya J Stephens, Blandina T Mmbaga, Susanna R Cohen","doi":"10.1002/puh2.70014","DOIUrl":"10.1002/puh2.70014","url":null,"abstract":"<p><strong>Background: </strong>Burnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of accomplishment, is a serious problem among healthcare workers. Burnout negatively impacts provider well-being, patient outcomes, and healthcare systems globally and is especially worrisome in settings with shortages of healthcare workers and resources.</p><p><strong>Methods: </strong>This study explores the experience of burnout among labor and delivery (L&D) providers in Tanzania, using three data sources. A structured assessment of burnout was collected at four timepoints from a sample of 60 L&D providers in 6 clinics. The same providers participated in an interactive group activity from which we drew observational prevalence data. Finally, we conducted in-depth interviews (IDIs) with 15 providers to further explore their experience of burnout.</p><p><strong>Results: </strong>Prior to any introduction to the concept, 18% of respondents met criteria for burnout. Immediately after a discussion and activity on burnout, 62% of providers met criteria. One and 3 months later, 29% and 33% of providers met criteria, respectively. In IDIs, participants saw the lack of understanding of burnout as the cause for low baseline rates and attributed the subsequent decrease in burnout to newly acquired coping strategies. The activity helped them realize they were not alone in their experience of burnout. High patient load, low staffing, limited resources, and low pay emerged as contributing factors.</p><p><strong>Conclusion: </strong>A lack of exposure to the concept of burnout leads to providers being unaware of the issue as a collective burden. Therefore, burnout remains rarely discussed and not addressed, thus continuing to impact provider and patient health.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70014"},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268099","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":"Determination of Iodine Concentration in Commonly Consumed Salt and Its Potential Impact on Household Consumers: An Examination and Assessment of Consumed Salt.","authors":"Md Shahedul Islam, Mohammad Asadul Habib, Mohammad Anwar Ul Alam, Oumma Halima, Nusrat Parvin, Md Rezaul Karim, Abdur Rahman Shanna, Rifat Jahan Romel, Abdur Rahman Sakib, Mohammad Ariful Islam","doi":"10.1002/puh2.70012","DOIUrl":"10.1002/puh2.70012","url":null,"abstract":"<p><strong>Introduction: </strong>Iodine deficiency disorder (IDD) can lead to health issues as it is necessary for metabolic functions. This study investigated the iodine content of commonly consumed salt and the potential impact on daily iodine requirements and IDDs.</p><p><strong>Methods: </strong>A cross-sectional survey was employed using multistage cluster sampling among 240 households, dividing them into eight clusters from four stratified areas. The sampled salts were analyzed using the World Health Organization's iodometric titration method.</p><p><strong>Results: </strong>The study revealed that most salt samples from the studied brands had an iodine content within the Bangladesh Standards and Testing Institution (BSTI) recommended range of 20-50 ppm, with two exceptions. The study found that most socioeconomic groups in cities, towns, and semirural areas meet their daily iodine requirements at over 100%. At the same time, many rural homes, regardless of income, fail to meet these requirements. However, the study found iodized salt in 97.9% of all surveyed households. Although 48.3% of unions, that is, rural respondents, was knowledgeable about the existence of iodized salt, 66.7% of respondents was not aware of the health benefits of iodized salt. Surprisingly, 63.3% of the town's household members and 61.7% of the rural population still consume raw salt. Additionally, 79.6% of individuals reported having no IDDs. However, only 44.2% of thyroid patients used iodine supplements.</p><p><strong>Conclusion: </strong>Although salt usage and consumption practices are satisfactory, there are still a few concerns about the 100% iodization of branded and raw salts. As a result, many households need help to satisfy their daily iodine requirements.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70012"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268103","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":"Malnutrition Risk Among Hospitalized Patients With Type 2 Diabetes Mellitus and Its Association With Hospital Length.","authors":"Philemon Kwizera, Reverien Niyomwungeri, Omar Gatera, Harriet Gyamfuah Adu-Amoah, Jeannine Ahishakiye","doi":"10.1002/puh2.70011","DOIUrl":"10.1002/puh2.70011","url":null,"abstract":"<p><strong>Background: </strong>Estimating malnutrition risk among hospitalized patients is challenging, yet critical due to its association with adverse outcomes such as prolonged hospital stays, increased mortality, impaired wound healing, depression, and increased hospital costs. This research study aims to evaluate the risk of malnutrition among Type 2 diabetic hospitalized patients and its impact on the patient's length of stay in two tertiary hospitals based in Kigali.</p><p><strong>Method: </strong>In this retrospective cross-sectional study, 300 adult hospitalized Type 2 diabetic patients from Kigali's tertiary hospitals were enrolled between January 2021 and October 2022. Data collected include demographics, anthropometrics, serum albumin, and length of hospital stay. The nutrition risk index was used to determine malnutrition risk.</p><p><strong>Results: </strong>Overall, 55.3% of hospitalized Type 2 diabetes patients was found to be at risk of malnutrition on the basis of the nutrition risk index. Gender distribution showed no significant difference (<i>p</i> = 0.724), with 56.6% females and 54.5% males at risk. Significant associations were found with age (<i>r</i> = 0.018, <i>p</i> = 0.017), hypertension as comorbidity (<i>r</i> = -0.169, <i>p</i> = 0.004), hospital stay duration (<i>r</i> = 0.139, <i>p</i> = 0.002), and blood glucose levels (<i>r</i> = -0.087, <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>A study finds high malnutrition risk in hospitalized Type 2 diabetes patients, linked to longer stays and poor outcomes. Early malnutrition screening, proper nutrition support, and a multidisciplinary care team are crucial for improved clinical care and cost-effectiveness.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70011"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268133","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":"Community Water Fluoridation a Cost-Benefit-Risk Consideration.","authors":"Bill Osmunson, Griffin Cole","doi":"10.1002/puh2.70009","DOIUrl":"10.1002/puh2.70009","url":null,"abstract":"<p><p>For over 70 years, the addition of fluoride to public water as community water fluoridation (CWF or fluoridation) with intent to prevent dental caries continues to be controversial, and risks are seldom included in monetary evaluations. Published operational costs and benefits of fluoridation are used, whereas published and clinical experience treating dental fluorosis are utilized to estimate treatment costs of patient-perceived dental fluorosis and lost wages from lower IQ (intelligence quotient). Published estimated caries averted, less operational costs at $8 PPPY (per person per year) were used, compensation for functional and cosmetic dental fluorosis $126 PPPY, and lower earnings from presumed harm of developmental neurotoxicity estimated at $438 PPPY. Net loss from CWF is estimated at $556 PPPY, although some individuals will have significantly more or less loss. Previous economic evaluations of fluoridation have estimated caries averted and costs of operations; however, few evaluations include the costs of treating harm. Fluoridation is not cost-effective if the cost of harm is included. Alternatives for the prevention of dental caries should be promoted, and the cessation of fluoridation is indicated.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70009"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268100","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":"Depression and Its Determinants Among Patients With Sickle Cell Disease: A Cross-Sectional Study.","authors":"Bhuwan Dahit, Madhusudan Subedi, Ajay Kumar Rajbhandari, Amit Arjyal, Data Ram Adhikari, Padam Kanta Dahal","doi":"10.1002/puh2.70010","DOIUrl":"10.1002/puh2.70010","url":null,"abstract":"<p><strong>Background: </strong>Depression among patients with sickle cell disease (SCD) is crucial as it is often underdiagnosed and undertreated. Therefore, this study aimed to determine the prevalence of depression and to identify its determinants.</p><p><strong>Methods: </strong>This cross-sectional study was conducted in the Bardiya district of Nepal, based on registered cases of SCD. Depression was measured using the validated Nepalese version of the Beck Depression Inventory (BDI). A random sample of 358 participants with SCD aged >13 years was included in the study. Descriptive and inferential statistics were applied to sociodemographic, clinical and psychological variables. Logistic regression analysis was performed for bivariate analysis. Variables with a <i>p</i> value of less than 0.05 were subjected to final multivariate logistic regression.</p><p><strong>Results: </strong>The prevalence of depression was 36.31% among patients with SCD, age (<i>p</i> = 0.0178), education (<i>p</i> = 0.0178) and sociodemographic status (<i>p</i> = 0.0328) were strongly associated. Factors such as patients aged 40-49 years (adjusted odds ratio [AOR] = 3.05), complications due to SCD (AOR = 1.86) and genetic counselling group (AOR = 4.72) had higher chances of experiencing depression compared to their relative counterparts. However, patients with lower middle-class economic status, who experience pain crisis, with moderate self-esteem and who experience discrimination were 52%, 83%, 58% and 58% less likely to have depression compared to their respective counterparts, respectively.</p><p><strong>Conclusions: </strong>Depression was prevalent in patients with SCD, and multiple sociodemographic, clinical and psychological factors were strongly associated. This warrants the urgent need for early diagnosis and treatment of depression among participants with SCD.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70010"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268102","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":"Identifying Individual and Household Level Predictors of Undernutrition Among 6-59 Months Children in Bangladesh: A Multivariate Approach.","authors":"Oumma Halima, Abira Nowar, Md Hafizul Islam, Akibul Islam Chowdhury, Kazi Turjaun Akhter, Nazma Shaheen","doi":"10.1002/puh2.70007","DOIUrl":"10.1002/puh2.70007","url":null,"abstract":"<p><strong>Introduction: </strong>Globally malnutrition is considered one of the greatest threats to public health, particularly in low- and middle-income countries. The present study examined the extent of undernutrition and the associated determinants among children aged 6-59 months in Bangladesh using data from the Nutrition Survey of Bangladesh (NSB), 2017-18.</p><p><strong>Methods: </strong>The sampling frame of NSB 2017-18 was specified by a 30 (locations) × 30 (households) cluster approach where 20 locations were from rural areas and the other 10 were from urban areas. Out of the sampled households, 566 children aged between 6 and 59 months were included in the analysis. Determinants of three anthropometric measures, weight-for-age (stunting), weight-for-height (wasting), and weight-for-age (underweight), were analyzed using a multiple logistic regression model.</p><p><strong>Result: </strong>The prevalence of stunting, underweight, and wasting of children was 34.5%, 40.6%, and 20.1%, respectively. Although the child's age, family size, cleanliness of the residential area, and food insecurity were significant determinants of malnutrition, inadequate and low-quality protein consumption strongly predicted the development of underweight and stunting in infants and children. The odds of being stunted were 2 times (adjusted odds ratio [AOR]: 2.02, 95% confidence interval [CI]: 1.17-3.46; <i>p</i> = 0.011) and underweight was almost 2.5 times (AOR: 2.41; 95% CI: 1.27-4.56; <i>p</i> < 0.01) higher, respectively, among children who consumed inadequate amounts of protein.</p><p><strong>Conclusion: </strong>Because the percentage of children from wealthy families was relatively low in the present study, cleanliness of residential areas, food insecurity, and inadequate protein intake are likely to be key drivers of malnutrition in Bangladesh, which might be significantly reduced with better coverage of preventive nutrition programs.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70007"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268132","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 Interplay of Tobacco Farming and Tobacco Control: Exploring Socioeconomic and Health Dynamics in Malawi.","authors":"Chimwemwe Ngoma, Sahan Lungu, George N Chidimbah Munthali, Martha Shantel Mwase","doi":"10.1002/puh2.70008","DOIUrl":"10.1002/puh2.70008","url":null,"abstract":"<p><p>Tobacco farming and tobacco control are closely inter-related issues, particularly in developing countries that are heavily reliant on tobacco farming like Malawi. This commentary explores the relationship among tobacco farming, economic sustainability, and public health, focusing on the context of Malawi as one of the major tobacco producers in Africa. Malawi's economy is significantly dependent on tobacco farming, yet the country also struggles with smoking-related health risks, creating a dilemma between socioeconomic and public health considerations. The commentary highlights the lack of empirical evidence regarding the socioeconomic implications of tobacco control measures on tobacco farming in the country. Moreover, despite the country's economic dependence on tobacco farming, a majority of cigarettes consumed domestically are imported, demonstrating the complexity of Malawi's tobacco industry. On public health implications, the article highlights the disease and death burden that is a result of tobacco smoking, underscoring the need for tobacco control measures. The article further draws insights from tobacco end-game strategies in other countries and proposes a comprehensive approach to tobacco control. However, the article notes Malawi's limited financial resources and healthcare infrastructure to implement traditional tobacco control measures and highlights an emphasis on tobacco harm reduction, a third pillar of the Framework Convention on Tobacco Control. The article also advocates for an emphasis on alternative livelihood opportunities for smallholder tobacco farmers in Malawi.</p>","PeriodicalId":74613,"journal":{"name":"Public health challenges","volume":"3 4","pages":"e70008"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268135","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}