SSM. Qualitative research in health最新文献

{"title":"Institutional and systemic barriers and facilitators affecting healthcare access for Black women in Alberta","authors":"Mary Olukotun ,&nbsp;Adedoyin Olanlesi-Aliu ,&nbsp;Yawa Idi ,&nbsp;Tehseen Ladha ,&nbsp;Paul Bailey ,&nbsp;Regine King ,&nbsp;Bukola Salami","doi":"10.1016/j.ssmqr.2024.100485","DOIUrl":"10.1016/j.ssmqr.2024.100485","url":null,"abstract":"<div><div>Canada's Black population has experienced significant growth in recent years, with substantial increases noted in the prairie provinces. As Black people continue to make up a growing proportion of the population, it is important to understand their experiences in accessing healthcare services, especially for those who are multiply marginalized. We undertook a qualitative study to examine the healthcare access experiences of Black women in Canada. We completed semi-structured interviews with a sample of 30 Black women from Alberta. Our study was guided by intersectionality to examine how Black women's experience of healthcare access is shaped by social processes related to their socio-demographic characteristics such as being Black, a woman, an immigrant or non-immigrant, and having high or low income. From our thematic analysis we identified three key factors that hinders healthcare access for Black women: socioeconomic barriers, health systems issues, and racism. We identified two types of facilitators: community and institutional facilitators and structural facilitators. Our findings elucidate how Black women's experiences of accessing and utilizing health services in Alberta are influenced by overlapping institutional, structural, and systemic factors.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100485"},"PeriodicalIF":1.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358089","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":"Older, gay men's navigation of mental health and substance use challenges: A qualitative exploration","authors":"Ingrid Handlovsky ,&nbsp;Tessa Wonsiak ,&nbsp;Bernadette Zakher ,&nbsp;Olivier Ferlatte ,&nbsp;Hannah Kia ,&nbsp;John L. Oliffe","doi":"10.1016/j.ssmqr.2024.100484","DOIUrl":"10.1016/j.ssmqr.2024.100484","url":null,"abstract":"","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100484"},"PeriodicalIF":1.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667321524000933/pdfft?md5=c2558e0fbfad17b2a71d2ee222e5a8dc&pid=1-s2.0-S2667321524000933-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315893","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":"“It seemed like she just wanted me to suffer”: Acts of obstetric racism and birthing rights violations against Black women","authors":"Dorian S. Odems ,&nbsp;Erica Czaja ,&nbsp;Saraswathi Vedam ,&nbsp;Na’Tasha Evans ,&nbsp;Barbara Saltzman ,&nbsp;Karen A. Scott","doi":"10.1016/j.ssmqr.2024.100479","DOIUrl":"10.1016/j.ssmqr.2024.100479","url":null,"abstract":"<div><h3>Introduction</h3><p>Studies that examine obstetric violence and mistreatment during perinatal care demonstrate that Black women experience higher levels of harm and abuse than other racialized groups. Yet these gender-based concepts do not fully recognize the intersectional gender-and race-based harms that Black women experience within the context of quality, safety, and human rights violations in the U.S. healthcare system.</p></div><div><h3>Methods</h3><p>We performed qualitative secondary analysis from Black women participants in the Giving Voice to Mothers (GVtM) study (n = 304). Primary data collection for the GVtM survey spanned from 2016 to 2017, and our analysis occurred in 2023, focusing on the interpretation of open-ended responses to three categories of inquiry: worst experiences with perinatal care, experiences of being pressured to undergo medical interventions, and desired revisions to birthing experiences. We employed a deductive approach and applied two analytic frameworks – obstetric racism and the Black Birthing Bill of Rights (BBBR)– to categorize Black women's narratives of harm during perinatal care as quality, safety, and human rights violations.</p></div><div><h3>Results</h3><p>Black women described perinatal care experiences with considerable violations of the BBBR, including disrupted time with babies, racially discordant care, and unaffordable care. These experiences illustrated all six domains of obstetric racism.</p></div><div><h3>Conclusion</h3><p>This study contributes to an emerging body of Black feminist approaches to knowledge production in obstetric patient safety, emphasizing the critical intersection of gender and race. Furthermore, this study underscores the value of using Black-women-defined frameworks with typologies to interpret the distinct experiences of Black women instead of the more limited gender-based concepts of obstetric violence, mistreatment, and respectful maternity care that lack historical context and contemporary implications of anti-Black racism and misogynoir.</p></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100479"},"PeriodicalIF":1.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266732152400088X/pdfft?md5=8f8f28cf9adae780fdd94d1164ad705a&pid=1-s2.0-S266732152400088X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272660","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":"“Mammograms are kind of my pacifier”: The cultural context of women's preference for annual mammograms in a risk-based screening cohort","authors":"Katherine Leggat-Barr,&nbsp;Galen Joseph,&nbsp;Leslie Riddle,&nbsp;Mikaella Caruncho,&nbsp;Barbara Koenig,&nbsp;Jennifer James","doi":"10.1016/j.ssmqr.2024.100476","DOIUrl":"10.1016/j.ssmqr.2024.100476","url":null,"abstract":"<div><div>Population genetic testing and risk-based screening have the potential to shift how we determine risk and screen for breast cancer. While much attention has been paid to the experiences of individuals who may be at elevated risk for breast cancer, less is known about how those at average risk make decisions about their health. Through qualitative interviews with 30 participants, we explore how those enrolled in a risk-based screening trial who are determined to be at average risk for breast cancer make screening decisions. We consider how the social context of breast health, known as ‘pink ribbon culture,’ and the pervasiveness of annual mammography as the standard of care make risk-based screening less acceptable for many participants. Risk-based screening paradigms assume that individuals will assess their risk quantitatively based on the risk models that are used. Yet, our findings demonstrate that social and cultural factors influence decision-making surrounding breast cancer screening, an important consideration when implementing risk-based screening programs. We will begin to address a gap in knowledge about how women who are told they are average risk after risk-based screening (most of the population) and recommended to screen less than annually make screening decisions.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100476"},"PeriodicalIF":1.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533346","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":"Sources of moral distress among obstetrician-gynecologists after Dobbs: A qualitative, multi-state study","authors":"Mara Buchbinder ,&nbsp;Kavita S. Arora ,&nbsp;Samantha M. McKetchnie ,&nbsp;Erika L. Sabbath","doi":"10.1016/j.ssmqr.2024.100483","DOIUrl":"10.1016/j.ssmqr.2024.100483","url":null,"abstract":"<div><p>Since the US Supreme Court's 2022 decision in <em>Dobbs v Jackson Women's Health Organization,</em> 18 states have enacted functional bans on abortion, yet little is known about how these laws contribute to workplace stress and its sequelae among clinicians. The purpose of this study was to characterize sources of moral distress—which occurs when a clinician knows the right course of clinical action but is barred from taking that action by external constraints—among obstetrician-gynecologists (OB-GYNs) in states with abortion bans. We conducted qualitative, semi-structured interviews with 54 OB-GYNs practicing in 13 of 14 states where abortion was illegal as of March 2023. Using a qualitative descriptive coding approach, we identified four types of clinical situations leading to moral distress: delaying treatment for patients with obstetric complications, conflict with other clinicians, denying care they would have provided locally prior to <em>Dobbs</em>, and restrictions on clinical counseling. These situations provoked feelings of anger, frustration, helplessness, and emotional exhaustion. Participants attributed moral distress to the cumulative toll of routinely being unable to provide evidence-based healthcare, in addition to the acute burden of managing obstetric emergencies in legal gray areas, which was relatively rarer. The findings demonstrate a previously unreported source of moral distress: the everyday chipping away of professional integrity that occurs when OB-GYNs cannot care for patients in the way that patients need. Next steps include developing institutional-level policies and programs to support clinicians and enable them to practice ethical medicine in abortion-restrictive policy environments.</p></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100483"},"PeriodicalIF":1.8,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667321524000921/pdfft?md5=a52a63ad13eba50c1a68478cd7e52f21&pid=1-s2.0-S2667321524000921-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229777","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":"‘ … You become a prisoner of your life’: A qualitative study exploring the experience of joint pain and accessing care in Hai, Tanzania","authors":"Emma Laurie ,&nbsp;Elizabeth F. Msoka ,&nbsp;Sally Wyke ,&nbsp;Nateiya M. Yongolo ,&nbsp;Christopher Bunn ,&nbsp;Perry Msoka ,&nbsp;Emma McIntosh ,&nbsp;Blandina T. Mmbaga","doi":"10.1016/j.ssmqr.2024.100481","DOIUrl":"10.1016/j.ssmqr.2024.100481","url":null,"abstract":"<div><p>The increased prevalence of non-communicable diseases (NCDs) in recent years has led many Low- and Middle-Income Countries (LMICs), including Tanzania, to develop policies to manage their burden. Musculoskeletal (MSK) conditions, such as arthritis, account for 20% of all years lived with disability in LMICs, but the NCD strategies rarely address them. There is substantial research on the disruption MSK conditions cause to people's lives within High-Income Countries, but very little is known about the lived experiences in LMICs. We investigated the experience of MSK conditions in 48 in-depth qualitative interviews with participants from the Hai District in Tanzania, East Africa, all of whom had a MSK disorder (confirmed through clinical examination as part of a broader study). We found that loss of mobility and pain associated with MSK disorders severely limits people's everyday lives and livelihoods. Help from others, mainly those within a household, is necessary for most tasks and those with limited or no support experience particular problems. We found barriers to accessing care and treatment in the form of high direct and indirect (through travel) care costs within formal health services in Tanzania. We argue for increased attention to the growing problem of MSK disorders in LMICs and that this agenda should be driven by a patient-centred approach which designs services accessible to the target population and designed to recognise their embodied expertise.</p></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100481"},"PeriodicalIF":1.8,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667321524000908/pdfft?md5=ff42337ea0fdf64bde5c93b0f570dc5b&pid=1-s2.0-S2667321524000908-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239976","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":"Health impacts of climate change in the UK: A qualitative synthesis detailing the conjuncture of social structure, extreme weather, and mental health","authors":"Steven Dodd ,&nbsp;Mette Kragh-Furbo ,&nbsp;Jessica Davies ,&nbsp;Scott Butterfield ,&nbsp;Abigail Morris ,&nbsp;Heather Brown","doi":"10.1016/j.ssmqr.2024.100475","DOIUrl":"10.1016/j.ssmqr.2024.100475","url":null,"abstract":"<div><div>This qualitative synthesis explores the experiences of UK communities facing growing health risks from climate change and extreme weather. The eight included studies show the profound impacts of extreme weather events such as floods on mental health, including challenges to self-identity and anxiety from the fear of flooding returning. Included data reveal individual and household impacts of extreme weather are mediated by a complex interaction of institutional support, community support, gender inequalities and personal agency. These factors are assessed against the backdrop of broader concepts in the social science and adaptation literature, including the role of the state, the inseparability of nature and society, the overlooked role of social structure, and environmental justice. It is argued that the use of qualitative synthesis methods in this topic area allows for an interconnected and context-sensitive analysis of the health impacts of climate change facing communities, diverging from other analytical approaches through inclusion of considerations such as social power, community dynamics, and the inter-relation of institutional action, community cohesion and individual agency. The resulting findings show how locally specific and highly contextual qualitative data can be used by those seeking to understand health risks from climate change within a locality.</div></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100475"},"PeriodicalIF":1.8,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358091","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":"“I am empowered by this opportunity”: The role of abortion funds as an antidote to abortion stigma","authors":"Al Garnsey ,&nbsp;Jessica L. Liddell ,&nbsp;Annie Glover ,&nbsp;Celina M. Doria ,&nbsp;Alex Buscaglia ,&nbsp;Lauren Buxbaum","doi":"10.1016/j.ssmqr.2024.100478","DOIUrl":"10.1016/j.ssmqr.2024.100478","url":null,"abstract":"<div><p>Beyond the many structural obstacles to obtaining abortion care in the United States, abortion stigma is a forceful impediment to accessing timely services and an injurious feature of the experience for some people who have abortions (Sorhaindo &amp; Lavelanet, 2022). This study utilized a qualitative methodology to explore the experiences of 830 abortion fund applicants in the Rocky Mountain Region to better understand the unique barriers they face in accessing care, the role that stigma plays in influencing applications for abortion fund support, and inform strategies to expand support infrastructure for those facing isolation and hostility in their pursuit of care. For the applicants in this study, stigma was frequently cited as an impetus for seeking abortion fund support and a burdensome aspect of the experience itself. Stigma—whether internalized, perceived, enacted, or structural—prevented many applicants from seeking material or emotional support from their social networks and spurred the dissolution of interpersonal relationships—with far-reaching emotional and material consequences. The results suggest that abortion funds go far beyond merely providing material support, also acting as an antidote to the harms associated with abortion stigma by promoting feelings of interconnectedness and mutuality among applicants. While accounts of stigma were pervasive in the applications, so, too, were the myriad strategies of resistance that applicants called upon to challenge stigmatizing narratives and position their choice to have an abortion as both moral and necessary.</p></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100478"},"PeriodicalIF":1.8,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667321524000878/pdfft?md5=aaea4ca9e0091c145a355cc0883203d3&pid=1-s2.0-S2667321524000878-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229775","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":"“It's the patient that suffers from poor communication”: Analyzing communication gaps and associated consequences in handover events from nurses’ experiences","authors":"Roger A. Atinga ,&nbsp;Mtebi Nkrabia Gmaligan ,&nbsp;Alice Ayawine ,&nbsp;John K. Yambah","doi":"10.1016/j.ssmqr.2024.100482","DOIUrl":"10.1016/j.ssmqr.2024.100482","url":null,"abstract":"<div><h3>Background</h3><p>Although routine communication gaps among clinical shift teams significantly account for adverse care and treatment outcomes, existing analysis of the phenomenon remain limited in low middle income countries battling with patient safety issues. This study analyzed the drivers and associated episodic consequences of communication gaps from nurses’ experiences in Ghana.</p></div><div><h3>Methods</h3><p>Qualitative design implemented in two referral hospitals. Data collection involved site observations and in-depth interviews with general nurses, midwives, and staff nurses across 3-cycle shift regimes in the emergency, ICU, inpatient wards, and maternity units. A two-stage data analysis was adopted by integrating deductive and inductive codes into broad thematic typologies explaining drivers of communication gaps and the consequences thereof.</p></div><div><h3>Results</h3><p>Communication gaps among shift teams were largely driven by a combination of three broad factors: <em>a</em>) Attitudinal elements of poor work ethics, poor documentation, interpersonal conflicts and use of unconventional language that impaired effective communication; <em>b</em>) organizational dynamics of taxing job demands, limited training exposure and lack of formal handover communication procedures which allowed shift teams to adopt default patterns of communication behavior; and <em>c</em>) cultural values, stereotyping and prejudicing behaviors that restricted inclusive interactions among shift teams. These communication gaps produced adverse episodic effects of diagnostic and treatment errors, complications, and extended hospitalizations.</p></div><div><h3>Conclusion</h3><p>The findings underscore the need to develop standard guidelines to direct structured communication alongside equipping shift teams with competences on emotional intelligence to overcome cultural and behavioral adversities that influence communication breakdown.</p></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100482"},"PeriodicalIF":1.8,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266732152400091X/pdfft?md5=4103e54e35cbf646c8b04ad22c9e912b&pid=1-s2.0-S266732152400091X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164451","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":"People discuss the men who can't get it up, but what about the women who can't get it in? Women's help-seeking experiences for sexual pain-penetration disorder","authors":"Rashmi Pithavadian ,&nbsp;Jane Chalmers ,&nbsp;Vijayasarathi Ramanathan ,&nbsp;Tinashe Dune","doi":"10.1016/j.ssmqr.2024.100480","DOIUrl":"10.1016/j.ssmqr.2024.100480","url":null,"abstract":"<div><h3>Purpose</h3><p>While it is common to hear of men who ‘can't get it up’ due to erectile dysfunction, people rarely discuss the women who ‘can't get it in’. These women often meet the criteria for sexual pain-penetration disorder (SPPD), which makes vaginal penetration painful or difficult. Lacking awareness of SPPD and the changing terminology from vaginismus to SPPD complicates help-seeking. Yet, there is lacking research on women's help-seeking experiences for SPPD. Therefore, this study aimed to examine Australian women's subjective experiences of formal and informal help-seeking for their SPPD to gain information, diagnosis, treatment, and support.</p></div><div><h3>Methods</h3><p>Help-seeking theory informed the study. Semi-structured interviews were conducted with 21 participants who sought help for their SPPD, which were inductively thematically analysed.</p></div><div><h3>Results</h3><p>Five major themes were developed. (1) <em>Recognition that help-seeking is necessary</em> varied depending on participants' presentation of SPPD. (2) <em>Initiating help-seeking</em> included accessing first points of contact and gaining diagnosis. (3) <em>Management of symptoms with treatment</em> involved conventional, complementary, and alternative treatments. Women discussed using sex toys as alternatives to vaginal trainers, the correlation between negotiating pain thresholds and treatment progress, and their perceptions towards Botox and nerve blocks. (4) <em>Traverse formal healthcare networks</em> facilitated or hindered help-seeking. (5) <em>Navigation of un/supportive informal networks</em> included women's partners, family, friends, and online communities.</p></div><div><h3>Conclusions</h3><p>The benefit of self-help kits, and complementary and alternative treatments for SPPD should be evaluated. Recommendations involve improving health professionals' approaches, including in online spaces. Women's immediate informal support networks should be engaged in healthcare management.</p></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100480"},"PeriodicalIF":1.8,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667321524000891/pdfft?md5=3f58fde8d42d7bf6c3b47f6adf7ebdcd&pid=1-s2.0-S2667321524000891-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148120","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}