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NURS FPX 5003 Assessment 4 Community Health Assessment

Capella University
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NURS FPX 5003 Assessment 4
Name
Capella University
NURS 5003
Professor Name
26th April, 2024
 

NURS FPX 5003 Assessment 4 Executive Summary: Community Health Assessment

 
In previous assessments, we have discussed communication skills, populations, and healthcare organizations. It is critical for us as healthcare providers to recognize the great variety that exists in our communities. This entails acknowledging the different requirements and obstacles encountered by many groups, including the LGBTQ+ community. LGBTQ+ people frequently face prejudice and obstacles while trying to get healthcare. When compared to the overall population, this may result in worse health results. The LGBTQ+ population is disproportionately affected by health disparities such as hypertension and high blood pressure. In addition to this, there are also additional issues to be concerned about greater prevalence of mental health disorders including sadness and anxiety; higher risk of certain malignancies; and lower rates of screenings for preventative care.
 
However, It is imperative to carry out a community health assessment with a particular focus on the LGBTQ+ group. Working together with LGBTQ+ individuals and groups is crucial to creating and delivering culturally appropriate healthcare services  (Julián Esparza-Romero & Diana Marcela Valenzuela-Guzmán, 2024). Moreover, We can build a healthcare system that is more effective and inclusive for every member of the community by addressing LGBTQ+ health inequities and encouraging cross-cultural collaboration, which will eventually improve overall health and well-being. LGBTQ+ people are more likely to encounter prejudice in the medical field, which may discourage them from obtaining treatment and preventative care. Health outcomes for this community can be improved by providing culturally competent treatment that is inclusive of LGBTQ+ identities and supportive of them. Moreover, Healthcare practitioners may significantly contribute to the advancement of health equity and the enhancement of everyone’s well-being by recognizing and addressing the special needs of the LGBTQ+ population. The conventional methods of delivering life support education include lectures, role-playing, and practical experience. With this method, the learning process is integrated with gaming components like points, badges, and leaderboards.
 
The goal is to increase the interaction and engagement of learning. To investigate the effects of gamified learning on clinical and educational outcomes in life support training, researchers carried out a comprehensive study. The International Liaison Committee on Resuscitation (ILCOR), a group dedicated to enhancing resuscitation results worldwide, oversaw the assessment. Major medical databases were reviewed by the researchers for pertinent papers published up until February 12, 2024. Additionally, The study includes studies that used gamification to teach life support skills. There were 2261 items found in the first search. Sixteen research made it into the final review after screening. A meta-analysis, a statistical approach for merging data from several studies, could not be performed by researchers due to considerable differences in treatments, participants, and outcomes examined across studies. Moreover, Researchers used the necessary techniques to evaluate each study’s likelihood of bias. The majority of studies had a moderate to high risk of bias, indicating that variables other than the intervention itself could be affecting the outcomes. There was just one study with a low bias risk. Two research concentrated on laypeople, whereas the majority involved healthcare practitioners. However, Eleven out of sixteen studies employed digital platforms, such as computers or smartphones, as their primary distribution mechanism. Most research discovered that gamified learning had a favorable effect on at least one area of learning connected to supporting life (Donoghue et al., 2024).
 

NURS FPX 5003 Assessment 4: Understanding Demographics and Addressing Hypertension in the LGBTQ Community in Arkansas

 
A life-supporting technique called extracorporeal membrane oxygenation replaces the heart and/or lungs in patients who are suffering from severe cardiac or respiratory failure. Large university hospitals with a broad spectrum of experts and cutting-edge technology are known as tertiary medical centers. Generally speaking, non-tertiary centers are smaller and could have fewer resources. The book Unique Challenges recognizes that creating an effective ECMO program can be extremely difficult in non-tertiary institutions due to their lack of resources and experience. restricted Existing Guidance identifies the dearth of comprehensive frameworks that particularly address the difficulties non-tertiary facilities encounter when launching ECMO programs in the body of recent medical research. The authors suggest smaller hospitals take the initiative to create LGBTQ programs. plans for resource allocation and projects. A retrospective examination of the authors’ own experience establishing an LGBTQ program at a non-tertiary medical facility, for instance, is presented. This probably entails methods to get beyond the restrictions listed above, such as staff training programs and resource allocation tactics. A retrospective examination of the authors’ own experience establishing an LGBTQ program at a non-tertiary medical facility, for instance, is presented.
 
They include information on the following: patient demographics; clinical features (disease severity and medical problems); ECMO setup; major complications that patients have encountered; and survival rates. The page “Data Analysis Methods” lists several statistical techniques, including mean, median, percentages, and standard deviation, that are used to summarize data. Moreover, These techniques aid in providing the results in an understandable and instructive manner. The population of Arkansas is estimated by the U.S. Census Bureau to be around 3 million. The majority population of the state is White (78.6%), followed by Asians (1.8%), Black or African American (15.7%), and Hispanic or Latino (8.3%). Arkansas has a near-even gender distribution (49.3% male, 50.7% female) with a median age of 38.6 years. Data on the prevalence of hypertension in Arkansas’s LGBTQ+ community is lacking. According to a 2019 Williams Institute research, 3.3% of Arkansas individuals identify as LGBTQ+.
 
According to the paragraph, there may be several reasons why LGBTQ+ people in Arkansas are more likely to develop hypertension, such as higher smoking rates, poor dietary habits, and restricted access to healthcare. Healthcare professionals must be aware of the particular health issues and difficulties that the LGBTQ+ population faces. To guarantee that patients receive the proper treatment and preventative care, this awareness is essential. This strategy is proved beneficial for patients. LGBTQ+ people frequently encounter prejudice in healthcare settings, which may discourage them from obtaining treatment and preventative care. Additionally, there may be a higher prevalence of mental health issues among them, which may have an indirect impact on health-related behaviors and exacerbate long-term health issues like hypertension. Arkansas may endeavor to improve health outcomes for all citizens, including the LGBTQ+ population, by being aware of these possible inequities and fostering a more accepting healthcare environment (Hassani et al., 2023).
 

NURS FPX 5003 Assessment 4: Summary of Arkansas Demographics Connected to Hypertension

 
Specialists can assess stroke patients remotely using telemedicine by employing video conferencing and other technology. This can be especially helpful in places where main stroke centers don’t have easy access to stroke experts. The goal of the study is to evaluate how well a telestroke system at a primary stroke center works to shorten the time it takes to provide patients with AIS clot-busting medicine, or thrombolysis. Controlling blood pressure is yet another essential component of stroke treatment.This makes it difficult to completely comprehend and take care of their high blood pressure-related healthcare demands. Moreover,  Excessively low blood pressure can restrict blood flow to the brain, whereas high blood pressure can exacerbate brain injury. The influence of a patient’s systolic blood pressure during transit to the major stroke center on their prognosis is another area of interest for the researchers. Researchers are evaluating data gathered from historical medical records in a retrospective analysis methodology. presented during a five-year period to a hospital within a telestroke network with sudden-onset neurological symptoms (symptoms that emerge quickly as a result of a brain disease). A verified diagnosis of AIS was made, and the patient’s functional outcome at discharge was measured using the modified Rankin Scale.
 
Using a statistical approach called multivariate analysis, the researchers will look at the correlations between various variables (such SBP during travel) and stroke outcomes while taking other aspects into consideration. The overall goals of this study are to examine the prognostic significance of blood management and the possible advantages of telestroke technology in accelerating stroke treatment. So, health care departments making ensure to communicate with staff members for enhancement features, Through investigating the efficaciousness of telestroke and blood pressure regulation, scholars may provide significant perspectives for enhancing stroke treatment and patient results. According to statistics cited in the paragraph, which comes from the American Heart Association, hypertension, or high blood pressure, affects around 40% of the population in Arkansas and is a serious public health concern. One of the main risk factors for heart disease, stroke, renal failure, and other severe health issues is hypertension.
 
Information on the prevalence of hypertension in Arkansas’s LGBTQ+ population is lacking. This particular stroke is brought on by a blood clot obstructing a brain artery. In order to reduce brain damage and enhance patient outcomes, prompt therapy is essential. Although there is a lack of evidence, what is known indicates that LGBTQ+ Arkansans may have a greater risk of hypertension than the overall population. The call to action highlights the need for more investigation to validate this possible discrepancy and pinpoint the precise causes. Comprehending these variables is pivotal in formulating focused therapies to cater to the distinct health requirements of the LGBTQ+ populace in Arkansas. People who identify as LGBTQ+ frequently face prejudice in healthcare settings, which may discourage them from getting blood pressure checked and receiving preventative treatment. In previous assessments, we discuss professional skills if health care departments such as communication skills. Additionally, they could have greater rates of stress and mental health issues, both of which increase the risk of high blood pressure (Jayanama et al., 2021).
 

NURS FPX 5003 Assessment 4: Analyzing Healthcare Interview Findings for Implementing National CLAS Strategies

 
Pay attention to LGBTQ+ Melissa Xiong, a psychiatrist at the Mayo Clinic, discusses mental health, emphasizing the clinic’s emphasis on meeting the mental health needs of the LGBTQ+ population. In order to address mental health issues, Northwest Health employs a variety of tactics, one of which is Cultural Competence Training. This program gives medical professionals the information and abilities they need to treat LGBTQ+ patients and other different communities in a way that is both courteous and inclusive. As in our previous assessments, we  determined CLAS strategies. Collaboration between patients and clinicians is emphasized in patient-centered care, guaranteeing that treatment plans take each patient’s requirements and preferences into account. However, Community Outreach: To lessen stigma and increase knowledge of mental health options, Northwest Health probably interacts with LGBTQ+ groups and community centers. Patients who get assistance and instructional information from health literacy resources are more equipped to make educated decisions about their mental health treatment.
 
Evaluation of techniques indicates that elements should be taken into consideration while determining these techniques’ efficacy.The United States Department of Health and Human Services created the National CLAS Standards. Guidelines for delivering healthcare services that are linguistically and culturally suitable are outlined in these standards. Benefits of Complying with CLAS Standards can result in a number of advantageous situations, like as Care that is sensitive to cultural differences can improve patient happiness, trust, and treatment compliance. More individuals are likely to seek out and make use of healthcare services if obstacles are removed and a friendly atmosphere is created. Care that is sensitive to cultural differences can aid in closing the gap between the health outcomes that various communities now face. Better patient involvement and communication can result in more efficient use of resources and more efficient delivery of healthcare. The final section of Mayo Clinic’s Strengths lists the organization’s advantages when it comes to meeting the National CLAS Standards. A friendly atmosphere for LGBTQ+ patients is fostered by policies and practices that demonstrate a commitment to diversity and inclusion. Their focus on patient-centered treatment is consistent with CLAS guidelines. In previous assessments we have discussed about CLAS techniques.
 
Putting money into training gives medical professionals the know-how and abilities to offer treatment that is sensitive to cultural differences. Compared to the general population, LGBTQ+ people have greater incidence of mental health issues like anxiety and depression. Social pressures, discrimination, and stigma can all lead to worse mental health outcomes for LGBTQ+ people. Moreover, Through the use of these tactics and adherence to CLAS guidelines, Mayo Clinic exhibits its dedication to enhancing mental health outcomes and accessibility for the LGBTQ+ community and the general public (T Kamalasundar et al., 2024).
 

NURS FPX 5003 Assessment 4: Essential Components of an Intervention and Health Promotion Plan for Healthcare Improvement and Outcomes

 
Information on health disparities—differences in health outcomes between groups barriers to care factors that make it difficult to get healthcare and social determinants of health factors that affect health outcomes such as social support, education, and income are all gathered as part of the data collection process. Moreover, We can learn more about the unique healthcare requirements of the LGBTQ+ population in Arkansas by gathering data through surveys, focus groups, and community needs assessments. Comparatively speaking to the overall population, LGBTQ+ people have greater incidence of anxiety, depression, and HIV. However, These discrepancies may be exacerbated by stigma, prejudice, and a dearth of healthcare providers who are culturally competent. Setting quantifiable, unambiguous goals is essential. These objectives must to be Time-bound, Relevant, Specific, Measurable, and Achievable. It is crucial to choose therapies that are backed by research. Increasing access to healthcare is one of these tactics.
 
This might entail establishing clinics that are accepting of LGBTQ+ people or providing longer clinic hours. Improving the welcoming atmosphere and educating medical professionals about LGBTQ+ health problems can enhance the quality of service. Giving LGBTQ+ people access to educational resources and support networks can enable them to make knowledgeable health decisions. Additionally, Creating an outreach and education campaign inside the community can be a successful tactic. It is essential to regularly gather data and track advancement toward objectives. Evaluation techniques include questionnaires, focus groups, and inspections of medical records. The plan can be modified in light of the assessment results to make sure it continues to be successful and satisfies the community’s changing requirements. Positive effects for the LGBTQ+ population in Arkansas can be anticipated via the implementation of a customized health promotion plan. More LGBTQ+ people will have access to critical healthcare treatments if barriers are removed.
 
Better tools will enable healthcare professionals to provide inclusive, polite treatment. Moreover, Targeted interventions can contribute to reducing the disparity in health outcomes that exists between the LGBTQ+ group and the broader public. Better access to treatment and services that are culturally sensitive should lead to better results for LGBTQ+ Arkansans’ physical and mental health. However, The strategy has the potential to increase the level of support and involvement for Arkansas’s LGBTQ+ population. By using this framework, Arkansas’s stakeholders may collaborate to create and carry out a comprehensive strategy for health promotion that takes into account the special needs of the LGBTQ+ community, eventually resulting in a more equitable and healthy future for all (Dong et al., 2024).
 

NURS FPX 5003 Assessment 4: Strategies for Promoting Cross-Cultural Collaboration to Enhance Patient Treatment

 
When cancer spreads, patients’ and their families’ burden of psychological and physical problems frequently gets worse. Despite the documented rise in symptoms, it is not clear how these changes impact the patient’s quality of life when they pass away. The purpose of this study is to look at the relationship between alterations in symptom severity and cancer patients’ overall quality of life after they pass away. This is a prospective cohort research conducted internationally. “Cohort” refers to a group of persons the researchers researched who shared comparable features (cancer patients), and “prospective” refers to the participants being tracked over time. “East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process”  was the name of the study that was carried out from 2017 to 2019. It included twenty-two palliative care facilities in Taiwan, South Korea, and Japan.
 
Adults with metastatic or locally advanced cancer were eligible to participate. Each nation had a somewhat different minimum age requirement. Observers  measured the patients’ physical and psychological symptoms when they were first admitted to the palliative care unit and again three days prior to their passing. Each participant’s quality of death was evaluated using a measure called the Good Death Scale, which was created in Taiwan. To find connections between variables, the researchers utilized statistical approaches known as univariate and multivariate regression analyses. Additionally, This aids in their assessment of whether and how variations in the intensity of symptoms might affect the perceived quality of dying. The overall goal of this research is to have a better knowledge of how cancer patients can have a more happy dying experience by managing their symptoms well in the latter stages of their lives. Palliative care aims to enhance the quality of life for individuals suffering from severe diseases by assisting with symptom management and offering spiritual and emotional support. Moreover, Through study on this subject, scholars can provide significant perspectives for enhancing palliative care procedures and perhaps ameliorating the dying process for cancer patients (Huang et al., 2023).
 

NURS FPX 5003 Assessment 4: Strategies Used by Stakeholders to Advocate for Intervention

 
It highlights that different stakeholders may collaborate to ensure the success of the health promotion strategy. People or organizations with a stake in the problem—in this example, LGBTQ+ health—are considered stakeholders.Their participation is essential to providing treatment that is culturally sensitive and attending to the unique health requirements of the LGBTQ+ population. Organizations in the Community. Organizations can offer insightful information and outreach help since they frequently have close relationships to the LGBTQ+ community.
 
Their participation is crucial to the plan’s financing and the possibility of laws supporting LGBTQ+ health equity being passed. Securing the funding required to carry out the strategy can be facilitated by pooling resources from different parties. In order to give healthcare professionals with the information and abilities necessary to offer LGBTQ+ patients with culturally competent care, stakeholders can work together to develop training programs. By working together, we can increase public knowledge of the significance of the health promotion strategy and the health needs of the LGBTQ+ population. Policymakers can collaborate with stakeholders to create regulations that specifically meet the healthcare requirements of the LGBTQ+ community. Examples might include laws that forbid discrimination in healthcare settings or that encourage insurance coverage for LGBTQ+-specific medical services.
 
Healthcare institutions might be encouraged by advocacy activities to establish internal policies and processes that guarantee LGBTQ+ patients are treated equally and with respect. However, This might be installing gender-neutral restrooms or providing LGBTQ+ cultural competence training for staff members. Moreover, In order to increase public knowledge of the particular health needs of the LGBTQ+ population, stakeholders can make use of media channels, including news sources and social media. This may contribute to the public’s support of the strategy for health promotion. The particular objectives and advantages of the health promotion plan can also be successfully promoted through the media, leading to increased community support. LGBTQ+ people frequently experience prejudice in medical settings, which has a negative impact on their health. For LGBTQ+ patients, inclusive, courteous, culturally competent treatment can greatly enhance health outcomes. Stakeholders may make a significant contribution to the health promotion plan’s effectiveness and, eventually, the improvement of the health and well-being of the LGBTQ+ community in Arkansas by encouraging cooperation and pushing for change (Jayanama et al., 2021).
 

NURS FPX 5003 Assessment 4: Professional Communication of Assessment

 
In previous assessments, we have clearly discussed about communication skills of healthcare professionals. By these three assessments we will again discuss it in this assessment. Clear communication between patients and healthcare professionals lowers miscommunication and guarantees that patients receive the best possible care, including follow-up visits. greater patient outcomes, such as greater drug adherence, enhanced chronic disease self-management, and increased patient satisfaction, can result from clear communication. Making sure patients understand their diagnosis, available treatments, potential dangers, and advantages requires avoiding complicated medical jargon and speaking to them in plain, ordinary terms.
 
It shows empathy to take the time to listen intently to patients’ questions, worries, and experiences because it enables physicians to adjust treatment plans appropriately. Certain patients may benefit from visual aids such as drawings or diagrams in addition to spoken explanations to assist them comprehend their illness or the course of therapy. When necessary, using certified interpreters or translators can help break down language barriers and guarantee that patients who don’t understand the healthcare provider’s native language are spoken with clearly. distant consultations between patients and clinicians are made possible via telehealth visits, which improve access to care particularly in distant places. However, Outside of scheduled visits, secure messaging services can help patients and physicians communicate by enabling patients to report any concerns, ask questions, and get clarification on orders. Moreover, Frequent training sessions may give healthcare professionals access to the newest communication best practices, ensuring they remain current and advance their communication abilities. Due to their inadequate health literacy, over half of all persons in the US may find it difficult to comprehend basic medical information. In order to overcome inadequate health literacy and enable patients to make educated decisions about their health, healthcare practitioners must communicate clearly. Incorporating these tactics and cultivating an environment of lucid communication allows healthcare professionals to increase patient trust, enhance the standard of care provided, and enable patients to actively participate in their own health (Nasser et al., 2024).

 

Conclusion

 
The paragraph emphasizes how crucial it is to have a strategy that particularly addresses the unique health needs and obstacles that Arkansas’ LGBTQ+ population faces. The strategy can attempt to lessen health inequalities between the LGBTQ+ group and the general population by recognizing these particular requirements. However, Collaboration across a range of stakeholders, including lawmakers, community-based groups, and healthcare practitioners, is necessary to the plan’s success. Cultural gaps should be closed through this partnership, and everyone’s opinions should be heard. As was previously said, successful cooperation and making sure that all parties are aware of the plan’s objectives and strategies depend on good communication. Moreover, Encouraging equitable treatment and equal access to high-quality healthcare services for all LGBTQ+ Arkansans should be a primary goal of the strategy (Janssens et al., 2024).  The strategy should pinpoint and remove any obstacles that now stand in the way of LGBTQ+ people receiving necessary medical care. The efficacy of the strategy must be regularly monitored and evaluated using quantifiable results (such as healthcare use rates or health indicators). According to the evaluation’s findings, the plan has to be flexible and updated often to stay effective in addressing the community’s changing requirements. Through the implementation of efficacious methods and the advocacy of change, stakeholders may foster a healthcare environment that is more fair for the LGBTQ+ population. However,  The quality of care and health outcomes for LGBTQ+ Arkansans can be significantly improved by a well-executed health promotion plan. LGBTQ+ people frequently encounter prejudice in healthcare settings and have higher incidence of various health issues (Hammoda Abu-Odah et al., 2024).

 

NURS FPX 5003 Assessment 4: References

 
Hammoda Abu-Odah, Engle Angela Chan, & Molassiotis, A. (2024). Factors Impacting on Patient-Centered Communication Skills and Their Opportunities to Be Involved in Decision-making From the Perspective of Patients With Cancer, Informal Caregivers, and/or Healthcare Professionals. Cancer Nursing.https://journals.lww.com/cancernursingonline/abstract/9900/factors_impacting_on_patient_centered.246.aspx
 
Janssens, O., Andreou, V., Mieke Embo, Valcke, M., Olivia De Ruyck, Marieke Robbrecht, & Leen Haerens. (2024). The identification of requirements for competency development during work-integrated learning in healthcare education. BMC Medical Education, 24(1).https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-024-05428-9
 
Huang, H.-L., Chen, P.-J., Mori, M., Suh, S.-Y., Wu, C.-Y., Peng, J.-K., Shih, C.-Y., Yao, C.-A., Tsai, J.-S., Chiu, T.-Y., Hiratsuka, Y., Kim, S.-H., Morita, T., Yamaguchi, T., Satoru Tsuneto, Hui, D., & Cheng, S.-Y. (2023). Improved Symptom Change Enhances Quality of Dying in Patients With Advanced Cancer: An East Asian Cross-Cultural Study. the Oncologist, 29(4), e553–e560.https://academic.oup.com/oncolo/article/29/4/e553/7284047?login=false
 
Dong, X., Du, L., Luo, Z., Xu, Y., Wang, C., Wang, F., Cao, W., Zhao, L., Zheng, Y., Zhu, H., Xia, C., Li, J., Du, M., Hang, D., Ren, J., Shi, J., Shen, H., Chen, W., Li, N., & He, J. (2024). Combining fecal immunochemical testing and questionnaire-based risk assessment in selecting participants for colonoscopy screening in the Chinese National Colorectal Cancer Screening Programs: A population-based cohort study. PLoS Medicine, 21(2), e1004340–e1004340.https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004340
 
T Kamalasundar, R Vengadapathy, A Surekha, TK Pruthu, Suryawanshi, D. M., Divya Rajaseharan, & Suguna Anbazhagan. (2024). Readiness, acceptability, and feasibility of differentiated TB care for COVID-positive pulmonary tuberculosis patients diagnosed in a district in South India: Mixed methods study. Journal of Family Medicine and Primary Care, 13(1), 112–123. https://journals.lww.com/jfmpc/fulltext/2024/13010/readiness,_acceptability,_and_feasibility_of.20.aspx
 
Donoghue, A., Sawyer, T., Olaussen, A., Greif, R., & Toft, L. (2024). Gamified learning for resuscitation education: A systematic review. Resuscitation Plus, 18, 100640–100640. https://www.sciencedirect.com/science/article/pii/S2666520424000912?via%3Dihub
 
Julián Esparza-Romero, & Diana Marcela Valenzuela-Guzmán. (2024). Relationship between food insecurity and malnutrition in schoolchildren from low- and middle-income countries: a systematic review. Nutrición Hospitalaria.https://www.nutricionhospitalaria.org/articles/04847/show
 
Nasser, S. C., Kanbar, R., Btaiche, I. F., Mansour, H., Elkhoury, R., Aoun, C., & Karaoui, L. R. (2024). Entrustable professional activities-based objective structured clinical examinations in a pharmacy curriculum. BMC Medical Education, 24(1).https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-024-05425-y
 
Hassani, B., Tran, T., Prakruti Hansaliya, Kelley, W., Enfinger, R., Nelson, D., & Wright, L. (2023). Successful Extracorporeal Membrane Oxygenation Implementation at a Non-tertiary Medical Center: A Single-Center Experience. Curēus.https://www.cureus.com/articles/185483-successful-extracorporeal-membrane-oxygenation-implementation-at-a-non-tertiary-medical-center-a-single-center-experience
 
Jayanama, K., Theou, O., Godin, J., Cahill, L., Shivappa, N., Hébert, J. R., Wirth, M. D., Park, Y.-M., Fung, T. T., & Rockwood, K. (2021). Relationship between diet quality scores and the risk of frailty and mortality in adults across a wide age spectrum. BMC Medicine, 19(1). https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-01918-5
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