{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T03:48:24Z","timestamp":1747194504875,"version":"3.40.5"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T00:00:00Z","timestamp":1579564800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T00:00:00Z","timestamp":1579564800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Fam Pract"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The study aimed to analyze anemia management in non-pregnant, and non-menopausal women aged from 18 to 50\u2009years old, in a French primary care setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An observational descriptive prospective study was conducted between November 2018 and February 2019. Inclusion criteria were as followed: anemia diagnosed in women aged from 18 to 50, not pregnant and not menopausal. Quantitative and qualitative data were anonymized and collected through an electronic survey. Investigating general practitioners completed the questionnaire for each newly diagnosed woman. Mean values and medians were calculated for the quantitative data. Answers to the open questions were encoded manually and proportions of the different modalities have been calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Altogether, 43 women with anemia were ascertained. Moderate microcytic anemia, due to an iron deficiency in a context of menorrhagia, was the most observed anemia profile. The mean value of hemoglobin was 10.5\u2009\u00b1\u20091\u2009g\/dl. Among these women: 32 (74%) presented an iron deficiency, 17 (53%) had inappropriate intakes, and 9 (28%) reported menorrhagia. For 17 (40%) women, unnecessary or inappropriate exams were prescribed. The investigations did not allow to establish a differential diagnosis for 12 women (28%). Even for similar clinical situations, anemia management was variable. Among the women who presented iron deficiency, 15 (47%) were informed about an iron-rich diet and received a daily iron supplementation of ferrous sulfate between 80\u2009mg and 160\u2009mg.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study highlights that, in the absence of specific national guidelines for anemia management in non-pregnant, non-menopausal women in primary care settings, French GPs undergo various clinical management strategies leading to a heterogeneous, sometimes inappropriate follow-up.<\/jats:p><jats:p>Women with iron deficiency were prescribed higher daily iron supplementation than recommended, according to new evidence, suggesting a maximal daily dose of 50\u2009mg of elementary iron in a context of Hepcidin up-regulation in the case of an iron overload.<\/jats:p><jats:p>Additional longitudinal studies with a bigger sample size and randomized controlled trials are needed to confirm our results and to elaborate national guidelines.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12875-020-1086-5","type":"journal-article","created":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T10:03:24Z","timestamp":1579601004000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Anemia management in non-menopausal women in a primary care setting: a prospective evaluation of clinical practice"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3334-9394","authenticated-orcid":false,"given":"Sabine","family":"Bayen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0596-8355","authenticated-orcid":false,"given":"Charline","family":"Le Grand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9355-3434","authenticated-orcid":false,"given":"Marc","family":"Bayen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0848-0091","authenticated-orcid":false,"given":"Florence","family":"Richard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3602-7120","authenticated-orcid":false,"given":"Nassir","family":"Messaadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,1,21]]},"reference":[{"key":"1086_CR1","unstructured":"FAO, IFAD, UNICEF, WFP and WHO. The State of Food Security and Nutrition in the World 2017. Building resilience for peace and food security. Rome, FAO. 2017."},{"key":"1086_CR2","unstructured":"World Health Organization. Global nutrition targets 2025: anaemia policy brief. World Health Organization. 2014. https:\/\/apps.who.int\/iris\/handle\/10665\/148556."},{"key":"1086_CR3","unstructured":"World Health Organization. Iron deficiency anemia: assessment, prevention, and control. In: A guide for programme managers. Geneva; 2011. Report No.: (WHO\/NHD\/01.3)."},{"key":"1086_CR4","unstructured":"World Health Organization, Regional Office for the Eastern Mediterranean. Micronutrient deficiency disorders. 2002. https:\/\/apps.who.int\/iris\/handle\/10665\/122090."},{"issue":"5","key":"1086_CR5","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1017\/S0007114509274745","volume":"102","author":"Katia Castetbon","year":"2009","unstructured":"Castetbon K, Vernay M, Malon A, Salanave B, Deschamps V, Roudier C, Oleko A, Szego E, Hercberg S. Dietary intake, physical activity and nutritional status in adults: the French nutrition and health survey (ENNS, 2006-2007). Br J Nutr. 2009;102:733-43.","journal-title":"British Journal of Nutrition"},{"key":"1086_CR6","doi-asserted-by":"publisher","first-page":"i41","DOI":"10.1093\/bja\/aer350","volume":"107","author":"A Shander","year":"2011","unstructured":"Shander A, Javidroozi M, Ozawa S, Hare GMT. What is really dangerous: anemia or transfusion? Br J Anaesth. 2011;107:i41\u201359.","journal-title":"Br J Anaesth"},{"issue":"9 Suppl 10","key":"1086_CR7","first-page":"125","volume":"16","author":"D Cella","year":"2002","unstructured":"Cella D. The effects of anemia and anemia treatment on the quality of life of people with cancer. Oncology (Williston Park). 2002;16(9 Suppl 10):125\u201332.","journal-title":"Oncology (Williston Park)"},{"issue":"12","key":"1086_CR8","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1089\/jwh.2012.3713","volume":"21","author":"AJ Friedman","year":"2012","unstructured":"Friedman AJ, Chen Z, Ford P, Johnson CA, Lopez AM, Shander A, et al. Iron deficiency Anemia in women across the life span. J Womens Health. 2012;21(12):1282\u20139.","journal-title":"J Womens Health"},{"issue":"2","key":"1086_CR9","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1172\/JCI108489","volume":"58","author":"CA Finch","year":"1976","unstructured":"Finch CA, Miller LR, Inamdar AR, Person R, Seiler K, Mackler B. Iron deficiency in the rat. Physiological and biochemical studies of muscle dysfunction. J Clin Invest. 1976;58(2):447\u201353.","journal-title":"J Clin Invest"},{"issue":"3","key":"1086_CR10","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1152\/jappl.2000.88.3.1103","volume":"88","author":"PS Hinton","year":"2000","unstructured":"Hinton PS, Giordano C, Brownlie T, Haas JD. Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J Appl Physiol. 2000;88(3):1103\u201311.","journal-title":"J Appl Physiol"},{"issue":"4","key":"1086_CR11","doi-asserted-by":"publisher","first-page":"e019240","DOI":"10.1136\/bmjopen-2017-019240","volume":"8","author":"Brett L Houston","year":"2018","unstructured":"Houston BL, Hurrie D, Graham J, Perija B, Rimmer E, Rabbani R, et al. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials. BMJ Open [Internet]. 8(4) Available at: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5892776\/, Assessed the 5 April 2018; cited the 6 June 2018].","journal-title":"BMJ Open"},{"issue":"3","key":"1086_CR12","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1093\/ajcn\/85.3.778","volume":"85","author":"LE Murray-Kolb","year":"2007","unstructured":"Murray-Kolb LE, Beard JL. Iron treatment normalizes cognitive functioning in young women. Am J Clin Nutr. 2007;85(3):778\u201387.","journal-title":"Am J Clin Nutr"},{"issue":"11","key":"1086_CR13","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.3390\/nu9111216","volume":"9","author":"Rebecca Cook","year":"2017","unstructured":"Cook RL, O\u2019Dwyer NJ, Parker HM, Donges CE, Cheng HL, Steinbeck KS, et al. Iron Deficiency Anemia, Not Iron Deficiency, Is Associated with Reduced Attention in Healthy Young Women. Nutrients. 2017;9(11).","journal-title":"Nutrients"},{"key":"1086_CR14","unstructured":"Greig AJ, Patterson AJ, Collins CE, Chalmers KA. Iron deficiency, cognition, mental health and fatigue in women of childbearing age: a systematic review. J Nutr Sci [Internet]. 2013;2 Available at: http:\/\/www.journals.cambridge.org\/abstract_S2048679013000074, [cited November 12th, 2018]."},{"issue":"2","key":"1086_CR15","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1111\/acps.12595","volume":"134","author":"H Vulser","year":"2016","unstructured":"Vulser H, Wiernik E, Hoertel N, Thomas F, Pannier B, Czernichow S, et al. Association between depression and anemia in otherwise healthy adults. Acta Psychiatr Scand. 2016;134(2):150\u201360.","journal-title":"Acta Psychiatr Scand"},{"key":"1086_CR16","doi-asserted-by":"crossref","unstructured":"Korkmaz S, Yildiz S, Korucu T, Gundogan B, Sumbul ZE, Korkmaz H, et al. Frequency of anemia in chronic psychiatry patients. Neuropsychiatr Dis Treat. 2015;2737.","DOI":"10.2147\/NDT.S91581"},{"issue":"1","key":"1086_CR17","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1186\/s12888-018-1796-6","volume":"18","author":"F Xu","year":"2018","unstructured":"Xu F, Roberts L, Binns C, Sullivan E, Homer CSE. Anemia and depression before and after birth: a cohort study based on linked population data. BMC Psychiatry. 2018;18(1):224.","journal-title":"BMC Psychiatry"},{"issue":"5","key":"1086_CR18","doi-asserted-by":"publisher","first-page":"5S14","DOI":"10.1016\/S0929-693X(17)24004-4","volume":"24","author":"L. de Pontual","year":"2017","unstructured":"de Pontual L. Iron and susceptibility to infections. Archives de P\u00e9diatrie. 2017;24(5):5S14-5S17.","journal-title":"Archives de P\u00e9diatrie"},{"issue":"12","key":"1086_CR19","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1038\/nrmicro1046","volume":"2","author":"UE Schaible","year":"2004","unstructured":"Schaible UE, Kaufmann SHE. Iron and microbial infection. Nat Rev Microbiol. 2004;2(12):946\u201353.","journal-title":"Nat Rev Microbiol"},{"key":"1086_CR20","unstructured":"Serraj K. An\u00e9mies ferriprives : de la physiopathologie \u00e0 la clinique ? [Iron deficiency anemia: from physiopathology to the clinical condition?]. 2013;19(1):10\u201320."},{"issue":"4","key":"1086_CR21","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/S0212-6567(00)78492-7","volume":"25","author":"M Farr\u00fas Palou","year":"2000","unstructured":"Farr\u00fas Palou M, P\u00e9rez Oca\u00f1a A, Mayer Pujadas MA, Piquer Gibert M, Mundet Tudur\u00ed X, Iglesias RM. Anemias en atenci\u00f3n primaria: etiolog\u00eda y caracter\u00edsticas morfol\u00f3gicas. [anemia in primary care: etiology and morphological carateristics.]. Aten Primaria. 2000;25(4):230\u20135.","journal-title":"Aten Primaria"},{"key":"1086_CR22","unstructured":"French High Authority of Health.Choice of exams relatives to iron metabolism in case of suspicion of an iron deficiency. 2011. p. 82. Available at: www.has-sante.fr."},{"key":"1086_CR23","unstructured":"Ministry of Solidarity and Health. Medical demography. Report folders. Table 6: statistics:average age of physicians graded on medical specialty, mode and area of exercise, gender. Available at: http:\/\/www.data.drees.sante.gouv.fr."},{"key":"1086_CR24","unstructured":"Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep. 1998;47(RR-3):1\u201329."},{"key":"1086_CR25","unstructured":"Gastroenterological Society of Australia. Iron deficiency. Clinical update. 2015. Available at: http:\/\/cart.gesa.org"},{"issue":"10","key":"1086_CR26","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1136\/gut.2010.228874","volume":"60","author":"A. F. Goddard","year":"2011","unstructured":"Goddard AF, James MW, McIntyre AS, Scott BB, on behalf of the British Society of Gastroenterology. Guidelines for the management of iron deficiency anemia. Gut. 2011;60 (10):1309\u20131316.","journal-title":"Gut"},{"issue":"5","key":"1086_CR27","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1177\/0148607112459648","volume":"37","author":"A von Drygalski","year":"2013","unstructured":"von Drygalski A, Adamson JW. Iron metabolism in man. J Parenter Enter Nutr. 2013;37(5):599\u2013606.","journal-title":"J Parenter Enter Nutr"},{"issue":"10","key":"1086_CR28","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1016\/j.amjmed.2005.01.065","volume":"118","author":"E Rimon","year":"2005","unstructured":"Rimon E, Kagansky N, Kagansky M, Mechnick L, Mashiah T, Namir M, et al. Are we giving too much iron? Low-dose iron therapy is effective in octogenarians. Am J Med. 2005;118(10):1142\u20137.","journal-title":"Am J Med"},{"issue":"3","key":"1086_CR29","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1111\/ggi.13194","volume":"18","author":"E Joosten","year":"2018","unstructured":"Joosten E. Iron deficiency anemia in older adults: a review: Iron deficiency anemia in older adults. Geriatr Gerontol Int. 2018;18(3):373\u20139.","journal-title":"Geriatr Gerontol Int"},{"issue":"9","key":"1086_CR30","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1136\/jclinpath-2016-204249","volume":"70","author":"M Salinas","year":"2017","unstructured":"Salinas M, L\u00f3pez-Garrig\u00f3s M, Flores E, Leiva-Salinas C. Primary care requests for anaemia chemistry tests in Spain: potential iron, transferrin and folate over-requesting. J Clin Pathol. 2017;70(9):760\u20135. https:\/\/doi.org\/10.1136\/jclinpath-2016-204249 Epub 2017 Feb 17.","journal-title":"J Clin Pathol"},{"key":"1086_CR31","doi-asserted-by":"crossref","unstructured":"Zinebi A, Eddou H, Moudden KM, Elbaaj M. Profil \u00e9tiologique des an\u00e9mies dans un service de m\u00e9decine interne. [Etiologic profile of anemia in an internal medicine unit in a hospital setting.]. Pan Afr Med J [Internet]. 2017; Assessed and cited the 5 February 2019]; 26. Available at: http:\/\/www.panafrican-med-journal.com\/content\/article\/26\/10\/full\/.","DOI":"10.11604\/pamj.2017.26.10.11368"},{"key":"1086_CR32","first-page":"A93","volume":"35","author":"T Ben Salem","year":"2014","unstructured":"Ben Salem T, Laanani A, El Ouni A, Said F, Hamzaoui A, Khanfir M, et al. Profil \u00e9tiologique des an\u00e9mies ferriprives dans un service de m\u00e9decine interne : \u00e0 propos de 187 cas. [Etiologic profile of iron deficiency anemia in an internal medicine unit in a hospital setting: about 187 cases]. Rev M\u00e9decine Interne. 2014;35:A93.","journal-title":"Rev M\u00e9decine Interne"},{"issue":"5","key":"1086_CR33","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1023\/A:1008978114650","volume":"9","author":"AJ Patterson","year":"2000","unstructured":"Patterson AJ, Brown WJ, Powers JR, Roberts DC. Iron deficiency, general health and fatigue: results from the Australian longitudinal study on Women\u2019s health. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2000;9(5):491\u20137.","journal-title":"Qual Life Res Int J Qual Life Asp Treat Care Rehab"},{"issue":"6","key":"1086_CR34","doi-asserted-by":"publisher","first-page":"1792","DOI":"10.3945\/ajcn.2009.27439","volume":"89","author":"JR Hunt","year":"2009","unstructured":"Hunt JR, Zito CA, Johnson LK. Body iron excretion by healthy men and women. Am J Clin Nutr. 2009;89(6):1792\u20138.","journal-title":"Am J Clin Nutr"},{"key":"1086_CR35","unstructured":"French National Agency of Sanitary Safety (ANSES). Expert report: Revision of nutritional references for a general adult population regarding vitamins and minerals. 2016. Available at: www.anses.fr."},{"key":"1086_CR36","unstructured":"French National Agency of Sanitary Safety (ANSES). National, individual survey of alimentary consumption. 2017. Available at: www.anses.fr."},{"issue":"9","key":"1086_CR37","doi-asserted-by":"publisher","first-page":"3747","DOI":"10.3390\/nu6093747","volume":"6","author":"K Beck","year":"2014","unstructured":"Beck K, Conlon C, Kruger R, Coad J. Dietary Determinants of and Possible Solutions to Iron Deficiency for Young Women Living in Industrialized Countries: A Review. Nutrients. 2014;6(9):3747\u201376.","journal-title":"Nutrients"},{"issue":"5","key":"1086_CR38","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1080\/07315724.2001.10719056","volume":"20","author":"AL Heath","year":"2001","unstructured":"Heath AL, Skeaff CM, O\u2019Brien SM, Williams SM, Gibson RS. Can dietary treatment of non-anemic iron deficiency improve iron status? J Am Coll Nutr. 2001;20(5):477\u201384.","journal-title":"J Am Coll Nutr"},{"issue":"5","key":"1086_CR39","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1093\/ajcn\/74.5.650","volume":"74","author":"AJ Patterson","year":"2001","unstructured":"Patterson AJ, Brown WJ, Roberts DC, Seldon MR. Dietary treatment of iron deficiency in women of childbearing age. Am J Clin Nutr. 2001;74(5):650\u20136.","journal-title":"Am J Clin Nutr"},{"issue":"4","key":"1086_CR40","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1080\/07315724.2001.10719054","volume":"20","author":"AJ Patterson","year":"2001","unstructured":"Patterson AJ, Brown WJ, Roberts DC. Dietary and supplement treatment of iron deficiency results in improvements in general health and fatigue in Australian women of childbearing age. J Am Coll Nutr. 2001;20(4):337\u201342.","journal-title":"J Am Coll Nutr"},{"issue":"6","key":"1086_CR41","doi-asserted-by":"publisher","first-page":"560","DOI":"10.26719\/2018.24.6.560","volume":"24","author":"M Jalambo","year":"2018","unstructured":"Jalambo M, Karim N, Naser I, Sharif R. Effects of iron supplementation and nutrition education on hemoglobin, ferritin and oxidative stress in iron-deficient female adolescents in Palestine: randomized control trial. East Mediterr Health J. 2018;24(6):560\u20138.","journal-title":"East Mediterr Health J"},{"key":"1086_CR42","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s12875-019-0971-2","volume":"20","author":"Larsson et al","year":"2019","unstructured":"Larsson et al. Rapid testing of red blood cell parameters in primary care patients using HemoScreen\u2122 point of care instrument. BMC Fam Pract. 2019;20:77. https:\/\/doi.org\/10.1186\/s12875-019-0971-2.","journal-title":"BMC Fam Pract"}],"container-title":["BMC Family Practice"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-020-1086-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12875-020-1086-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-020-1086-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T11:51:54Z","timestamp":1695642714000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-020-1086-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,21]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1086"],"URL":"https:\/\/doi.org\/10.1186\/s12875-020-1086-5","relation":{},"ISSN":["1471-2296"],"issn-type":[{"type":"electronic","value":"1471-2296"}],"subject":[],"published":{"date-parts":[[2020,1,21]]},"assertion":[{"value":"5 August 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 January 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This observational study was declared at the French National Commission for Data Protection and Liberties (CNIL-France) the 30th August 2018. A verbal informed consent was obtained from the investigating GPs, who assessed an anonymized online survey without direct implication of human beings. In that context, further need for consent is deemed unnecessary according to national regulations (Decree of May 20017, MR001).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"13"}}