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Arthritis in the Regional Cultures of the American Nations: An Overlooked Component of a Larger Unhealthy Lifestyle Syndemic 美洲民族地区文化中的关节炎:更广泛的不健康生活方式综合症中被忽视的组成部分
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-14 DOI: 10.1177/15598276241283762
Ross Arena, Nicolaas P. Pronk, Elie Gertner, Kharma C Foucher, Colin Woodard
Introduction: Health indices vary widely within the United States (U.S.), with clear “belts and epicenters” where the prevalence of unhealthy lifestyle behaviors, chronic disease, and disability are all high. Arthritis is a significant, well-established risk factor for developing chronic disease. In this paper, we hypothesize that the prevalence and patterns of arthritis in the U.S. will mirror that of other leading health issues across the country. Methods: We merged county-level data on arthritis, disability, and depression prevalence, the Lifestyle Health Index (LHI), the Social Vulnerability Index (SVI) and the American Nations regional cultures schematic. Results: Data was available from 3073 U.S. counties. We found age-adjusted arthritis prevalence has statistically significant and generally strong Pearson product correlations (r ≈ 0.70, P < 0.001) with (1) LHI sub scores and overall score; (2) Depression prevalence; (3) Disability prevalence; and (4) SVI. The geographic distribution of age-adjusted arthritis prevalence according to the American Nations regional cultures model demonstrated clear heterogeneity across regions. Conclusions: The status of population health in the U.S. is disconcerting and the current model of health care delivery, which is often approached from a siloed (condition-specific vs holistic care), reactionary, secondary prevention model, is inadequate to the challenge.
导言:美国国内的健康指数差异很大,有明显的 "带状和震中",在这些地方,不健康的生活方式行为、慢性疾病和残疾的发病率都很高。关节炎是罹患慢性疾病的一个重要、公认的风险因素。在本文中,我们假设美国关节炎的发病率和发病模式将与全国其他主要健康问题的发病率和发病模式如出一辙。研究方法我们合并了有关关节炎、残疾和抑郁症患病率的县级数据、生活方式健康指数 (LHI)、社会脆弱性指数 (SVI) 和美国民族地区文化图表。结果:我们获得了来自美国 3073 个县的数据。我们发现,年龄调整后的关节炎患病率与(1) LHI 分项得分和总分;(2) 抑郁症患病率;(3) 残疾患病率;(4) SVI 具有显著的统计学意义和普遍较强的皮尔逊乘积相关性(r ≈ 0.70, P < 0.001)。根据美洲民族地区文化模型,年龄调整后关节炎患病率的地理分布在各地区之间存在明显的异质性。结论美国的人口健康状况令人担忧,而目前的医疗保健服务模式往往是从孤立的(特定病症与整体护理)、反应性的二级预防模式出发,不足以应对挑战。
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引用次数: 0
An Innovative Program for Hospital Nutrition 医院营养创新计划
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-14 DOI: 10.1177/15598276241283158
Samantha Morgenstern, Mercedes Redwood, Anna Herby
New York City (NYC) Health + Hospitals implemented a nutrition program making plant-based meals the primary lunch and dinner options for patients at its 11 hospitals. Plant-based and culturally diverse meals are prepared and distributed by a central culinary center, managed by Sodexo. Food service associates visit patient rooms and verbally introduce the featured meals each day. To ensure alignment among all staff members, staff are educated about the health benefits of plant-based nutrition and about the new menu items. The plant-based meals have been well received, with patient acceptance over 95% and patient satisfaction above 90%. Per-tray food costs for plant-based entrees cost $0.59 less compared to trays including animal products. Furthermore, the hospital system has achieved a 36% reduction in calculated carbon emissions as a result of the new plant-based menu. Because dietary choices contribute significantly to health and may influence the likelihood of hospital readmissions, prioritizing plant-based meals and nutrition education during the hospital stay may help improve patient outcomes.
纽约市健康与医院(NYC Health + Hospitals)实施了一项营养计划,将植物餐作为其 11 家医院病人的主要午餐和晚餐选择。由索迪斯管理的中央烹饪中心负责准备和分发以植物为基础、具有文化多样性的膳食。餐饮服务人员每天都会走访病房,口头介绍特色餐食。为确保所有员工的配合,还对员工进行了有关植物营养对健康的益处和新菜单项目的教育。植物餐深受欢迎,病人接受度超过 95%,满意度超过 90%。与含有动物性食品的餐盘相比,植物性主食的每盘食品成本降低了 0.59 美元。此外,由于采用了新的植物性菜单,医院系统计算出的碳排放量减少了 36%。由于饮食选择对健康有重大影响,并可能影响再次入院的可能性,因此在住院期间优先考虑植物性膳食和营养教育可能有助于改善患者的预后。
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引用次数: 0
Development and Psychometric Evaluation of the Lifestyle Medicine Health Behavior Scale 生活方式医学健康行为量表的开发和心理测量学评估
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-10 DOI: 10.1177/15598276241280207
Julia Pangalangan, Jini Puma, Michelle Tollefson, Beth Frates
Purpose. The purpose of this study was to develop and validate a scale to measure health behavior across the six pillars of lifestyle medicine: sleep, social connectedness, physical activity, nutrition, substance use, and stress management. A pilot study (n = 94) investigated the construct, convergent, and content validity and reliability of the Lifestyle Medicine Health Behavior (LMHM) scale. Based on the pilot study results and literature, the scale was revised for further psychometric evaluation. Methods. A sample (n = 399) of participants completed the LMHB scale. Confirmatory factor analysis was used to assess construct validity. Face validity was assessed using qualitative feedback. Reliability was assessed using Cronbach’s alpha. Results. The final model included five latent dimensions and one observed to represent each of the distinct pillars in lifestyle medicine. The open-ended response item elicited preponderance of positive feedback (∼80%); the scale was perceived as easy to understand and complete. Overall, the scale was reliable (α = 0.84). Conclusion. The LMHB scale assesses health behaviors across all six lifestyle medicine pillars, addressing each one systematically and individually. The scale had sufficient validity and reliability to measure health behaviors in this sample of adults. This is the first lifestyle medicine survey instrument to evaluate content, face, and construct validity and reliability.
研究目的本研究旨在开发并验证一种量表,用于测量生活方式医学六大支柱的健康行为:睡眠、社会联系、体育锻炼、营养、药物使用和压力管理。一项试点研究(n = 94)调查了生活方式医学健康行为量表(LMHM)的构建、收敛和内容效度及可靠性。根据试点研究结果和文献,对量表进行了修订,以便进一步进行心理测量学评估。研究方法样本参与者(n = 399)完成了 LMHB 量表。采用确认性因子分析来评估建构效度。通过定性反馈来评估表面效度。信度采用 Cronbach's alpha 进行评估。结果。最终模型包括五个潜在维度和一个观察维度,分别代表生活方式医学的各个不同支柱。开放式回答项目获得了绝大多数正面反馈(∼80%);量表被认为易于理解和完成。总体而言,量表是可靠的(α = 0.84)。结论LMHB量表可评估所有六大生活方式医学支柱的健康行为,系统且单独地评估每一个支柱的健康行为。该量表具有足够的有效性和可靠性,可用于测量该成人样本的健康行为。这是首个对内容、表面和结构的有效性和可靠性进行评估的生活方式医学调查工具。
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引用次数: 0
Examining Real-World Evidence of Depression-Related Symptom Reduction Through a Comprehensive Holistic Lifestyle Intervention 研究通过综合全面的生活方式干预减少抑郁症相关症状的现实证据
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-10 DOI: 10.1177/15598276241280883
Jay T. Sutliffe, Nanette V. Lopez, Natalie M. Papini, Stephen D. Herrmann
Depression is a global health concern, with various treatments available. In this study, participants (n = 430) were self-selected or medically referred to a residential lifestyle program at the Black Hills Health & Education Center (BHHEC), with a mean stay of 19 days. Individualized treatment plans included structured physical activity sessions, counseling sessions, and the provision of a vegan diet. Beck Depression Inventory-II, self-reported total exercise minutes, resistance exercise minutes, and sleep, along with the number of holistic treatments and counseling sessions, were evaluated. Paired samples t-tests indicated a significant decrease in depression scores over time (MT1 = 20.14, MT2 = 6.17, P < .001). Results from the multiple linear regression that evaluated total exercise minutes, resistance exercise, number of treatments and counseling sessions, and average reported hours of nightly sleep on depression scores at time 2 indicated that average reported hours of nightly sleep were the only significant predictor of depression scores at time 2 ( P < .05). While depression scores significantly improved from baseline to post-assessment for all participants, it is possible that an unmeasured variable, or the synergistic intervention effect of the wellness program, accounted for changes in depressive symptoms over time. Future studies should incorporate sleep quality and assessing time spent in nature to explore these relationships further.
抑郁症是一个全球性的健康问题,目前有多种治疗方法。在这项研究中,参与者(n = 430)通过自我选择或医疗转诊参加了黑山健康与教育中心(BHHEC)的住宿生活方式项目,平均住院时间为 19 天。个性化治疗计划包括有组织的体育锻炼课程、咨询课程和提供素食。对贝克抑郁量表-II、自我报告的总运动分钟数、阻力运动分钟数、睡眠以及整体治疗和咨询次数进行了评估。配对样本 t 检验表明,随着时间的推移,抑郁评分显著下降(MT1 = 20.14,MT2 = 6.17,P < .001)。多元线性回归评估了总运动分钟数、阻力运动、治疗和咨询次数以及平均每晚睡眠时间对第 2 次抑郁评分的影响,结果表明,平均每晚睡眠时间是第 2 次抑郁评分的唯一重要预测因素(P <.05)。虽然从基线到评估后,所有参与者的抑郁评分都有明显改善,但可能是一个未测量的变量或健康计划的协同干预效应导致了抑郁症状随着时间的推移而发生变化。未来的研究应结合睡眠质量和在大自然中度过的时间评估来进一步探讨这些关系。
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引用次数: 0
World Day of Remembrance for Road Traffic Victims 世界道路交通事故受害者纪念日
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-10 DOI: 10.1177/15598276241274486
David A. Sleet, William Scarbrough, Chad J. Brown
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引用次数: 0
Promoting Physical Activity Among Health Professional Students, Faculty, and Staff Members: A Competition-Based Intervention 促进卫生专业学生、教职员工的体育锻炼:基于竞赛的干预措施
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-09 DOI: 10.1177/15598276241279170
Chenyu Zou, Joshua C. Hollingsworth, Robin Gosdin Farrell, Brent I. Fox
This program review presents data for the Deans’ Fit Family Challenge (DFFC) and proposes future directions for improvement, informed by the Social Cognitive Theory. The DFFC is a multi-week physical activity competition held annually between three health professional programs, focusing on the development of self-efficacy, self-regulation, and social support of health-related fitness. Participants competed in teams of two and tracked their activity minutes weekly using the ChallengeRunner app or through manual entry. Weekly winners were announced, and the winning college was determined from a composite score of active minutes and weight loss. Since 2019, 1164 participants reported an average of 217.1 weekly minutes of physical activity during the DFFC. An average of 94.0% of participants reported minutes in week 1, compared to 56.3% in week 8. The DFFC is an important initiative to potentially promote physical activity levels among participating programs. While motivational strategies are being incorporated and executed in the DFFC, there is a need for ongoing exploration and improvement to enhance future competition-based interventions among health professional students, faculty, and staff.
本计划回顾介绍了 "院长健康家庭挑战赛"(Deans' Fit Family Challenge,DFFC)的数据,并根据社会认知理论提出了未来的改进方向。迪恩斯健身家庭挑战赛是一项为期多周的体育活动竞赛,每年在三个健康专业项目之间举行,重点关注与健康相关的健身的自我效能、自我调节和社会支持的发展。参赛者两人一组,每周使用 ChallengeRunner 应用程序或通过手动输入的方式跟踪自己的活动时间。每周公布优胜者,并根据活动时间和体重减轻的综合得分确定获胜学院。自 2019 年以来,共有 1164 名参与者在 DFFC 期间报告了平均每周 217.1 分钟的体育活动时间。第 1 周平均 94.0% 的参与者报告了活动分钟数,而第 8 周为 56.3%。DFFC 是一项重要举措,有可能提高参与计划者的体育锻炼水平。虽然激励策略已被纳入 DFFC 并付诸实施,但仍需不断探索和改进,以加强未来在卫生专业学生、教职员工中开展的基于竞赛的干预措施。
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引用次数: 0
Association of Parent and Child Intuitive Eating: A Scoping Review 父母与子女直觉饮食的关联:范围审查
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-07 DOI: 10.1177/15598276241279223
Michaela L. Dowling, Madeline E. Hubbard, Richa Agnihotri
Children’s eating behaviors are dependent on childhood food experiences, which involve their parental feeding practices, home food environments, and modeling of eating behavior. Intuitive eating (IE) promotes eating based on internal hunger and satiety cues. IE has been associated with improvements in mental and physical health. There has been increasing interest in exploring the association between parent and child IE. The aim of this scoping review was to synthesize current literature reporting on parent and child IE associations. Four databases (MEDLINE, EMBASE, Web of Science and CINAHL) were searched using keywords focusing on IE, parents, and children. Inclusion criteria were reporting on parental and/or child IE, and reporting on parent–child relationships. After screening, 15 studies were retained. From these, 3 main correlations were described. Parental IE was associated with child feeding, child weight concerns, and the home food environment. As well, environmental factors (i.e., family cohesion, food security) were associated with components of child IE. Moreover, IE was directly correlated between parents and children. Overall, this study highlights how child IE behaviors may be shaped by both parental IE and the broader environments that they are raised within. Additional high-quality studies are required to verify these findings.
儿童的饮食行为取决于童年的饮食经历,其中包括父母的喂养方式、家庭饮食环境以及饮食行为的示范。直觉进食(IE)提倡根据内心的饥饿和饱腹感来进食。直觉进食与身心健康的改善有关。越来越多的人开始关注父母与子女之间的直觉进食关系。本范围综述旨在综合目前有关父母与子女 IE 关联的文献。我们使用有关 IE、父母和儿童的关键词检索了四个数据库(MEDLINE、EMBASE、Web of Science 和 CINAHL)。纳入标准是关于父母和/或儿童 IE 的报告,以及关于亲子关系的报告。经过筛选,保留了 15 项研究。在这些研究中,描述了 3 种主要的相关性。父母的 IE 与儿童喂养、儿童体重问题和家庭饮食环境有关。此外,环境因素(即家庭凝聚力、食品安全)也与儿童 IE 的组成部分相关。此外,父母和儿童之间的 IE 也直接相关。总之,这项研究强调了儿童的 IE 行为是如何受父母的 IE 和他们成长的大环境影响的。还需要更多高质量的研究来验证这些发现。
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引用次数: 0
A Defined, Plant-Based Diet and Other Integrative Therapies Improve Functional Status and Ejection Fraction while Reducing Medications in Patients With Heart Failure: A Case Series 明确的植物性饮食和其他综合疗法可改善心衰患者的功能状态和射血分数,同时减少用药:病例系列
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-06 DOI: 10.1177/15598276241281475
Camille V. Owens, Rami S. Najjar, Marino A. Bruce, Bettina M. Beech, Baxter D. Montgomery
Heart failure with reduced ejection fraction (HFrEF) is a major contributor of premature cardiovascular-related deaths. Patients are typically on numerous medications to manage this condition; however, patients continue to experience poor quality of life. Alternative therapeutic approaches are needed to treat HFrEF. The clinical course of seven patients with Stage C and D HFrEF who failed guideline-directed medical therapy were retrospectively analyzed based on medical chart data. All patients consumed a defined, plant-based diet as part of their clinical treatment, and a subset also underwent alternative treatment modalities: External Counterpulsation therapy, BEMER therapy, infrared sauna therapy, ozone therapy, or PlaqueX® therapy. Chart review of these patients indicated improvement in left ventricular ejection fraction (LVEF) and right ventricular systolic pressure (RVSP). All patients also had a significant reduction in medication needs and body weight. Further, all patients reported significant improvements in their quality of life. These data suggest that a defined, plant-based diet combined with other alternative modalities may be efficacious in reducing HFrEF medications and treating Stage C or D HFrEF patients who failed guideline-direct medical therapies. Observations from this case series indicate a need for rigorous prospective studies to confirm these effects.
射血分数降低性心力衰竭(HFrEF)是导致心血管相关性过早死亡的主要原因。患者通常需要服用多种药物来控制病情,但患者的生活质量仍然很差。我们需要其他治疗方法来治疗心房颤动缺氧(HFrEF)。我们根据病历数据回顾性分析了七名C期和D期HFrEF患者的临床病程,这些患者均未能接受指导性药物治疗。作为临床治疗的一部分,所有患者都摄入了明确的植物性饮食,部分患者还接受了其他治疗方式:此外,部分患者还接受了其他治疗方法:体外反搏疗法、BEMER疗法、红外线桑拿疗法、臭氧疗法或PlaqueX®疗法。对这些患者进行的病历审查显示,他们的左心室射血分数(LVEF)和右心室收缩压(RVSP)均有所改善。所有患者的用药需求和体重也都明显减少。此外,所有患者的生活质量都有明显改善。这些数据表明,明确的植物性饮食与其他替代方法相结合,可有效减少高心衰患者的用药量,并治疗指导性药物治疗失败的 C 期或 D 期高心衰患者。本系列病例的观察结果表明,需要进行严格的前瞻性研究来证实这些效果。
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引用次数: 0
What do Climate Change, Nutrition, and the Environment Have to do With Mental Health? 气候变化、营养和环境与心理健康有什么关系?
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-04 DOI: 10.1177/15598276241280245
Steven G. Sugden, Gia Merlo
Climate change is becoming the most significant global challenge and must be addressed on a global scale. At the time that this article is being written, the planetary heat in 2023 was the hottest on record. Similarly, the World Health Organization reports that 99% of the world’s population lives in regions of unhealthy air pollution. Similarly, depression has become one of the leading causes of global mental and physical disabilities, and the impact of depression is predicted to only worsen over the next 25 years. It is interesting to note that climate experts often overlook the adoption of nutrition via a whole plant-based diet as a solution to both mental illness and climate change. In this review, we will touch upon the role of nutrition in gut microbiota and mental health, the impact diet has on greenhouse gases, the role of ultra-processed food, and environmental factors such as air pollution and increasing planetary heat and their growing impacts on mental health. In the end, the promotion of plant-based foods has the potential to improve personal mental and physical health while improving planetary health.
气候变化正在成为最重大的全球性挑战,必须在全球范围内加以解决。在撰写本文时,2023 年的地球热量是有记录以来最热的。同样,世界卫生组织报告称,全球 99% 的人口生活在空气污染不健康的地区。同样,抑郁症已成为全球精神和身体残疾的主要原因之一,据预测,抑郁症的影响在未来 25 年内只会进一步恶化。值得注意的是,气候专家往往忽视了通过全植物饮食来补充营养,以此来解决精神疾病和气候变化问题。在这篇综述中,我们将探讨营养在肠道微生物群和心理健康中的作用、饮食对温室气体的影响、超加工食品的作用,以及空气污染和地球热量增加等环境因素及其对心理健康日益严重的影响。归根结底,推广植物性食品有可能在改善地球健康的同时,改善个人的身心健康。
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引用次数: 0
Fast-Food Outlets in Hospitals Affiliated With U.S. Medical Schools 美国医学院附属医院内的快餐店
IF 1.9 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-04 DOI: 10.1177/15598276241267252
Zeeshan Ali, Saray Stancic, Roxanne Becker, Anna Herby, Sankeerth K Kondapalli, Alex M. Dombrower, Neal D. Barnard
Objectives: To determine the current prevalence and type of fast-food outlets at medical-school-affiliated hospitals and compare them to previous findings to assess progress in improving the hospital food environment. Method: We invited medical students at 192 medical and osteopathic schools to complete Sogolytics surveys reporting on fast-food restaurants that are affiliated with their main teaching hospital or medical centers. Results: Of 192 medical and osteopathic schools, 255 individual completed surveys were received from 146 schools. 101 schools (69.2%) reportedly hosted at least one fast-food restaurant associated with the hospitals at which students rotate, these include 15.1% schools that gave a mixed response to the question if fast-food restaurants are present in any affiliated hospitals. 45 schools (30.8%) reported no fast-food restaurants in any affiliated hospitals. The five most common fast-food restaurants reported were Starbucks (27.9%), Subway (18.8%), Chick-fil-A (9.2%), Au Bon Pain (8.8%), and McDonald’s (5.4%). Regarding the statement, “It is acceptable for fast-food restaurants to be in hospitals,” 27.8% of students strongly disagreed, 29.0% somewhat disagreed, 16.9% neither agreed nor disagreed, 21.2% somewhat agreed, and only 5.1% strongly agreed. Conclusions: The majority of the teaching hospitals affiliated with the schools have at least one fast-food restaurant onsite.
目的:确定医学院附属医院目前快餐店的普遍程度和类型,并与以前的调查结果进行比较:确定医学院附属医院目前快餐店的普遍程度和类型,并与以前的调查结果进行比较,以评估在改善医院饮食环境方面取得的进展。调查方法我们邀请 192 所医学院和骨科医学院的医学生完成 Sogolytics 调查,报告其主要教学医院或医疗中心附属快餐店的情况。调查结果显示在 192 所医学和骨科学校中,共收到来自 146 所学校的 255 份填写完整的调查问卷。据报告,101 所学校(69.2%)至少有一家快餐店与学生轮转的医院相关联,其中包括 15.1%的学校,这些学校对是否有快餐店存在于任何附属医院的问题回答不一。有 45 所学校(30.8%)表示其附属医院中没有快餐店。最常见的五家快餐店是星巴克(27.9%)、Subway(18.8%)、Chick-fil-A(9.2%)、Au Bon Pain(8.8%)和麦当劳(5.4%)。对于 "快餐店进驻医院是可以接受的 "这一说法,27.8% 的学生非常不同意,29.0% 的学生有点不同意,16.9% 的学生既不同意也不反对,21.2% 的学生有点同意,只有 5.1% 的学生非常同意。结论:大多数学校附属教学医院内至少有一家快餐店。
{"title":"Fast-Food Outlets in Hospitals Affiliated With U.S. Medical Schools","authors":"Zeeshan Ali, Saray Stancic, Roxanne Becker, Anna Herby, Sankeerth K Kondapalli, Alex M. Dombrower, Neal D. Barnard","doi":"10.1177/15598276241267252","DOIUrl":"https://doi.org/10.1177/15598276241267252","url":null,"abstract":"Objectives: To determine the current prevalence and type of fast-food outlets at medical-school-affiliated hospitals and compare them to previous findings to assess progress in improving the hospital food environment. Method: We invited medical students at 192 medical and osteopathic schools to complete Sogolytics surveys reporting on fast-food restaurants that are affiliated with their main teaching hospital or medical centers. Results: Of 192 medical and osteopathic schools, 255 individual completed surveys were received from 146 schools. 101 schools (69.2%) reportedly hosted at least one fast-food restaurant associated with the hospitals at which students rotate, these include 15.1% schools that gave a mixed response to the question if fast-food restaurants are present in any affiliated hospitals. 45 schools (30.8%) reported no fast-food restaurants in any affiliated hospitals. The five most common fast-food restaurants reported were Starbucks (27.9%), Subway (18.8%), Chick-fil-A (9.2%), Au Bon Pain (8.8%), and McDonald’s (5.4%). Regarding the statement, “It is acceptable for fast-food restaurants to be in hospitals,” 27.8% of students strongly disagreed, 29.0% somewhat disagreed, 16.9% neither agreed nor disagreed, 21.2% somewhat agreed, and only 5.1% strongly agreed. Conclusions: The majority of the teaching hospitals affiliated with the schools have at least one fast-food restaurant onsite.","PeriodicalId":47480,"journal":{"name":"American Journal of Lifestyle Medicine","volume":"43 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142177382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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