Adequate hospital foodservice is important to improve patient's nutritional status. Research aimed to evaluate patients' satisfaction with hospital foodservice during their treatment at a general hospital in Greece using a validated instrument, adding to the existing research.
Methodology
A cross-sectional study was conducted on a random sample of patients aged > 18 years who were hospitalized for at least 2 days in the selected hospital between March and April 2022. The hospital applies a conventional cooking preparation system, a central distribution system, and a quality management system. Data were collected using a Greek-translated version of the “Acute Care Hospital Foodservice Patient Satisfaction Questionnaire”, and analysed using descriptive measures, parametric and non-parametric tests.
Results
In total, 202 questionnaires (response rate 87.7%) were included in the analysis. The majority (90.1%) stated an overall satisfaction of “good” or “very good”. Questions related to “Staff & Service” received the highest scores, while questions related to “Food Quality” and “Meal Size” received the lowest. “Food Quality” was found to have the greatest effect on overall satisfaction. There were differences between wards. Men and younger patients were more likely to report hunger after and between meals.
Conclusions
Hospital foodservice faces the challenge of catering to a range of nutritional needs of different patients. Systematic assessment of patient satisfaction is crucial to improving evidence-based, patient-centered care. Although patients' overall satisfaction with foodservice was high, reflection on the interpretation of results is required as patient satisfaction is a complex measure, and the study was conducted during a pandemic.
{"title":"Evaluation of Patient Satisfaction With Hospital Foodservice During Treatment at a General Hospital in Mainland Greece","authors":"Foteini Potsi, Aristomenis Syngelakis","doi":"10.1111/jhn.70026","DOIUrl":"https://doi.org/10.1111/jhn.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Adequate hospital foodservice is important to improve patient's nutritional status. Research aimed to evaluate patients' satisfaction with hospital foodservice during their treatment at a general hospital in Greece using a validated instrument, adding to the existing research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>A cross-sectional study was conducted on a random sample of patients aged > 18 years who were hospitalized for at least 2 days in the selected hospital between March and April 2022. The hospital applies a conventional cooking preparation system, a central distribution system, and a quality management system. Data were collected using a Greek-translated version of the “Acute Care Hospital Foodservice Patient Satisfaction Questionnaire”, and analysed using descriptive measures, parametric and non-parametric tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 202 questionnaires (response rate 87.7%) were included in the analysis. The majority (90.1%) stated an overall satisfaction of “good” or “very good”. Questions related to “Staff & Service” received the highest scores, while questions related to “Food Quality” and “Meal Size” received the lowest. “Food Quality” was found to have the greatest effect on overall satisfaction. There were differences between wards. Men and younger patients were more likely to report hunger after and between meals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hospital foodservice faces the challenge of catering to a range of nutritional needs of different patients. Systematic assessment of patient satisfaction is crucial to improving evidence-based, patient-centered care. Although patients' overall satisfaction with foodservice was high, reflection on the interpretation of results is required as patient satisfaction is a complex measure, and the study was conducted during a pandemic.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Elizabeth Weekes, Marian A. E. de van der Schueren, Heather Keller, Alison Steiber, Skye Marshall, Su Lin Lim, Christine Baldwin
Introduction
The evidence for the use of dietary counselling interventions in the management of malnutrition is inconsistent. Lack of consistency limits the ability to compare studies, impacting research, clinical practice and policy development.
Aims
To establish an international consensus on minimum requirements for dietary counselling interventions used for the prevention and management of malnutrition in adults in a clinical research context.
Methods
An international expert panel with seven members was formed. An amended Delphi study was conducted with 37 initial consensus statements generated from a targeted search of the literature. The agreement was assessed across two Delphi rounds and two online meetings. The full consensus was defined as the assignment of a score of 5 (strongly agree). A preliminary external validation was conducted with clinical and/or research dietetic professionals when delegates at the International Congress of Dietetics (ICD) 2021 voted during an online meeting on agreement with statements relating to patient assessment and delivery of a dietary counselling intervention.
Results
Consensus was achieved for 27 statements across four themes, with justifications and commentary. Minimum requirements included eight statements for ‘nutritional assessment’ (theme 1), seven for ‘nutritional intervention content’ (theme 2), five for ‘nutritional intervention delivery’ (theme 3) and seven for ‘monitoring and follow-up’ (theme 4). The ICD delegates voted on elements of assessment (77 of 140 delegates in agreement) and delivery of the intervention (37 of 101 delegates in agreement), demonstrating that consensus on these aspects of nutritional support interventions was low to moderate in this delegate sample.
Conclusions
Consensus was achieved by an international group of experts to define the minimum essential factors for delivering dietary counselling interventions for the management of malnutrition in a research context; however, further external validation is required. The minimum requirements have the potential to influence research, clinical practice and policy development.
{"title":"Dietary Counselling Interventions in Malnutrition Research: Achieving an International Consensus on Best Practices Using an Amended Delphi Process","authors":"C. Elizabeth Weekes, Marian A. E. de van der Schueren, Heather Keller, Alison Steiber, Skye Marshall, Su Lin Lim, Christine Baldwin","doi":"10.1111/jhn.70028","DOIUrl":"https://doi.org/10.1111/jhn.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The evidence for the use of dietary counselling interventions in the management of malnutrition is inconsistent. Lack of consistency limits the ability to compare studies, impacting research, clinical practice and policy development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To establish an international consensus on minimum requirements for dietary counselling interventions used for the prevention and management of malnutrition in adults in a clinical research context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An international expert panel with seven members was formed. An amended Delphi study was conducted with 37 initial consensus statements generated from a targeted search of the literature. The agreement was assessed across two Delphi rounds and two online meetings. The full consensus was defined as the assignment of a score of 5 (strongly agree). A preliminary external validation was conducted with clinical and/or research dietetic professionals when delegates at the International Congress of Dietetics (ICD) 2021 voted during an online meeting on agreement with statements relating to patient assessment and delivery of a dietary counselling intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Consensus was achieved for 27 statements across four themes, with justifications and commentary. Minimum requirements included eight statements for ‘nutritional assessment’ (theme 1), seven for ‘nutritional intervention content’ (theme 2), five for ‘nutritional intervention delivery’ (theme 3) and seven for ‘monitoring and follow-up’ (theme 4). The ICD delegates voted on elements of assessment (77 of 140 delegates in agreement) and delivery of the intervention (37 of 101 delegates in agreement), demonstrating that consensus on these aspects of nutritional support interventions was low to moderate in this delegate sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Consensus was achieved by an international group of experts to define the minimum essential factors for delivering dietary counselling interventions for the management of malnutrition in a research context; however, further external validation is required. The minimum requirements have the potential to influence research, clinical practice and policy development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paola S. Baratto, Daniel J. Hoffman, Júlia L. Valmórbida, Paula S. Leffa, Carlos A. Feldens, Márcia R. Vitolo
Background
The early consumption of ultra-processed foods (UPFs) and added sugars (AS) has been linked to adverse outcomes in infancy. The objective of this study was to determine the effectiveness of a dietary counselling strategy to prevent the consumption of UPFs and AS in the first year of life.
Methodology
A multicentre randomised controlled trial was conducted with 516 mother–child pairs in three state capitals of Brazil. Mothers were randomly assigned to the control group (CG) or intervention group (IG) after childbirth. The IG received orientation based on UNICEF dietary guidelines and five monthly telephone calls to reinforce the intervention. Dietary intake was measured using food introduction questionnaires and 24-h recalls during home visits at 6 and 12 months. Between-group differences were analysed by generalised estimating equations and presented as mean difference (95% CI).
Results
Children in the IG had lower UPF intake at 6 and 12 months of age (−20.69 g/day; 95% CI: −37.87 to −3.50; p = 0.018 and −32.51 g/day; 95% CI: −61.03 to −3.99; p = 0.025) and lower AS intake at 12 months of age (−4.92 g/day; 95% CI: −9.43 to −0.41; p = 0.033). The intervention also had a positive impact on the period of exclusive breastfeeding, reducing the offer of infant formula, cow's milk, and toddler milk in the first year of life.
Principal Conclusions
The dietary counselling strategy was effective at preventing the early consumption of UPFs and AS in the first year of life. Future research should focus on social and cultural barriers to improve adherence to infant feeding interventions.
{"title":"Effectiveness of an Intervention to Prevent Ultra-Processed Foods and Added Sugar in the First Year of Life: A Multicentre Randomised Controlled Trial in Brazil","authors":"Paola S. Baratto, Daniel J. Hoffman, Júlia L. Valmórbida, Paula S. Leffa, Carlos A. Feldens, Márcia R. Vitolo","doi":"10.1111/jhn.70022","DOIUrl":"https://doi.org/10.1111/jhn.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The early consumption of ultra-processed foods (UPFs) and added sugars (AS) has been linked to adverse outcomes in infancy. The objective of this study was to determine the effectiveness of a dietary counselling strategy to prevent the consumption of UPFs and AS in the first year of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>A multicentre randomised controlled trial was conducted with 516 mother–child pairs in three state capitals of Brazil. Mothers were randomly assigned to the control group (CG) or intervention group (IG) after childbirth. The IG received orientation based on UNICEF dietary guidelines and five monthly telephone calls to reinforce the intervention. Dietary intake was measured using food introduction questionnaires and 24-h recalls during home visits at 6 and 12 months. Between-group differences were analysed by generalised estimating equations and presented as mean difference (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children in the IG had lower UPF intake at 6 and 12 months of age (−20.69 g/day; 95% CI: −37.87 to −3.50; <i>p</i> = 0.018 and −32.51 g/day; 95% CI: −61.03 to −3.99; <i>p</i> = 0.025) and lower AS intake at 12 months of age (−4.92 g/day; 95% CI: −9.43 to −0.41; <i>p</i> = 0.033). The intervention also had a positive impact on the period of exclusive breastfeeding, reducing the offer of infant formula, cow's milk, and toddler milk in the first year of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Conclusions</h3>\u0000 \u0000 <p>The dietary counselling strategy was effective at preventing the early consumption of UPFs and AS in the first year of life. Future research should focus on social and cultural barriers to improve adherence to infant feeding interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Food processing converts fresh food into products and is of interest to nutrition professionals including dietitians given emerging evidence linking consumption of 'ultra-processed' products with health.
Objective
To explore dietitians' professional practice around the topic of processed foods and health, including their perceptions of individual food products.
Methods
An online survey was developed to evaluate professional involvement, confidence and views using a 5-point scale (i.e., 1 = never, 5 = daily). Respondents' perceptions of three products were also obtained, including level of processing (LoP) (from 1 = unprocessed to 5 = ultra-processed) and recommended frequency of consumption (FoC) (from 1 = avoid to 5 = several times/day). Eligible survey respondents (UK dietitians) were recruited via the British Dietetic Association and social media. Data were analysed descriptively. A focus group was held with five dietitians to discuss current practice around this topic. Verbal data were thematically analysed.
Results
Survey respondents (n = 366) possessed an average of 13 ± 9.8 years practising across various specialisms. Most discussed (82%) and provided guidance on (77%) processed foods and health monthly or more frequently, with 'high' levels of confidence (61%–59%), and agreed that healthy diets may include processed (94%) or 'highly/ultra' processed (71%) foods. Perceptions of each individual food product varied, yet the largest proportion of respondents selected LoP and FoC options for Tinned tomatoes: 'minimally processed' (54%), 'several times/week' (69%); mycoprotein mince: 'highly/ultra-processed' (57%), 'several times/month' (40%); and wholemeal bread: 'processed' (46%), 'several times/week' (58%). Focus group themes included uncertainties in definitions of ultra-processed and negative consumer perceptions around processing.
Conclusion
This first survey of UK dietitians on processed foods suggests that dietetic practice frequently involves this topic and that views on the role of these foods in healthy diets are varied. Respondents also possessed a range of perceptions on the LoP of individual products, and further work is now warranted to support future development for dietetic practice.
{"title":"Ultra-Processed Foods and Dietetic Practice: Findings From a Survey and Focus Group With UK Dietitians","authors":"Veronica Moran, Sally G. Moore, Peter Ho","doi":"10.1111/jhn.70029","DOIUrl":"https://doi.org/10.1111/jhn.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Food processing converts fresh food into products and is of interest to nutrition professionals including dietitians given emerging evidence linking consumption of 'ultra-processed' products with health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore dietitians' professional practice around the topic of processed foods and health, including their perceptions of individual food products.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An online survey was developed to evaluate professional involvement, confidence and views using a 5-point scale (i.e., 1 = never, 5 = daily). Respondents' perceptions of three products were also obtained, including level of processing (LoP) (from 1 = unprocessed to 5 = ultra-processed) and recommended frequency of consumption (FoC) (from 1 = avoid to 5 = several times/day). Eligible survey respondents (UK dietitians) were recruited via the British Dietetic Association and social media. Data were analysed descriptively. A focus group was held with five dietitians to discuss current practice around this topic. Verbal data were thematically analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Survey respondents (<i>n</i> = 366) possessed an average of 13 ± 9.8 years practising across various specialisms. Most discussed (82%) and provided guidance on (77%) processed foods and health monthly or more frequently, with 'high' levels of confidence (61%–59%), and agreed that healthy diets may include processed (94%) or 'highly/ultra' processed (71%) foods. Perceptions of each individual food product varied, yet the largest proportion of respondents selected LoP and FoC options for Tinned tomatoes: 'minimally processed' (54%), 'several times/week' (69%); mycoprotein mince: 'highly/ultra-processed' (57%), 'several times/month' (40%); and wholemeal bread: 'processed' (46%), 'several times/week' (58%). Focus group themes included uncertainties in definitions of ultra-processed and negative consumer perceptions around processing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This first survey of UK dietitians on processed foods suggests that dietetic practice frequently involves this topic and that views on the role of these foods in healthy diets are varied. Respondents also possessed a range of perceptions on the LoP of individual products, and further work is now warranted to support future development for dietetic practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Austin Milton, Natalie Frech, Anna Shadid, Nicholas Hollman, Sarah Beth Bell, Marianna S. Wetherill
Objective
This study describes the implementation of a 6-week nutrition and culinary education curriculum at a transitional housing facility for single mothers in Tulsa, Oklahoma, United States.
Methods
Using a novel, trauma-informed approach to nutrition education, we delivered the Around the Table: Nourishing Families curriculum across three, small group cohorts (n = 15) over a period of 2 years. Lessons emphasized small group dialogue and group-directed learning on the topics of toxic stress, food as nourishment and family resilience combined with hands-on recipe preparation by the group. We evaluated process measures of participation and attrition and outcome measures of self-reported food skills, dietary intake, emotional well-being, and other indicators of nutrition self-care using a pre–post design.
Results
Food skills significantly improved post-curriculum (p = 0.026) with additional improvement in several areas of dietary intake, mindful eating, nutrition self-care and greater use of healthy foods at family mealtimes.
Conclusions
Hands-on, participatory nutrition and cooking education that emphasizes mind–body connections to food can be a feasible strategy for teaching introductory food skills and may also support socioemotional healing in this population.
{"title":"Evaluation of a Trauma-Informed Nutrition Curriculum for Women With Children Living in Transitional Housing","authors":"Austin Milton, Natalie Frech, Anna Shadid, Nicholas Hollman, Sarah Beth Bell, Marianna S. Wetherill","doi":"10.1111/jhn.70015","DOIUrl":"https://doi.org/10.1111/jhn.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study describes the implementation of a 6-week nutrition and culinary education curriculum at a transitional housing facility for single mothers in Tulsa, Oklahoma, United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a novel, trauma-informed approach to nutrition education, we delivered the <i>Around the Table: Nourishing Families</i> curriculum across three, small group cohorts (<i>n</i> = 15) over a period of 2 years. Lessons emphasized small group dialogue and group-directed learning on the topics of toxic stress, food as nourishment and family resilience combined with hands-on recipe preparation by the group. We evaluated process measures of participation and attrition and outcome measures of self-reported food skills, dietary intake, emotional well-being, and other indicators of nutrition self-care using a pre–post design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Food skills significantly improved post-curriculum (<i>p</i> = 0.026) with additional improvement in several areas of dietary intake, mindful eating, nutrition self-care and greater use of healthy foods at family mealtimes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hands-on, participatory nutrition and cooking education that emphasizes mind–body connections to food can be a feasible strategy for teaching introductory food skills and may also support socioemotional healing in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renske M. van Lonkhuijzen, Suzanne Prins, Fleur van Loghem, Jeanne H. M. de Vries, Annemarie Wagemakers
Background
Pregnancy is a crucial period prompting increased intentions for lifestyle changes. Suboptimal diet quality during pregnancy can cause adverse health outcomes for both mother and child. The Power 4 a Healthy Pregnancy (P4HP) programme aims to improve the diet quality of pregnant women through empowerment, by providing four additional consultations to discuss nutrition with a midwife and dietitian. This research aimed to study the experiences of pregnant women engaged in the P4HP programme.
Methods
A qualitative study using in-depth interviews was conducted. Participants were recruited through purposive sampling from women who completed the P4HP programme. Semi-structured interviews were conducted using time-lining as an explorative tool. Interview transcripts underwent thematic analysis following Braun and Clarke's six-phase process, combining inductive and deductive coding approaches.
Results
Twenty-two interviews were conducted with women from eight midwifery practices. Four main themes emerged: (1) women report various dietary improvements, influenced by diverse factors, (2) most pregnant women evaluate the P4HP programme positively, (3) the dietitian plays a key role in empowering pregnant women towards healthy dietary intakes and (4) midwives support pregnant women in maintaining dietary improvements. Participants viewed the P4HP consultations favourably, which facilitated empowerment through personalized guidance, reassurance, and increased awareness and confidence levels. Motivated by their desire to ensure optimal nutrition for their babies, women made multiple improvements in their diet quality. While the guidance of the midwife served as a motivational factor to sustain these changes, it was the personalized nutritional guidance provided by the dietitian that women found instrumental in achieving actual dietary changes.
Conclusion
Our outcomes emphasize the importance of integrating dietitian consultations in standard antenatal care to promote enhancements in the diet quality of pregnant women.
{"title":"Pregnant Women's Experiences With a Collaborative Midwife-Dietitian Empowerment Programme to Improve Diet Quality","authors":"Renske M. van Lonkhuijzen, Suzanne Prins, Fleur van Loghem, Jeanne H. M. de Vries, Annemarie Wagemakers","doi":"10.1111/jhn.70027","DOIUrl":"https://doi.org/10.1111/jhn.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pregnancy is a crucial period prompting increased intentions for lifestyle changes. Suboptimal diet quality during pregnancy can cause adverse health outcomes for both mother and child. The Power 4 a Healthy Pregnancy (P4HP) programme aims to improve the diet quality of pregnant women through empowerment, by providing four additional consultations to discuss nutrition with a midwife and dietitian. This research aimed to study the experiences of pregnant women engaged in the P4HP programme.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative study using in-depth interviews was conducted. Participants were recruited through purposive sampling from women who completed the P4HP programme. Semi-structured interviews were conducted using time-lining as an explorative tool. Interview transcripts underwent thematic analysis following Braun and Clarke's six-phase process, combining inductive and deductive coding approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two interviews were conducted with women from eight midwifery practices. Four main themes emerged: (1) women report various dietary improvements, influenced by diverse factors, (2) most pregnant women evaluate the P4HP programme positively, (3) the dietitian plays a key role in empowering pregnant women towards healthy dietary intakes and (4) midwives support pregnant women in maintaining dietary improvements. Participants viewed the P4HP consultations favourably, which facilitated empowerment through personalized guidance, reassurance, and increased awareness and confidence levels. Motivated by their desire to ensure optimal nutrition for their babies, women made multiple improvements in their diet quality. While the guidance of the midwife served as a motivational factor to sustain these changes, it was the personalized nutritional guidance provided by the dietitian that women found instrumental in achieving actual dietary changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our outcomes emphasize the importance of integrating dietitian consultations in standard antenatal care to promote enhancements in the diet quality of pregnant women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ioanna Kontele, Demosthenes Panagiotakos, Mary Yannakoulia, Tonia Vassilakou
<div> <section> <h3> Background</h3> <p>Despite the well-known benefits of the Mediterranean diet (MD), low adherence is observed globally, highlighting the need to investigate the underlying causes of this trend. Large-scale, periodically repeated surveys, such as the European Health Interview Survey (EHIS), could be useful for the investigation of the factors that influence adherence to healthy dietary patterns. National EHIS-3 in Greece was designed to collect data on the consumption of all food groups, making it possible to determine adherence to MD.</p> </section> <section> <h3> Methodology</h3> <p>This study aimed to investigate the socioeconomic factors that influence MD adherence by conducting a secondary data analysis from 7706 participants aged 15–85 years who participated in the 2019 national EHIS. MD adherence was evaluated by MedDietScore. Bivariate comparisons between the score tertiles and socioeconomic groups were performed. Logistic regression analyses were used to estimate the association between MedDietScore tertiles and demographic and socioeconomic factors, using high adherence as the reference category. Finally, cluster analysis was applied to identify the most significant factors in relation to the classification of the participants in MD adherence groups.</p> </section> <section> <h3> Results</h3> <p>Educational level, followed by income status, emerged as the most significant factor associated with adherence to MD. Individuals who have attained only primary education had a 3.80 times higher likelihood of presenting low MD adherence instead of high MD adherence compared to persons with tertiary education. Individuals in the lower income group had 2.53 times higher odds of being in the low MD adherence instead of high MD adherence than individuals in the higher income group. These relationships remained statistically significant after adjusting for confounding factors. The group that most frequently adhered to high MD (53.4%) comprised individuals who had tertiary education, higher income, and were couples without children. Conversely, those with primary or secondary education who are single parents or live in one-person households and fall into the lower and medium income groups are most likely to have low MD adherence (44.8%).</p> </section> <section> <h3> Conclusions</h3> <p>Public policies to promote MD adherence should consider socioeconomic factors. Integrating questions to evaluate adherence to dietary patterns into EHIS would allow for future intercountry and longitudinal comparisons.</p> </section>
{"title":"Socio-Demographic Determinants of Mediterranean Diet Adherence: Results of the EU-National Health Interview Survey (EHIS-3)","authors":"Ioanna Kontele, Demosthenes Panagiotakos, Mary Yannakoulia, Tonia Vassilakou","doi":"10.1111/jhn.70023","DOIUrl":"https://doi.org/10.1111/jhn.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the well-known benefits of the Mediterranean diet (MD), low adherence is observed globally, highlighting the need to investigate the underlying causes of this trend. Large-scale, periodically repeated surveys, such as the European Health Interview Survey (EHIS), could be useful for the investigation of the factors that influence adherence to healthy dietary patterns. National EHIS-3 in Greece was designed to collect data on the consumption of all food groups, making it possible to determine adherence to MD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>This study aimed to investigate the socioeconomic factors that influence MD adherence by conducting a secondary data analysis from 7706 participants aged 15–85 years who participated in the 2019 national EHIS. MD adherence was evaluated by MedDietScore. Bivariate comparisons between the score tertiles and socioeconomic groups were performed. Logistic regression analyses were used to estimate the association between MedDietScore tertiles and demographic and socioeconomic factors, using high adherence as the reference category. Finally, cluster analysis was applied to identify the most significant factors in relation to the classification of the participants in MD adherence groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Educational level, followed by income status, emerged as the most significant factor associated with adherence to MD. Individuals who have attained only primary education had a 3.80 times higher likelihood of presenting low MD adherence instead of high MD adherence compared to persons with tertiary education. Individuals in the lower income group had 2.53 times higher odds of being in the low MD adherence instead of high MD adherence than individuals in the higher income group. These relationships remained statistically significant after adjusting for confounding factors. The group that most frequently adhered to high MD (53.4%) comprised individuals who had tertiary education, higher income, and were couples without children. Conversely, those with primary or secondary education who are single parents or live in one-person households and fall into the lower and medium income groups are most likely to have low MD adherence (44.8%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Public policies to promote MD adherence should consider socioeconomic factors. Integrating questions to evaluate adherence to dietary patterns into EHIS would allow for future intercountry and longitudinal comparisons.</p>\u0000 </section>\u0000 ","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to explore how expert stakeholders involved in research, policy and practice would define an ideal dataset for collecting infant feeding data, to better align efforts to monitor and evaluate breastfeeding across the UK four nations.
Methodology
Using the Delphi method, two phases of consultation were completed with a total of 42 stakeholders. First, qualitative (Round 1) and quantitative (Round 2) surveys were distributed to an interdisciplinary panel of experts, to identify individual-level agreement for key terms and timepoints for data collection relevant to infant age. Second, policy-led stakeholders discussed outcomes from Phase 1, before contributing to a written consultation response for their nation to indicate group-level agreement.
Results
Across Phase 1 surveys, 13 of 15 indicators reached consensus for definitions, and 11 of 13 reached consensus for timepoints. During Phase 2, 5 of 7 indicators reached a level of final agreement. Data collection was suggested to focus on the intention to breastfeed (around birth), and the early initiation of feeding (from birth to 10 days). Monitoring of ‘exclusive’ breastfeeding from 0 to 6 months, ‘any’ breastfeeding from 0 to 24 months, and complementary feeding at 6 and 12 months, were identified as key touchpoints.
Principal Conclusions
To support the feasibility of data reforms across UK nations, these results identify consensus for a shortlist of shared data indicators (see Supplementary Figure 1), highlighting opportunities for data collection that close the gap with international standards, and align with existing monitoring frameworks and healthcare practice.
{"title":"Expert Opinions on an Optimal Infant Feeding Quantitative Data Framework: A Mixed Methods Delphi-Style Study in the UK","authors":"Rochelle Embling, Rachel Evans, Niamh Mchugh, Anna Kolosowska, Varsha Nagaraj, Rachel Bath","doi":"10.1111/jhn.70025","DOIUrl":"https://doi.org/10.1111/jhn.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to explore how expert stakeholders involved in research, policy and practice would define an ideal dataset for collecting infant feeding data, to better align efforts to monitor and evaluate breastfeeding across the UK four nations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>Using the Delphi method, two phases of consultation were completed with a total of 42 stakeholders. First, qualitative (Round 1) and quantitative (Round 2) surveys were distributed to an interdisciplinary panel of experts, to identify individual-level agreement for key terms and timepoints for data collection relevant to infant age. Second, policy-led stakeholders discussed outcomes from Phase 1, before contributing to a written consultation response for their nation to indicate group-level agreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across Phase 1 surveys, 13 of 15 indicators reached consensus for definitions, and 11 of 13 reached consensus for timepoints. During Phase 2, 5 of 7 indicators reached a level of final agreement. Data collection was suggested to focus on the intention to breastfeed (around birth), and the early initiation of feeding (from birth to 10 days). Monitoring of ‘exclusive’ breastfeeding from 0 to 6 months, ‘any’ breastfeeding from 0 to 24 months, and complementary feeding at 6 and 12 months, were identified as key touchpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Principal Conclusions</h3>\u0000 \u0000 <p>To support the feasibility of data reforms across UK nations, these results identify consensus for a shortlist of shared data indicators (see Supplementary Figure 1), highlighting opportunities for data collection that close the gap with international standards, and align with existing monitoring frameworks and healthcare practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maternal nutrition during pregnancy is crucial to ensure positive outcomes for both the mother and newborn. Despite its importance, maternal nutritional status remains poor, particularly in low- and middle-income countries, where social, cultural and economic factors play a pivotal role. This study assessed the adequacy of energy and dietary nutrient intake among Sri Lankan pregnant women compared to their dietary reference intakes.
Methods
This study was part of the Sri Lanka Mother and Newborn Growth study, a nationwide prospective cohort of 2000 pregnant women. We prospectively investigated maternal dietary intake using a validated food frequency questionnaire during the first, second and third trimesters.
Results
We observed an imbalanced macronutrient distribution, with carbohydrates contributing over 67% of total median energy intake, while protein and fat contributed approximately 11% and 17%, respectively. Ethnic and socio-economic disparities in energy and macronutrient intake were notable. The Sinhalese ethnic group showed the highest median percentage of energy consumption derived from carbohydrates at 68.0% (IQR: 64.6%‒71.1%), significantly exceeding the intake of Tamil and Moor groups. Estate residents reported the lowest proportion of energy from protein (10.6%, IQR: 10.1%‒11.3%), which was significantly lower than the intakes of urban and rural residents. Additionally, women in the lowest income group had a lower total energy intake (1871 kcal/day, IQR: 1464–2392) than those in higher income groups, highlighting socio-economic influences on maternal nutrition. Micronutrient deficiencies were pervasive, particularly for vitamin B2 (88.6%–91.0%), folate (99.3%–99.8%), vitamin B12 (97.8%–99.5%), calcium (80.8%–91.4%) and iron (91.1%–96.5%). Sodium intake exceeded recommended levels for over 75% of women across all trimesters.
Conclusion
Imbalances in macronutrient intake and widespread micronutrient deficiencies among Sri Lankan pregnant women underscore the urgent need for interventions targeting maternal nutrition. Addressing socio-economic disparities is critical to improving maternal and neonatal health outcomes.
{"title":"Dietary Energy and Nutrient Intake Among Pregnant Women in Sri Lanka: Findings From the Sri Lanka Mother and Newborn Growth Cohort Study","authors":"Malshani Lakshika Pathirathna, Megumi Haruna, Satoshi Sasaki, Kaori Yonezawa, Yuriko Usui, Yasuhiro Hagiwara","doi":"10.1111/jhn.70020","DOIUrl":"https://doi.org/10.1111/jhn.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Maternal nutrition during pregnancy is crucial to ensure positive outcomes for both the mother and newborn. Despite its importance, maternal nutritional status remains poor, particularly in low- and middle-income countries, where social, cultural and economic factors play a pivotal role. This study assessed the adequacy of energy and dietary nutrient intake among Sri Lankan pregnant women compared to their dietary reference intakes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was part of the Sri Lanka Mother and Newborn Growth study, a nationwide prospective cohort of 2000 pregnant women. We prospectively investigated maternal dietary intake using a validated food frequency questionnaire during the first, second and third trimesters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We observed an imbalanced macronutrient distribution, with carbohydrates contributing over 67% of total median energy intake, while protein and fat contributed approximately 11% and 17%, respectively. Ethnic and socio-economic disparities in energy and macronutrient intake were notable. The Sinhalese ethnic group showed the highest median percentage of energy consumption derived from carbohydrates at 68.0% (IQR: 64.6%‒71.1%), significantly exceeding the intake of Tamil and Moor groups. Estate residents reported the lowest proportion of energy from protein (10.6%, IQR: 10.1%‒11.3%), which was significantly lower than the intakes of urban and rural residents. Additionally, women in the lowest income group had a lower total energy intake (1871 kcal/day, IQR: 1464–2392) than those in higher income groups, highlighting socio-economic influences on maternal nutrition. Micronutrient deficiencies were pervasive, particularly for vitamin B2 (88.6%–91.0%), folate (99.3%–99.8%), vitamin B12 (97.8%–99.5%), calcium (80.8%–91.4%) and iron (91.1%–96.5%). Sodium intake exceeded recommended levels for over 75% of women across all trimesters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Imbalances in macronutrient intake and widespread micronutrient deficiencies among Sri Lankan pregnant women underscore the urgent need for interventions targeting maternal nutrition. Addressing socio-economic disparities is critical to improving maternal and neonatal health outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Objectives</h3> <p>London has the highest proportion of people experiencing homelessness (PEH) living in temporary accommodation in the United Kingdom. PEH have poorer health outcomes, greater dietary inequalities, and die younger than the general population. Despite this, little is known about the nutrition status of PEH. This study aimed to examine the dietary health inequalities experienced by PEH in London, specifically assessing malnutrition among PEH living in temporary accommodation.</p> </section> <section> <h3> Methods</h3> <p>This was a prospective cross-sectional study in 18 hostels in London. Participants were recruited from the temporary accommodation in which they resided through a combination of purposive, snowballing and convenience sampling. Demographic information was gathered, including age, gender, ethnicity and hostel of residence. The primary outcome was malnutrition risk assessed by the Malnutrition Universal Screening Tool (MUST), other outcomes included body composition, dietary intake and quality, mental health and food insecurity. Ethical approval was obtained from the University College London Ethics Committee (16191/006).</p> </section> <section> <h3> Findings</h3> <p>Two hundred participants were recruited between July and December 2023. The majority were male (84.5%), were of White ethnicity (61%), with a mean (SD) age of 45.7 years (11.6) and a BMI of 23.4 kg/m<sup>2</sup> (4.7). The median MUST score was 2 (interquartile range [IQR]: 0.0, 3.0), and 60% had a risk of malnutrition. The median mental health score was 6 (3.0, 10.0), with 55% having moderate to severe depression/anxiety. Median food security score was low (4.5 [(0.0, 8.0]), with 44% experiencing very low food security. The median dietary quality score was low (8.0 [6.0, 9.0]) with low intakes of energy, fibre, and micronutrients, including vitamin D, iron, folate, and calcium, with a higher intake of free sugars compared with UK dietary recommendations and intakes.</p> </section> <section> <h3> Conclusion</h3> <p>This is the first study to show that PEH living in temporary residences had a high risk of malnutrition and experienced dietary inequalities related to poor diet quality and severe food insecurity. There is an urgent need for improved food environments, dietary quality of donated foods and improved nutrition screening and nutrition support provision for PEH in temporary accommodation. Findings could help inform policymakers, health services and food aid charities to set nutrition standards for temporary accommodation to prom
{"title":"Nutrition Status of People Experiencing Homelessness Residing in Temporary Accommodation in London","authors":"Hannah Style, Victoria Vickerstaff, Adrian Brown","doi":"10.1111/jhn.70024","DOIUrl":"https://doi.org/10.1111/jhn.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>London has the highest proportion of people experiencing homelessness (PEH) living in temporary accommodation in the United Kingdom. PEH have poorer health outcomes, greater dietary inequalities, and die younger than the general population. Despite this, little is known about the nutrition status of PEH. This study aimed to examine the dietary health inequalities experienced by PEH in London, specifically assessing malnutrition among PEH living in temporary accommodation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective cross-sectional study in 18 hostels in London. Participants were recruited from the temporary accommodation in which they resided through a combination of purposive, snowballing and convenience sampling. Demographic information was gathered, including age, gender, ethnicity and hostel of residence. The primary outcome was malnutrition risk assessed by the Malnutrition Universal Screening Tool (MUST), other outcomes included body composition, dietary intake and quality, mental health and food insecurity. Ethical approval was obtained from the University College London Ethics Committee (16191/006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Two hundred participants were recruited between July and December 2023. The majority were male (84.5%), were of White ethnicity (61%), with a mean (SD) age of 45.7 years (11.6) and a BMI of 23.4 kg/m<sup>2</sup> (4.7). The median MUST score was 2 (interquartile range [IQR]: 0.0, 3.0), and 60% had a risk of malnutrition. The median mental health score was 6 (3.0, 10.0), with 55% having moderate to severe depression/anxiety. Median food security score was low (4.5 [(0.0, 8.0]), with 44% experiencing very low food security. The median dietary quality score was low (8.0 [6.0, 9.0]) with low intakes of energy, fibre, and micronutrients, including vitamin D, iron, folate, and calcium, with a higher intake of free sugars compared with UK dietary recommendations and intakes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first study to show that PEH living in temporary residences had a high risk of malnutrition and experienced dietary inequalities related to poor diet quality and severe food insecurity. There is an urgent need for improved food environments, dietary quality of donated foods and improved nutrition screening and nutrition support provision for PEH in temporary accommodation. Findings could help inform policymakers, health services and food aid charities to set nutrition standards for temporary accommodation to prom","PeriodicalId":54803,"journal":{"name":"Journal of Human Nutrition and Dietetics","volume":"38 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143379907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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