Search Results (2,944)

Background: Previous research has confirmed that dietary diversity is positively linked to mental health outcomes in older populations. Nevertheless, relevant evidence focusing specifically on Chinese older adults remains limited, and the internal mechanisms underlying this association I confirm. are not fully understood. Against this background, this study intended to investigate the association between dietary diversity and mental health among Chinese older individuals, explore the chain mediating roles of sleep quality and self-perceived quality of life, and further test whether gender moderates the above direct and mediating pathways. Methods: Using 2018 CLHLS data, 10,089 older adults aged 60 and above were selected as valid samples. Pearson correlation analysis was employed to determine the relationships between key variables. Hayes’ PROCESS macro Model 6 was used for baseline serial mediation analysis, and Model 85 was used for moderated serial mediation with gender as the moderator, adopting 5000 bootstrap samples. Results: The results revealed significant positive correlations (p < 0.01) between key variables, including dietary diversity, sleep quality, self-rated quality of life, and mental health. Model 6 showed that dietary diversity serves as a positive and significant predictor of mental health (B = 0.130, p < 0.001). Three significant mediating pathways were identified through which dietary diversity affects mental health: (1) sleep quality (B = 0.076, 95% CI: 0.062, 0.092), (2) self-rated quality of life (B = 0.100, 95% CI: 0.083, 0.118), and (3) sleep quality and self-rated quality of life (B = 0.020, 95% CI: 0.016, 0.025). The total mediating effect of the three pathways reached 59.94%. Model 85 found that the interaction term of dietary diversity x gender was non-significant (p > 0.05), demonstrating no statistically significant gender moderation of any pathway. Gender-stratified conditional effects revealed numerical differences across subgroups. Conclusions: Higher dietary diversity is significantly correlated with better mental health among Chinese older adults. Sleep quality and self-rated quality of life play significant roles as serial mediators in this association. Although gender does not statistically moderate the whole association mechanism, subtle gender heterogeneity exists in the pathway effect magnitude. The above findings offer novel insights into the underlying mechanisms. Strategies aimed at improving dietary diversity, combined with targeted interventions to enhance sleep quality and self-rated quality of life, with slight gender-differentiated auxiliary suggestions, may effectively promote mental health and contribute to active aging in later life. Full article

Background/Objectives: Adequate micronutrient intake during pregnancy is critical for fetal development, yet whether pregnant women and healthcare professionals share consistent knowledge, beliefs, and supplementation practices remains poorly characterized. Methods: Two parallel cross-sectional surveys using identical core items were conducted at a German tertiary care center between April and November 2024. Pregnant women (n = 132) and healthcare professionals who initiated the survey (n = 105) completed anonymous QR-code-based questionnaires assessing micronutrient-related knowledge, perceived dietary adequacy, and supplementation practices or recommendation patterns. Comparative analyses were restricted to fully completed healthcare professional questionnaires (n = 80). Group differences were analyzed using chi-square or Fisher’s exact tests. Results: Healthcare professionals demonstrated higher knowledge levels across most micronutrients. Knowledge gaps were most pronounced for vitamin B12, with 53.0% of pregnant women unable to identify any fetal effect compared with 20.0% of providers (p < 0.001). Beliefs about dietary sufficiency were broadly aligned for folic acid (p = 0.452) and vitamin D (p > 0.999), but diverged markedly for vitamin B12, where 79.2% of providers considered dietary intake alone adequate compared with 47.3% of pregnant women (p < 0.001). Substantial differences were observed between patient-reported supplementation practices and provider-reported recommendation patterns: Vitamin B12 (70.0% vs. 3.8%), vitamin D (76.2% vs. 41.3%), omega-3 fatty acids (76.2% vs. 47.5%), and folic acid (98.5% vs. 81.3%; all p < 0.001). The internet was the most frequently cited information source among pregnant women (89.4%), while healthcare professionals reported using both scientific literature (75.0%) and internet-based resources (76.3%), the latter primarily for accessing professional and scientific information. Conclusions: Substantial patient–provider differences in micronutrient knowledge, beliefs, and supplementation practices persist even within a highly educated population at a tertiary care center. These findings suggest potential differences between patient-reported supplementation behavior and provider-reported recommendation practices, particularly for vitamin B12 and vitamin D. These findings suggest that more structured communication regarding micronutrient supplementation during pregnancy is needed. Full article

Objective: The aim of this study was to evaluate associations between flavonoid intake at dinner versus breakfast and the odds of non-alcoholic fatty liver disease (NAFLD) using data from the National Health and Nutrition Examination Survey (NHANES). Methods: According to total flavonoids, flavonoids intake at breakfast and dinner, or flavonoids intake differences at dinner and breakfast (Δ = dinner-breakfast), we divided 3240 participants from the NHANES (2007–2010) into five groups. Logistic regression analyses were performed to examine associations between total flavonoids, flavonoid intake at breakfast and dinner or Δ flavonoids and NAFLD after the adjustment of several confounding factors. Dietary substitution models were used to estimate the association between replacing 5% of flavonoid intake at dinner with that at breakfast and the odds of NAFLD. Results: For total flavonoids intake and flavonoids intake at breakfast, when compared to the lowest quintile (Q1), participants in the highest quintile of total flavonoids intake had lower odds of NAFLD, with an adjusted odds ratio (OR) for NAFLD of 0.78 (95% confidence interval (CI): 0.61–0.98) and a p-trend of 0.076. Participants in the highest quintile of flavonoid intake at breakfast had an adjusted OR for NAFLD of 0.87 (95% CI: 0.69–1.09) and a p-trend of 0.035, also showing a trend toward lower odds of NAFLD. Conversely, for Δ flavonoids, participants in the highest quintile had higher odds of NAFLD, with an adjusted OR for NAFLD of 1.27 (95% CI: 1.01–1.60) and a p-trend of 0.093. When total flavonoid intake in participants remained constant, replacing 5% of dietary flavonoid intake at dinner with that at breakfast was associated with 7% lower odds of NAFLD. Conclusions: Higher flavonoid intake at breakfast than at dinner may be associated with lower odds of NAFLD. Future research should focus on the potential role of breakfast-timed flavonoid intake in preventing the onset of NAFLD. Full article

Background: Pelvic inflammatory disease (PID) is a prevalent chronic inflammatory condition among women. The Composite Dietary Antioxidant Index (CDAI), a measure of dietary antioxidant capacity, has been associated with various inflammatory diseases, but evidence concerning its association with PID remains limited. Methods: The final analytic sample included 4539 women. CDAI was calculated from six dietary antioxidant components: vitamin A, vitamin C, vitamin E, carotenoids, zinc, and selenium. Survey-weighted multivariable logistic regression models were used to evaluate the association between CDAI and self-reported history of treated PID, incorporating the sampling weights, strata, and primary sampling units of NHANES. Restricted cubic spline (RCS) analysis was used to assess both linear and non-linear associations. Subgroup analyses and a machine learning model based on random forest, combined with SHapley Additive exPlanations (SHAP) value ranking, were conducted to evaluate the relative importance of individual components of CDAI. Results: In the fully adjusted spline model including smoking status, CDAI was inversely associated with the odds of self-reported history of treated PID, with no statistical evidence of nonlinearity. Compared with the lowest quartile (Q1), the odds ratios (ORs) for self-reported history of treated PID across higher quartiles of CDAI were as follows: Q2 (OR = 0.682, 95% CI: 0.485–0.959, p = 0.036), Q3 (OR = 0.524, 95% CI: 0.334–0.819, p = 0.009), and Q4 (OR = 0.666, 95% CI: 0.380–1.167, p = 0.167). Among the components of CDAI, vitamin E intake showed an independent inverse association with the odds of self-reported history of treated PID. The SHAP value interpretation indicated that vitamin A, vitamin C, and carotenoids were the three components in CDAI with the highest predictive contribution. Furthermore, subgroup analysis demonstrated a significant interaction effect of age on the association between CDAI and PID. Conclusions: This cross-sectional study suggests an inverse association between CDAI and self-reported history of treated PID, particularly in spline analyses; however, the quartile-based fully adjusted results were non-monotonic and attenuated after adjustment for smoking status. These findings provide hypothesis-generating evidence for future longitudinal and mechanistic studies on antioxidant-related dietary patterns and PID-related reproductive health. Full article

Global food production must reduce environmental impact while meeting rising demand for dietary protein. Plant-based meats aim to preserve the sensory and cultural role of animal meat while lowering greenhouse gas emissions, land use, and health risks. Advances in protein structure and flavor chemistry have improved product quality, yet consumers continue to prioritize taste and texture over sustainability, and systematic large-scale consumer surveys are scarce. It remains unclear how plant-based products rank against animal benchmarks and which product attributes most strongly influence overall liking. Here we show, in a large-scale blinded in-person sensory evaluation across 14 product categories, 2684 consumers, more than 11,000 product evaluations and 800,000 data points, that plant-based products still trail animal benchmarks at the category average level but approach parity in selected formats. Plant-based unbreaded chicken filets, chicken nuggets, and burgers achieved mean overall liking scores of 5.1, 4.9, and 5.2, differing from the animal benchmarks by only $\Delta$ = 0.1, 0.2, and 0.3 points on a seven-point scale. For unbreaded chicken filets and burgers, 48% and 47% of the participants rated the plant-based product the same as or better than the animal benchmark. Categories with higher sensory parity captured 5–14% market share compared with less than 1% for low-parity categories. Penalty analysis identified savoriness, aftertaste, juiciness, and tenderness as the strongest determinants of liking. These findings show that sensory parity is technically achievable but not yet consistent across product types. By publicly sharing all the sensory, preference, and market-linked data, we establish an open benchmark for alternative protein performance to democratize research and accelerate principled data-driven innovation. All the data are freely available at https://www.nectar.org/sensory-research/2025-taste-of-the-industry. Full article

Background/Objectives: In Croatia, national data on adolescents’ dietary habits are limited, resulting in a lack of evidence-based food-based dietary guidelines and public health interventions. This study aims to conduct an in-depth evaluation of dietary habits in a national sample of Croatian adolescents stratified by region, sex and age, from the National food consumption survey on adolescents and adults (NIPNOD 2018–2023). Methods: This cross-sectional study included 258 adolescents (50.4% boys; aged 10 to < 18) from the NIPNOD 2018–2023 survey (OC/EFSA/DATA/2017/01), conducted according to the EU Menu methodology. For analysis, the sample was divided into two age groups (10–13 and 14–17 years). To assess dietary intake, two 24 h recalls were analyzed using NutriCro^® v. 3.0 software. Dietary intake was compared with European Food Safety Authority dietary reference values (DRV). The contribution of 14 food groups to daily energy intake was analyzed. Diet quality was assessed using the Diet Quality Index for Adolescents (DQI-A). Results: The mean daily energy intake was 1820 ± 529 kcal, consisting of 45.5 ± 7.0% carbohydrates, 37.8 ± 6.3% fats, and 15.1 ± 3.1% protein. The observed two-day mean intake suggested that 51.6% of adolescents had carbohydrate intake within the EFSA DRV range, while 5.4% and 32.2% had protein and fat intake within the EFSA DRVs, respectively. The main contributors to daily energy intake were grains and grain products (31.5%), meat, poultry, fish, and eggs (18.1%), and cakes, confectionery, sweets, and sugar (14.9%). Frequent breakfast skipping and snack consumption were common, particularly among older adolescents. Adolescents had moderate overall diet quality (57.4 ± 11.6% DQI-A), with no differences between age groups. Conclusions: Analysis of the dietary habits of adolescents in Croatia indicates that most have inadequate macronutrient intake, irregular meal frequency, and moderate overall diet quality. These results highlight the need to develop public health strategies and interventions to improve dietary habits among adolescents in Croatia. Full article

Background: The use of sports supplements among adolescents is rising globally, driven by fitness trends and social media influence, yet knowledge gaps persist. This study aimed to assess supplement usage patterns, knowledge, attitudes, information sources, and the impact of a social media educational intervention among Serbian secondary school students. Methods: A single-group pre–post educational intervention study was conducted in secondary school students (aged 14–18) in Vojvodina, Serbia. A 21-question anonymous questionnaire was distributed to 1000 students along with parental informed consent forms. Pre-intervention survey assessed sociodemographics, physical activity and social media habits, supplement use information sources, and awareness of risks and banned substances. Based on the initial findings, an educational campaign delivered 56 short videos (≈70 s each) on Instagram and TikTok covering most frequently used supplements (e.g., creatine, proteins, caffeine, energy drinks). After, the intervention survey was repeated. The data were analyzed using the McNemar–Bowker test of symmetry. Results: In this study, 65% of Serbian secondary school adolescents reported being physically active, engaging predominantly in gym workouts and team sports. The majority of participants initiate dietary supplement use independently, without consulting healthcare professionals or adults. The most commonly used supplements were vitamins and minerals, while energy drinks ranked notably high. Social media intervention had a limited impact due to its short duration; however, certain changes were detected. Conclusions: Serbian adolescents frequently use sports supplements without adequate professional guidance. Long-term TikTok/Instagram interventions could be used in the future in order to influence behaviors and improve knowledge about sport supplement use. Full article

Background: Dietary management of phenylketonuria (PKU) focuses on restricting phenylalanine (Phe) intake. The European PKU guidelines and the PKU Dietary Handbook recommend a simplified PKU diet, allowing unrestricted consumption of many low-Phe foods, called free foods. While this approach may reduce the treatment burden for patients, its implementation varies. This study investigated practices of Swedish metabolic dietitians regarding the simplified diet and the use of free foods for classical PKU (cPKU) and compared these with European recommendations. Methods: A survey was distributed to all metabolic dietitians in Sweden. The survey included questions on professional experience, the use of free foods and the classification of 135 low-protein food items as never, sometimes or always counted in cPKU. Data were summarised descriptively. Results: All 13 eligible dietitians participated. The use of free foods was recommended by 8/13 dietitians. Of foods classified as free in the PKU Handbook, about one third were commonly restricted in Swedish PKU practice. For 39% of the foods surveyed, no single response option (never, sometimes or always counted) reached >50%, indicating variation in practice. Classification of individual foods partially aligned with their Phe content, but portion size and concerns about excessive Phe intake also influenced advice. Conclusions: Significant variation exists in the dietary management of PKU in Sweden, and the simplified diet approach is not consistently implemented. Dietitians’ concerns about the safety of increased Phe intake from free foods play a central role in this. These findings highlight challenges in incorporating international guidelines into national practice and underscore the need for further research to address dietitians’ safety concerns related to the simplified diet. Full article

Background/objective: This study determined the prevalence of dietary behaviours and examined their relationship with nutritional status among Malaysian school-based adolescents. Methods: Data from 33,523 adolescents who participated in the Adolescent Health Survey (AHS 2022) were analysed. Multiple logistic regression was employed to assess associations between dietary behaviours and nutritional status, adjusting for potential confounders. Results: Our findings demonstrated a double burden of malnutrition, with 6.8% stunting, 8.3% thinness, and 30.5% overweight/obese. High prevalence of inadequate daily intake of fruit and vegetables (FV) (83.9%) and insufficient daily dairy consumption (62.7%) was observed. Approximately one-third of adolescents reported frequent fast-food consumption (i.e., at least one day per week) (35.4%) and daily intake of carbonated soft drinks (32.4%). Daily carbonated soft drink consumption was associated with higher odds of overweight/obesity (aOR:1.11; 95% CI:1.04–1.20), highlighting the need to prioritise the public health strategies aimed at reducing sugar intake. Conversely, inadequate FV intake (aOR:0.88; 95% CI:0.81–0.95) and frequent fast-food consumption (aOR:0.87; 95% CI:0.82–0.94) were associated with lower odds of overweight/obesity, while insufficient daily dairy intake was associated with lower odds of thinness (aOR:0.83; 95% CI:0.73–0.94). These negative associations should be interpreted cautiously due to possible reverse causality and reporting bias. Conclusions: The findings highlight the importance of strengthening nutrition education and the food environment among Malaysian adolescents. Full article

Background/Objectives: Plant-based dietary patterns like the Dietary Approaches to Stop Hypertension (DASH) reduce cardiovascular risk, which is a leading cause of mortality globally and in Spain. Diet is also a major environmental determinant, highlighting the need to evaluate public health alongside environmental sustainability. The aim of this study was to analyze the evolution of adherence to the DASH dietary pattern in Spain between 2006 and 2023 and evaluate its relationship with environmental sustainability indicators. Methods: This was an ecological epidemiological study. Food consumption data were harmonized into daily servings to calculate annual DASH scores using a standard 80-point methodology. Environmental impact was assessed by calculating the comprehensive Ecological Footprint (EF) using the Agribalyse^® 3.2 database. The study utilized open data from the Spanish Household Budget Surveys, capturing the consumption habits of approximately 24,000 randomly selected Spanish households annually from 2006 to 2023. The primary measures evaluated were the annual DASH adherence index score and the overall environmental Ecological Footprint. Temporal trends were evaluated using segmented regression models selected via the Akaike Information Criterion and Davies test. Pareto analysis determined individual food group environmental contributions, and correlations assessed the relationship between DASH scores and the EF. Results: DASH adherence increased by 8.26% over the study period, peaking in 2020. The EF demonstrated an overall decrease over time, largely driven by reduced consumption of meat, fish, and eggs. A strong inverse correlation was found between the DASH score and the EF (r = −0.8237 (95% CI: −0.932 to −0.580; p < 0.001)). Conclusions: A shift toward the DASH dietary pattern in Spain demonstrates potentially convergent health and environmental associations, promoting population cardiovascular health potential while simultaneously mitigating environmental impacts. Full article

Background/Objectives: Current evidence suggests that Hispanic/Latino adults experience a disproportionate burden of depression. Dairy consumption has been associated with fewer depressive symptoms, but examinations in Hispanic/Latino cohorts are unavailable. Our objective was to measure the 6-year prospective associations between dairy consumption and depressive symptoms among Hispanic/Latino adults. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective population-based cohort study of 16,415 Hispanic/Latino adults residing in the US. We estimated daily dairy product consumption from two 24 h baseline dietary recalls using the National Cancer Institute method. The 10-item Center for Epidemiological Studies Depression Scale (CESD10) administered at baseline and follow-up assessed depressive symptoms. Survey multiple linear regression models adjusted for baseline CESD10 and other covariates, including sociodemographic, dietary and health factors. Standardized β coefficients represent the standard deviation difference in 6-year CESD10 score per one standard deviation increase in daily dairy intake at baseline. Complete data were available among 10,618 participants. Results: Neither baseline total dairy consumption (standardized β (95% CI); −0.019 (−0.048, 0.011)), nor milk (−0.006 (−0.029, 0.018)), cheese (0.038 (−0.006, 0.081)), or cream (−0.005 (−0.037, 0.028), p > 0.05 for all) consumption was significantly associated with the follow-up CESD10 score. Conversely, we observed a significant and inverse association between yogurt (−0.036 (−0.058, −0.013), p = 0.002) and butter (−0.049 (−0.092, −0.006), p = 0.027) with the CESD10 score. Conclusions: Total dairy, fat-based dairy groupings, milk, cheese, and cream were not associated with CESD10 score at 6-year follow-up; yogurt and butter showed inverse associations that require cautious interpretation due to very small effect sizes. Although additional prospective analyses in other diverse cohorts are needed to confirm these results, our findings suggest that dairy consumption is not adversely associated with depressive symptoms in Hispanic/Latino adults. Full article

Background/Objectives: The etiology of oral lichen planus (OLP) is unknown, and the treatment is palliative. Considering the possible influence of factors related to lifestyle on the etiopathogenesis and behavior of OLP, the aim of the present study was to investigate the association of sleep quality, nutritional profile, and salivary melatonin and cortisol levels with OLP. Methods: Thirty-two OLP patients and 31 controls completed the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale, and 24 h dietary recall survey. Saliva was collected to determine melatonin and cortisol levels by liquid chromatography coupled to mass spectrometry. Results: The OLP patients showed higher scores in the sleep disturbances component of PSQI (p = 0.021) and lower salivary melatonin levels (p = 0.015), whereas salivary cortisol did not differ between the groups (p = 0.402). The Control group had higher prevalence of coffee drinkers (p = 0.045), whereas the OLP group had higher consumption of protein (p = 0.011), lipids (p = 0.043), calories (p = 0.022), monounsaturated fat (p = 0.030), polyunsaturated fat (p = 0.007), saturated fat (p = 0.027), cholesterol (p = 0.041), iron (p = 0.014), zinc (p = 0.048), magnesium (p = 0.025), sodium (p = 0.008), and vitamin E (p = 0.016) compared to controls. Conclusions: The results suggest that OLP is associated with lifestyle factors related to sleep and diet, as well as with lower levels of salivary melatonin. Given the exploratory nature of the study, further research is needed to better understand these findings. Full article

College students often maintain poor dietary habits, notably low fruit and vegetable intake. Common barriers include limited time, cost, and lack of nutritional knowledge. This study examined dietary behaviors, barriers, and factors influencing Healthy Eating Scores (HES) among college students. Participants (N = 224; age = 20.3 ± 2.5 years, BMI = 23.9 ± 4.1 kg/m², 78.9% female, and 91.3% white) completed an online survey. Results indicate meat overconsumption with underconsumption of water, fruits, and vegetables. Limited time and healthy options were the primary perceived barriers. Tests of between-subject effects identified gender (F = 4.38, p = 0.04) and living situation (F = 4.42, p < 0.01) as independent HES predictors. Backward stepwise linear regression (adj. R² = 0.22, p < 0.001) further indicated that being male, an athlete, living off-campus, and cooking at home were significantly associated with higher HES. Conversely, non-athlete females living on campus emerged as the most vulnerable group for low HES. These findings suggest that future interventions should target specific demographic vulnerabilities to improve dietary outcomes and mitigate barriers in the college population. Full article

Background/Objectives: Adequate choline intake is critical across the peripartum period for optimal maternal-offspring health. Maternal depressive symptoms are associated with poor dietary quality, but the relationship between postpartum depression and choline intake in lactating mothers of preterm infants, a period of heightened intake requirements, has not been previously explored. Methods: Lactating mothers of hospitalized preterm infants (born ≤36 weeks gestational age) completed depression screening with the Edinburgh Postnatal Depression Scale (EPDS) and a dietary choline intake survey. Mann–Whitney U tests compared maternal choline intake based on EPDS screen status (low-risk or at-risk for depression). Multivariable linear regression assessed the relationship between maternal depressive symptoms and choline intake. Results: EPDS screens were at-risk in 18 (42%) of the 43 participants. Median choline intake across the cohort was <50% of recommended dietary intake (median [IQR] 221 [147, 308] mg), with lower intake in mothers with at-risk EPDS screens compared to low-risk screens (median [IQR] score: 156 [105, 218] mg vs. 298 [196, 357] mg, p < 0.01). In multivariable linear regression, EPDS score was negatively associated with maternal choline intake (β [95% CI] = −0.13 [−0.26, −0.01], p = 0.03). Conclusions: Dietary choline intake is low among lactating mothers of preterm infants, particularly those with postpartum depressive symptoms. Full article

Background/Objectives: Vestibular migraine is a common but often underrecognized cause of dizziness in otolaryngology practice. Although awareness has increased, variation in clinician training and management may contribute to inconsistent care. This study evaluated current diagnostic and treatment practices of Canadian otolaryngologists for vestibular migraine, including familiarity with diagnostic criteria, therapeutic approaches, perceived barriers, and educational needs. Methods: A national cross-sectional electronic survey was distributed to practicing and emeritus members of the Canadian Society of Otolaryngology–Head and Neck Surgery from February to April 2025. The 14-item survey assessed demographics, clinical exposure to dizzy patients, residency training, diagnostic familiarity, treatment patterns, referral practices, barriers to care, and preferred educational resources. Responses were anonymized and analyzed using descriptive statistics. Results: Forty-four otolaryngologists completed the survey (response rate: 7.4%). Most respondents reported being very familiar (59.1%) or moderately familiar (38.6%) with vestibular migraine diagnostic criteria, and 97.7% reported currently diagnosing and/or treating these patients. However, only 15.9% had received extensive residency training specific to migraine or vestibular migraine. Common treatments included lifestyle and dietary modification (90.9%), nutraceutical supplements (59.1%), tricyclic antidepressants (54.5%), and analgesics (52.3%). Vestibular rehabilitation therapy (29.5%) and calcitonin gene-related peptide-targeted therapies (<10%) were used less frequently. Major barriers were clinical time constraints (65.9%), lack of training or knowledge (54.5%), and diagnostic complexity (47.7%). Clinical guidelines (70.5%) and continuing medical education courses (65.9%) were identified as the most valuable supports. Conclusions: Among surveyed Canadian otolaryngologists engaged in dizziness and vestibular migraine care, substantial heterogeneity existed in training and management practices. Standardized guidance, enhanced education, and interdisciplinary collaboration may improve consistency of care and patient outcomes. Full article