BMJ Global Health最新文献

{"title":"Primary healthcare models for refugees involving nurses: a systematic review and narrative synthesis.","authors":"Andreas W Gold, Clara Perplies, Louise Biddle, Kayvan Bozorgmehr","doi":"10.1136/bmjgh-2024-018105","DOIUrl":"10.1136/bmjgh-2024-018105","url":null,"abstract":"<p><strong>Introduction: </strong>Primary healthcare (PHC) is key to addressing the health and social needs of refugees. Nurses are often part of multidisciplinary teams in PHC, but little is known about their roles and responsibilities in refugee healthcare. We aimed to synthesise the existing knowledge about models of care (MoC) for refugees in primary care settings which involve nursing professionals.</p><p><strong>Methods: </strong>Systematic review, searching PubMed, CINAHL and Web of Science for scientific literature, as well as Google Search and Scholar, Microsoft Bing and DuckDuckGo for grey literature. We included publications that reported MoC for refugees in primary care which involve nursing professionals. Following a relevancy rating, we extracted information about structural components (setting, target population, available services, funding and workforce composition), and inductively coded the roles and responsibilities of nurses within these models. Data were synthesised using qualitative and narrative synthesis.</p><p><strong>Results: </strong>We included 120 publications in the review. Of these, 67 (56%) provided in-depth insights into MoC and nurse involvement and were included for narrative synthesis, yielding 49 MoC mainly from high-income countries. Most MoCs identified to set up parallel healthcare structures (specialised-focus services) that refugees can access for a limited period of time or targeting specific conditions in a vertical approach. However, some of the MoCs we studied focus on referral support as gateway services or are embedded in mainstream services. Nurses in these models typically experience a high degree of autonomy within defined responsibilities, encompassing clinical, administrative, educational and coordinating tasks.</p><p><strong>Conclusions: </strong>Nurses take on key roles in parallel healthcare structures for refugees, and specially trained nurses are well positioned to facilitate the integration of refugees into mainstream healthcare. Future research into the long-term impact of existing models, identifying best practices and defining competency requirements for healthcare workers/nurses in refugee care may foster evidence-based policy and practice improvements.</p><p><strong>Prospero registration number: </strong>CRD42020221045.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between sexual violence and mental disorders among women victim-survivors in sub-Saharan Africa: a systematic review and meta-analysis.","authors":"Sintayehu Abebe Woldie, Genevieve Walker, Sarah Bergman, Kristin Diemer, Karen Block, Gregory Armstrong, Mirgissa Kaba, Cathy Vaughan","doi":"10.1136/bmjgh-2024-017962","DOIUrl":"10.1136/bmjgh-2024-017962","url":null,"abstract":"<p><strong>Background: </strong>Sexual violence is a serious public health and human rights problem with both short-term and long-term consequences. This review aims to systematically assess the link between sexual violence and poor mental health among sub-Saharan African women.</p><p><strong>Methods: </strong>Systematic review and meta-analyses of observational studies were performed. MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane, Global Health and the University of Melbourne library electronic databases were used to find relevant published literature over 12 years from 2012 to 2024 in sub-Saharan Africa with stringent eligibility criteria. Random effects meta-analyses were used to pool estimates of ORs and 95% CIs. The I² statistic was used to assess heterogeneity.</p><p><strong>Results: </strong>This systematic review and meta-analysis of 76 observational studies included a total of 80 313 participants and found a consistent small-to-medium association between lifetime sexual violence and experiences of poor mental health. The pooled ORs suggest that women who were exposed to sexual violence were more than twice as likely to experience post-traumatic stress disorder (OR 2.75; 95% CI 1.96 to 3.86; I²=73.4%), depression (OR 2.38; 95% CI 2.04 to 2.77; I²=56.6%), anxiety (OR 2.81; 95% CI 1.67 to 4.72; I²=77.2%), common mental disorders (OR 2.12; 95% CI 1.70 to 2.64; I²=0.0%), suicidal behaviour (OR 2.44; 95% CI 1.92 to 3.10; I²=68.0%) and emotional distress (OR 3.14; 95% CI 1.73 to 5.69; I²=79.6%) compared with women who have not experienced sexual violence.</p><p><strong>Conclusions: </strong>Exposure to lifetime sexual violence was consistently associated with small to medium effects on poor mental health among women in sub-Saharan Africa. Thus, policy-makers should develop response strategies as well as mental health screening tools for all violence response service delivery points. In addition, health practitioners must prioritise screening for mental health conditions in patients who present with a history of sexual violence.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human papillomavirus vaccine: a welcome addition to the national immunisation schedule in Nepal.","authors":"Prayash Paudel","doi":"10.1136/bmjgh-2024-018723","DOIUrl":"10.1136/bmjgh-2024-018723","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health workers' perspectives on self-monitoring of blood pressure by pregnant women: a qualitative study among community health workers, midwives, doctors and health system managers in Lombok, Indonesia.","authors":"Tigest Tamrat, Yuni Dwi Setiyawati, Raissa Manika Purwaningtias, Nya Jeumpa Madani, María Barreix, Antoine Geissbuhler, Anuraj H Shankar, Özge Tunçalp","doi":"10.1136/bmjgh-2024-017532","DOIUrl":"10.1136/bmjgh-2024-017532","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertensive disorders of pregnancy (HDPs) are a leading cause of maternal mortality and morbidity globally but could be mitigated through accurate and timely blood pressure (BP) monitoring. Self-monitoring of blood pressure (SMBP) in pregnancy is an emerging approach for the management of HDPs but mainly studied from the perspectives of pregnant women, in high-income contexts, or tertiary care. This qualitative study explored health workers' perspectives on SMBP by pregnant women, including through using a smartphone application, within primary healthcare settings of Lombok, Indonesia.</p><p><strong>Methods: </strong>We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) with community health workers, community-based midwives, facility-based midwives from primary healthcare centres, obstetrician/gynaecologists and health system managers (including heads of facilities, midwife supervisor and District Health Office administrators). Themes were grouped according to the normalisation process theory, which includes (1) coherence/understanding of the intervention, (2) cognitive participation/perceived value and (3) collective action/how the intervention will affect processes and organisational practices.</p><p><strong>Results: </strong>We recruited 68 participants across 8 FGDs and 26 IDIs. SMBP was perceived to improve timeliness of care and detection of high BP, but health workers expressed concerns about women's ability to accurately self-monitor, reliability and affordability of BP devices, and accountability and management of SMBP results. Embedding SMBP into routine antenatal care counselling, collaboration with family members, clarification on liability implications and protocols on SMBP follow-up actions, and use of digital communication channels were cited as potential ways to facilitate uptake of SMBP.</p><p><strong>Conclusion: </strong>For SMBP to be valued by health workers and effectively integrated into the health system as a strategy for addressing HDPs, it needs to be accompanied by clear clinical and data management protocols, referral mechanisms, reassurance on the accuracy and trust in the self-monitored measurements and demonstration of timeliness in the provision of follow-up care for pregnant women.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing global health in an unprecedented (and unpredictable) era.","authors":"Mark G Shrime","doi":"10.1136/bmjgh-2025-019159","DOIUrl":"10.1136/bmjgh-2025-019159","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination strategies against wild poliomyelitis in polio-free settings: outbreak risk modelling study and cost-effectiveness analysis.","authors":"Megan Auzenbergs, Kaja Abbas, Corey M Peak, Arend Voorman, Mark Jit, Kathleen M O'Reilly","doi":"10.1136/bmjgh-2024-016013","DOIUrl":"10.1136/bmjgh-2024-016013","url":null,"abstract":"<p><p>The 2021 importation of wild poliovirus serotype 1 (WPV1) into Malawi with subsequent international spread represented the first WPV1 cases in Africa since 2016. Preventing importations and spread of WPV1 is critical and dependent on population immunity provided through routine immunisation (RI) and supplementary immunisation activities (SIAs). We aim to estimate outbreak risk and costs, given the importation of WPV1 for non-endemic countries in the WHO Africa region. We developed a stochastic mathematical model of polio transmission dynamics to evaluate the probability of an outbreak, expected number of poliomyelitis cases, costs and incremental cost-effectiveness ratios under different vaccination strategies. Across variable RI coverage, we explore three key strategies: RI+outbreak SIAs (oSIAs), RI+oSIAs+annual preventative SIAs (pSIAs) and RI+oSIAs+biennial pSIAs. Results are presented in 2023 USD over a 5year- time horizon from the Global Polio Eradication Initiative (GPEI) and health system perspectives. The annual pSIA strategy has the greatest probability of no outbreaks in comparison to other strategies: under our model assumptions, annual pSIAs result in an 80% probability of no outbreaks when RI coverage is ≥50%. The biennial pSIA strategy requires RI coverage ≥65% to achieve an equivalent risk of no outbreaks. The strategy with no pSIAs requires ≥75% RI coverage to achieve an equivalent risk of no outbreaks. For the health system, when RI coverage is between 35% and 60%, both pSIA strategies are cost-saving. For the GPEI, below 65% RI pSIA strategies are cost-effective, but the biennial pSIA strategy incurs higher costs in comparison to annual pSIAs due to more oSIAs required to stop outbreaks. Prioritisation of pSIAs must balance outbreak risk against implementation costs, ideally favouring the smallest manageable outbreak risk compatible with elimination. We infer that there are few short-term risks due to population immunity from RI, but without pSIAs, long-term risks accumulate and can result in outbreaks with the potential for international spread.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public-targeted interventions addressing antimicrobial resistance and antibiotic use in Sub-Saharan Africa: a scoping review.","authors":"Winifred Maduko, Emmanuel Olamijuwon, Mike Kesby, Jo Mhairi Hale","doi":"10.1136/bmjgh-2024-017455","DOIUrl":"10.1136/bmjgh-2024-017455","url":null,"abstract":"<p><strong>Introduction: </strong>Antimicrobial resistance (AMR) is a global health threat, with sub-Saharan Africa (SSA) experiencing the heaviest health burden and the highest AMR-related mortality. Most interventions in the region focus on hospital settings and provider behaviour, with few empirical papers discussing how theories inform those interventions specifically, community-centred interventions often lack a theoretical framework. However, using behavioural change theories can help us understand public behaviour around antibiotic usage and how to develop theoretically based interventions to maximise effectiveness. This scoping review critically investigates public-targeted interventions on AMR and antibiotic use within SSA, paying close attention to the theories underpinning those interventions. Given the concerning global rise in the spread of AMR and its severe implications, the situation may likely deteriorate if interventions are not significantly enhanced.</p><p><strong>Methods: </strong>A comprehensive search of peer-reviewed literature published in three databases (PubMed, Web of Science and Google Scholar) between 1997 and 2023 was conducted to determine the extent, range and nature of existing studies in this area. This review used the Arksey and O'Malley five-step scoping review framework.</p><p><strong>Results: </strong>The final review included seven publications, with three of the studies conducted in Ghana and the remaining studies carried out across other SSA nations. Findings revealed that AMR interventions were tailored to various demographics, including school children, parents, patients and online audiences. There is a notable lack of inclusive interventions for vulnerable populations, such as persons living with disabilities.</p><p><strong>Conclusion: </strong>The study findings emphasise the critical need for more community-centred research and AMR interventions that integrate relevant theoretical frameworks while being appropriately tailored to local contexts.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating tobacco cessation in chronic respiratory disease care: a comprehensive approach to reducing the global burden.","authors":"Jing Han, Yulan Qu, Elif Dagli, Lars-Åke Söderlund, Louise Restrick, Moss Uromtah, Sian Williams, Surabhi Joshi, Darush-Attar Zadeh, David Cl Lam, Kerstin Schotte, Yuanlin Song, Sarah Rylance","doi":"10.1136/bmjgh-2024-017851","DOIUrl":"10.1136/bmjgh-2024-017851","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Levels and determinants of person-centred maternity care among women living in urban informal settlements: evidence from client exit surveys in Nairobi, Lusaka and Ouagadougou.","authors":"Safia S Jiwani, Kadari Cissé, Martin Kavao Mutua, Choolwe Jacobs, Anne Njeri, Godfrey Adero, Mwiche Musukuma, Dennis Ngosa, Fatou Bintou Sissoko, Seni Kouanda, Amanuel Abajobir, Cheikh Mbacké Faye, Ties Boerma, Agbessi Amouzou","doi":"10.1136/bmjgh-2024-017337","DOIUrl":"10.1136/bmjgh-2024-017337","url":null,"abstract":"<p><strong>Background: </strong>Sub-Saharan Africa's rapid urbanisation has led to the sprawling of urban informal settlements. The urban poorest women are more likely to experience worse health outcomes and poor treatment during childbirth. This study measures levels of person-centred maternity care (PCMC) and identifies determinants of PCMC among women living in urban informal settlements in Nairobi, Lusaka and Ouagadougou.</p><p><strong>Methods: </strong>We conducted phone, home-based or facility-based exit surveys of women discharged from childbirth care in facilities serving urban informal settlements. We estimated overall and domain-specific PCMC scores covering dignity and respect, communication and autonomy, and supportive care. We ran multilevel linear regression models to identify structural, intermediary and health systems factors associated with PCMC.</p><p><strong>Results: </strong>We included 1249 women discharged from childbirth care: the majority were aged 20-34 years and were unemployed. In Lusaka and Nairobi, over 65% of women had secondary education, and over half gave birth in a hospital, whereas in Ouagadougou one-third had secondary education and 30.4% gave birth in a hospital. The mean PCMC score ranged from 57.1% in Lusaka to 73.8% in Ouagadougou. Across cities, women reported high dignity and respect mean scores (73.5%-84.3%), whereas communication and autonomy mean scores were consistently poor (47.6%-63.2%). In Ouagadougou, women with formal employment, those who delivered in a private for-profit facility, and whose newborn received postnatal care before discharge reported significantly higher PCMC. In Nairobi and Lusaka, women who were attended by a physician during childbirth, and those whose newborn was checked before discharge reported significantly higher PCMC.</p><p><strong>Conclusions: </strong>Women living in urban informal settlements experience inadequate PCMC and report poor communication with health providers. Select health systems and provision of care factors are associated with PCMC in this context. Quality improvement efforts are needed to enhance PCMC and ensure women's continuity in care seeking.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal study on quality of life following cervical cancer treatment in Botswana.","authors":"Surbhi Grover, Rohini K Bhatia, Salman Khan, Paseka Tladi, Lesego Gabaitiri, Memory Bvochora-Nsingo, Sebathu Chiyapo, Dawn Balang, Shalini Vinod, Mark N Polizzotto, Natalie Taylor, Karen Canfell, Nicola Zetola, Doreen Ramogola-Masire, Lilie L Lin, Erle Robertson, Katharine A Rendle","doi":"10.1136/bmjgh-2024-017206","DOIUrl":"10.1136/bmjgh-2024-017206","url":null,"abstract":"<p><strong>Purpose: </strong>This study longitudinally assessed the quality of life (QoL) in patients who completed chemoradiation (CRT) for cervical cancer in Botswana and compared the QoL for those living with and without HIV infection.</p><p><strong>Methods: </strong>Patients with cervical cancer recommended for curative CRT were enrolled from August 2016 to February 2020. The European Organisation for Research and Treatment of Cancer Core Quality-of-Life (QLQ-C30) and cervical cancer-specific (QLQ-Cx24) questionnaires, translated into Setswana, were used to assess the QoL of patients prior to treatment (baseline), at the end of treatment (EOT) and in 3 month intervals post-treatment for 2 years, and statistical analyses were performed.</p><p><strong>Results: </strong>A total of 294 women (median age: 46 years) were enrolled and followed up for an average of 16.4 months. Of women with recorded staging, most had FIGO stage III/IV disease (64.4%). Women living with HIV (WLWH; 74.1%) presented at earlier ages than those without HIV (44.8 years vs 54.7 years, p<0.001). The QoL for all domains did not differ by HIV status at baseline, EOT or 24 month follow-up. Per QLQ-C30, the mean global health status score (72.21 vs 78.37; p<0.01) and the symptom (12.70 vs 7.63; p=0.04) and functional scales (88.34 vs 91.85; p<0.01) improved significantly from the EOT to the 24 month follow-up for all patients; however, using the QLQ-Cx24 survey, no significant differences in the symptom burden (12.53 vs 13.67; p=0.6) or functional status (91.23 vs 89.90; p=0.53) were found between these two time points.</p><p><strong>Conclusion: </strong>The QoL increased significantly for all patients undergoing CRT, underscoring the value of pursuing curative CRT, regardless of the HIV status.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}