11 results on '"Body max index"'
Search Results
2. Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis
- Author
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Eijiro Okada, Shinichi Ishihara, Koichiro Azuma, Takehiro Michikawa, Satoshi Suzuki, Osahiko Tsuji, Satoshi Nori, Narihito Nagoshi, Mitsuru Yagi, Michiyo Takayama, Takashi Tsuji, Nobuyuki Fujita, Masaya Nakamura, Morio Matsumoto, and Kota Watanabe
- Subjects
diffuse idiopathic skeletal hyperostosis ,metabolic syndrome ,spinal epidural lipomatosis ,body max index ,blood pressure ,spinal ankylosis ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective Diffuse idiopathic skeletal hyperostosis (DISH) causes spinal ankylosis, which can result in patients suffering specific spinal fractures that lead to a reduction in the activities of daily life in older patients. Currently, DISH is associated with diabetes mellitus and cardiovascular disease; however, the association between DISH and metabolic syndrome has not been established. The purpose of this study was to investigate a potential association between DISH and metabolic syndrome. Methods We retrospectively reviewed clinical data from consecutive subjects undergoing the musculoskeletal health medical checkups, and enrolled 327 subjects (174 men and 153 women; mean, 63.4 ± 13.7-years). Subjects who had spinal ankylosis at least 4 contiguous vertebral bodies were classified as the DISH group (n = 39) while the others were part of the non-DISH group (n = 288). The definition of the metabolic syndrome comes from diagnostic criteria used by the Japanese Society for Internal Medicine. Age, sex, body max index (BMI), hematological evaluation, blood pressure, presence of metabolic syndrome, the visceral fat area on abdominal computed tomography, and spinal epidural lipomatosis (SEL) on magnetic resonance imaging were evaluated. Results Compared to the non-DISH group, in the DISH group, mean age (DISH group, 74.3 years; non-DISH group, 1.9 years; p < 0.001), male prevalence were higher (DISH group, 82.1%; non-DISH group, 49.3%; p < 0.001), and BMI was greater (DISH group, 24.8; non-DISH group, 23.0; p = 0.006). the metabolic syndrome was more frequently observed in DISH group (28.9%) than in the non-DISH group (16.0%) (p = 0.045). The visceral fat area was significantly larger in the DISH group than in the non-DISH group (DISH group, 130.7 ± 58.2 cm2; Non-DISH group, 89.0 ± 48.1 cm2; p < 0.001). The prevalence of SEL was similar between the 2 groups (10.3% in the DISH group vs. 8.7% in the nonDISH group; p = 0.464). Poisson regression analysis revealed that the metabolic syndrome was significantly associated with DISH with odds ratio of 2.0 (95% confidence interval, 1.0–3.7; p = 0.004). Conclusion Metabolic syndrome was significantly associated with DISH. Our data showed metabolic syndrome is potentially related to DISH.
- Published
- 2021
- Full Text
- View/download PDF
3. Obesity as an 'infectious' disease
- Author
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Daria Żuraw, Paulina Oleksa, and Mateusz Sobczyk
- Subjects
obesity ,epidemy ,children ,body max index ,Education ,Sports ,GV557-1198.995 ,Medicine - Abstract
Introduction: Obesity has been recognized as a global epidemic by the WHO, followed by a wealth of empirical evidence supporting its contagiousness. However, the dynamics of the spread of obesity between individuals are rarely studied. A distinguishing feature of the obesity epidemic is that it is driven by a process of social contagion that cannot be perfectly described by the infectious disease model. There is also social discrimination in the obesity epidemic. Social discrimination against obese people plays quite different roles in two cases: on the one hand, when obesity cannot be eliminated, social discrimination can reduce the number of obese people; on the other hand, when obesity is eradicable, social discrimination can cause it to explode.(1) Materiał and methods: A literature analysis on obesity epidemic was carried out within the Pubmed, Google scholar and Research Gate platform. The following keywords were used in serach: obesity, epidemy, children, body max index. Purpose of the work: The aim of the following analysis is to present an obesity as an infectious disease. The steadily increasing percentage of obese people, including children, shows that there is an obesity epidemic. This is the phenomenon of social contagion, which partially explains the concept of homophily, which involves the grouping of people with similar characteristics. Potential explanations are also provided by sharing a living environment with similar access to certain foods and similar opportunities for physical activity, which defines the occurrence of analogous health habits
- Published
- 2021
- Full Text
- View/download PDF
4. Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis
- Author
-
Masaya Nakamura, Satoshi Nori, Eijiro Okada, Kota Watanabe, Mitsuru Yagi, Shinichi Ishihara, Nobuyuki Fujita, Michiyo Takayama, Osahiko Tsuji, Morio Matsumoto, Koichiro Azuma, Narihito Nagoshi, Takashi Tsuji, Satoshi Suzuki, and Takehiro Michikawa
- Subjects
medicine.medical_specialty ,Lipomatosis ,Gastroenterology ,lcsh:RC346-429 ,Spinal ankylosis ,Diabetes mellitus ,Internal medicine ,medicine ,Ankylosis ,lcsh:Neurology. Diseases of the nervous system ,Diffuse idiopathic skeletal hyperostosis ,Diffuse Idiopathic Skeletal Hyperostosis ,business.industry ,Odds ratio ,medicine.disease ,Metabolic syndrome ,Confidence interval ,Spinal epidural lipomatosis ,Blood pressure ,Body max index ,Original Article ,Surgery ,Neurology (clinical) ,business - Abstract
Objective Diffuse idiopathic skeletal hyperostosis (DISH) causes spinal ankylosis, which can result in patients suffering specific spinal fractures that lead to a reduction in the activities of daily life in older patients. Currently, DISH is associated with diabetes mellitus and cardiovascular disease; however, the association between DISH and metabolic syndrome has not been established. The purpose of this study was to investigate a potential association between DISH and metabolic syndrome. Methods We retrospectively reviewed clinical data from consecutive subjects undergoing the musculoskeletal health medical checkups, and enrolled 327 subjects (174 men and 153 women; mean, 63.4 ± 13.7-years). Subjects who had spinal ankylosis at least 4 contiguous vertebral bodies were classified as the DISH group (n = 39) while the others were part of the non-DISH group (n = 288). The definition of the metabolic syndrome comes from diagnostic criteria used by the Japanese Society for Internal Medicine. Age, sex, body max index (BMI), hematological evaluation, blood pressure, presence of metabolic syndrome, the visceral fat area on abdominal computed tomography, and spinal epidural lipomatosis (SEL) on magnetic resonance imaging were evaluated. Results Compared to the non-DISH group, in the DISH group, mean age (DISH group, 74.3 years; non-DISH group, 1.9 years; p < 0.001), male prevalence were higher (DISH group, 82.1%; non-DISH group, 49.3%; p < 0.001), and BMI was greater (DISH group, 24.8; non-DISH group, 23.0; p = 0.006). the metabolic syndrome was more frequently observed in DISH group (28.9%) than in the non-DISH group (16.0%) (p = 0.045). The visceral fat area was significantly larger in the DISH group than in the non-DISH group (DISH group, 130.7 ± 58.2 cm2; Non-DISH group, 89.0 ± 48.1 cm2; p < 0.001). The prevalence of SEL was similar between the 2 groups (10.3% in the DISH group vs. 8.7% in the nonDISH group; p = 0.464). Poisson regression analysis revealed that the metabolic syndrome was significantly associated with DISH with odds ratio of 2.0 (95% confidence interval, 1.0–3.7; p = 0.004). Conclusion Metabolic syndrome was significantly associated with DISH. Our data showed metabolic syndrome is potentially related to DISH.
- Published
- 2021
5. Prevalence, clinical characteristics, risk factors, and indicators for lean Chinese adults with nonalcoholic fatty liver disease
- Author
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Rui-Nan Zhang, Ying Hu, Qin Pan, Rui-Xu Yang, Guang-Yu Chen, Chao Sun, Jian-Gao Fan, and Jing Zeng
- Subjects
Male ,China ,medicine.medical_specialty ,Polymorphism, Single Nucleotide ,digestive system ,Triglyceride ,Gastroenterology ,Body Mass Index ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Liver Function Tests ,Reference Values ,Risk Factors ,Retrospective Study ,Internal medicine ,Nonalcoholic fatty liver disease ,Prevalence ,Humans ,Mass Screening ,Medicine ,Triglycerides ,Ultrasonography ,Fatty liver index ,business.industry ,nutritional and metabolic diseases ,Chinese adults ,gamma-Glutamyltransferase ,General Medicine ,Middle Aged ,medicine.disease ,digestive system diseases ,Liver ,Body max index ,chemistry ,030220 oncology & carcinogenesis ,Waist circumference ,Female ,Lean ,030211 gastroenterology & hepatology ,business ,Biomarkers ,Non-alcoholic fatty liver disease - Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic diseases in the world. Nowadays, the percentage of non-obese or lean patients with NAFLD is increasing. NAFLD in non-obese populations, especially the lean subgroup with a normal waist circumference (WC), might lead to more problems than obese individuals, as these individuals may not visit clinics for NAFLD diagnosis or ignore the diagnosis of NAFLD. If the precise characteristics of these populations, especially the lean subgroup, are identified, the clinicians would be able to provide more appropriate advice and treatment to these populations. AIM To investigate the prevalence, clinical characteristics, risk factors, and possible indicators for NAFLD in lean Chinese adults with a normal WC. METHODS People without diabetes mellitus or significant alcohol consumption who underwent routine health examinations were included. Their fatty liver index (FLI), abdominal ultrasonography results, and controlled attenuation parameter were all assessed. Genotyping for single-nucleotide polymorphisms associated with NAFLD was performed in another small group consisting of biopsy-proven NAFLD subjects and healthy controls. RESULTS A total of 2715 subjects who underwent routine health examinations were included in the study. Among 810 lean participants with a normal WC, 142 (17.5%) fulfilled the diagnostic criteria for NAFLD. Waist-height ratio, hemoglobin, platelets, and triglycerides were significant factors associated with the presence of NAFLD in these participants. The appropriate cut-off value of the FLI score in screening for NAFLD in the lean subjects with a normal WC was 25.15, which had a 77.8% sensitivity and 75.9% specificity. There was no significant difference in the single-nucleotide polymorphisms in the SIRT1, APOC3, PNPLA3, AGTR1, and PPARGC1A genes between lean subjects with and without NAFLD (P < 0.05). CONCLUSION NAFLD is not uncommon in lean Chinese adults even with a normal WC. Metabolic factors, rather than genetic factors, may play important roles in the development of NAFLD in this population. A lower cut-off value of the FLI score in screening for NAFLD should be used for lean Chinese adults with a normal WC.
- Published
- 2020
6. Indice di massa corporeo materno e allattanmento al seno.
- Author
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Druil, L., Forzano, L., Londero, A. P., Fachechi, G., Liva, S., and Marchesoni, D.
- Published
- 2012
7. Well-Being, Obesity and Motricity Observatory in Childhood and Youth (WOMO): A Study Protocol
- Author
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Miguel Ángel García-Gordillo, María Mendoza-Muñoz, Jorge Carlos-Vivas, Jorge Pérez-Gómez, Laura Muñoz-Bermejo, and Jose C. Adsuar
- Subjects
Gerontology ,Pediatric Obesity ,Health, Toxicology and Mutagenesis ,Happiness ,Physical fitness ,lcsh:Medicine ,literacy ,Personal Satisfaction ,body max index ,Overweight ,self-perceived ,0302 clinical medicine ,Physical literacy ,Protocol ,030212 general & internal medicine ,Child ,fitness ,Research Design ,medicine.symptom ,strength ,Psychology ,Sports ,motor-skills ,lifestyle ,medicine.medical_specialty ,Adolescent ,physical condition ,Motor Activity ,Childhood obesity ,03 medical and health sciences ,Quality of life (healthcare) ,medicine ,Humans ,Exercise ,obese ,business.industry ,Public health ,lcsh:R ,Public Health, Environmental and Occupational Health ,Bullying ,030229 sport sciences ,Anthropometry ,medicine.disease ,Nature ,Self Concept ,Cross-Sectional Studies ,Physical Fitness ,Spain ,Well-being ,Quality of Life ,business ,Follow-Up Studies - Abstract
Background: Childhood obesity is one of the greatest public health problems facing advanced societies, and Spain is one of the countries with the highest incidence. There are many studies that monitor at the national level, but given the lack of specificity, lack of updating and scarcity of epidemiological data on overweight, obesity, physical condition and well-being of children and adolescents in Extremadura, it seems necessary to create a Well-being, Obesity and Motricity Observatory in Childhood and Youth (WOMO) in Extremadura in order to follow up on the evolution of this problem and to propose strategies to combat it. Therefore, this project aims (1) to obtain information on the physical condition, body composition and well-being of children and youth in Extremadura every year and (2) to evaluate the relationship between obesity, overweight, physical condition, well-being, self-perceived physical fitness, physical activity adherence, physical literacy, health-related quality of life (HRQoL), happiness and satisfaction with life, connection with nature, barriers to sports practice, self-concept and bullying in children and youth. Methods: An annual monitoring cross-sectional and follow-up study will be performed. Primary outcome measures will be (1) personal data and anthropometric measurements, (2) family and school information, (3) physical condition, (4) obesity and overweight level, and (5) well-being. Secondary outcome measures will be (1) self-perceived physical fitness, (2) physical activity adherence, (3) physical literacy, (4) HRQoL, (5) happiness and satisfaction with life, (6) connection with nature, (7) barriers to sports practice, (8) self-concept and (9) bullying. Discussion: This project will provide valuable information to adopt appropriate strategies to reduce the level of overweight and obesity in children and youth. Furthermore, orientations will be given to transfer the results obtained to the business sector or to the public sector to evaluate or change the policies adopted.
- Published
- 2020
8. Diferencias de composición corporal y condición fisica en educadoras de párvulo con normopeso, sobrepeso y obesidad: estudio transversal
- Author
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Zapata-Lamana, Rafael, Monsalves-Alvarez, Matías, Cigarroa Cuevas, Igor, Castro-Sepúlveda, Mauricio, Salazar Rodríguez, Gabriela, and Abad-Colil, Felipe
- Subjects
aptitud física ,body composition ,faculty ,índice de masa corporal ,physical fitness ,docentes ,body max index ,composición corporal - Abstract
Objetivo: Describir el índice de masa corporal (IMC), composición corporal, la tasa metabólica basal, condición física y su relación en educadoras de párvulos chilenas. Sujetos y Métodos: 46 educadoras (edad 39,5±8,6) de la provincia de Bio-Bio (Chile) se pesaron, midieron y se obtuvo su IMC. Se midió el porcentaje de masa grasa, magra, ósea, tasa metabólica basal, fuerza explosiva y capacidad cardiorrespiratoria. Resultados: Las educadoras tuvieron un IMC promedio de sobrepeso (26,7±3,5) y un elevado porcentaje de grasa (35,1±5,9) de acuerdo a referencias nacionales. El 58,7% de ellas presentó sobrepeso y obesidad moderada. Cuando se comparó por IMC, las educadoras con obesidad presentaron en promedio un mayor porcentaje de masa grasa (P =,000), menor de masa magra (P =,000), demoraron más tiempo en terminar el UKK test (P =,035) y tuvieron un menor vo2max (P =,001) en comparación a las educadoras con normopeso. El IMC se asoció negativamente a los test de rendimiento físico. Conclusión: Las maestras con sobrepeso/obesidad presentaron más masa grasa, menos masa muscular y peores resultados en las pruebas de condición física. Condición preocupante pensando en su importante rol modelando hábitos de vida saludables en los prescolares. Objective: To describe body mass index (BMI), body composition, basal metabolic rate, physical condition and the relation-ship between them in Chilean kindergarten teachers. Subjects and Methods: 46 teachers (age 39,5 ± 8,6) from the Bio Bio province(Chile) were weighed and heighted and BMI was measured. In addition, fat mass, lean and bone percentages, basal metabolic rate, muscular strength and cardiorespiratory fitness were measured. Results: The teachers had an average BMI of overweight (26,7 ± 3,5) and a high fat percentage (35,1 ± 5,9) according to national reference values. 58,7%were overweight and moderately obese. When teachers were compared according BMI, teachers with obesity had on average a higher percentage of fat mass (P =,000), less lean mass (P = ,000), took more time to complete the UKK test (P = ,035 ) and had a lower vo2max (P = ,001) than normal weight teachers. BMI had a negative association in relation to scores of the physical performance test. Conclusions: The overweight/obese teachers had more fat mass, reduced muscle mass and had worse results on fitness tests. Condition worrying thinking about the important role in modeling healthy habits to preschoolers.
- Published
- 2016
9. Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis.
- Author
-
Okada E, Ishihara S, Azuma K, Michikawa T, Suzuki S, Tsuji O, Nori S, Nagoshi N, Yagi M, Takayama M, Tsuji T, Fujita N, Nakamura M, Matsumoto M, and Watanabe K
- Abstract
Objective: Diffuse idiopathic skeletal hyperostosis (DISH) causes spinal ankylosis, which can result in patients suffering specific spinal fractures that lead to a reduction in the activities of daily life in older patients. Currently, DISH is associated with diabetes mellitus and cardiovascular disease; however, the association between DISH and metabolic syndrome has not been established. The purpose of this study was to investigate a potential association between DISH and metabolic syndrome., Methods: We retrospectively reviewed clinical data from consecutive subjects undergoing the musculoskeletal health medical checkups, and enrolled 327 subjects (174 men and 153 women; mean, 63.4 ± 13.7-years). Subjects who had spinal ankylosis at least 4 contiguous vertebral bodies were classified as the DISH group (n = 39) while the others were part of the non-DISH group (n = 288). The definition of the metabolic syndrome comes from diagnostic criteria used by the Japanese Society for Internal Medicine. Age, sex, body max index (BMI), hematological evaluation, blood pressure, presence of metabolic syndrome, the visceral fat area on abdominal computed tomography, and spinal epidural lipomatosis (SEL) on magnetic resonance imaging were evaluated., Results: Compared to the non-DISH group, in the DISH group, mean age (DISH group, 74.3 years; non-DISH group, 1.9 years; p < 0.001), male prevalence were higher (DISH group, 82.1%; non-DISH group, 49.3%; p < 0.001), and BMI was greater (DISH group, 24.8; non-DISH group, 23.0; p = 0.006). the metabolic syndrome was more frequently observed in DISH group (28.9%) than in the non-DISH group (16.0%) (p = 0.045). The visceral fat area was significantly larger in the DISH group than in the non-DISH group (DISH group, 130.7 ± 58.2 cm2; Non-DISH group, 89.0 ± 48.1 cm2; p < 0.001). The prevalence of SEL was similar between the 2 groups (10.3% in the DISH group vs. 8.7% in the nonDISH group; p = 0.464). Poisson regression analysis revealed that the metabolic syndrome was significantly associated with DISH with odds ratio of 2.0 (95% confidence interval, 1.0-3.7; p = 0.004)., Conclusion: Metabolic syndrome was significantly associated with DISH. Our data showed metabolic syndrome is potentially related to DISH.
- Published
- 2021
- Full Text
- View/download PDF
10. Prevalence, clinical characteristics, risk factors, and indicators for lean Chinese adults with nonalcoholic fatty liver disease.
- Author
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Zeng J, Yang RX, Sun C, Pan Q, Zhang RN, Chen GY, Hu Y, and Fan JG
- Subjects
- Biomarkers analysis, China epidemiology, Female, Humans, Liver diagnostic imaging, Liver pathology, Liver Function Tests methods, Liver Function Tests statistics & numerical data, Male, Mass Screening statistics & numerical data, Middle Aged, Non-alcoholic Fatty Liver Disease blood, Non-alcoholic Fatty Liver Disease diagnosis, Non-alcoholic Fatty Liver Disease metabolism, Polymorphism, Single Nucleotide, Prevalence, Reference Values, Risk Factors, Triglycerides blood, Triglycerides metabolism, Ultrasonography, gamma-Glutamyltransferase blood, Body Mass Index, Mass Screening methods, Non-alcoholic Fatty Liver Disease epidemiology, Waist Circumference
- Abstract
Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic diseases in the world. Nowadays, the percentage of non-obese or lean patients with NAFLD is increasing. NAFLD in non-obese populations, especially the lean subgroup with a normal waist circumference (WC), might lead to more problems than obese individuals, as these individuals may not visit clinics for NAFLD diagnosis or ignore the diagnosis of NAFLD. If the precise characteristics of these populations, especially the lean subgroup, are identified, the clinicians would be able to provide more appropriate advice and treatment to these populations., Aim: To investigate the prevalence, clinical characteristics, risk factors, and possible indicators for NAFLD in lean Chinese adults with a normal WC., Methods: People without diabetes mellitus or significant alcohol consumption who underwent routine health examinations were included. Their fatty liver index (FLI), abdominal ultrasonography results, and controlled attenuation parameter were all assessed. Genotyping for single-nucleotide polymorphisms associated with NAFLD was performed in another small group consisting of biopsy-proven NAFLD subjects and healthy controls., Results: A total of 2715 subjects who underwent routine health examinations were included in the study. Among 810 lean participants with a normal WC, 142 (17.5%) fulfilled the diagnostic criteria for NAFLD. Waist-height ratio, hemoglobin, platelets, and triglycerides were significant factors associated with the presence of NAFLD in these participants. The appropriate cut-off value of the FLI score in screening for NAFLD in the lean subjects with a normal WC was 25.15, which had a 77.8% sensitivity and 75.9% specificity. There was no significant difference in the single-nucleotide polymorphisms in the SIRT1 , APOC3 , PNPLA3 , AGTR1 , and PPARGC1A genes between lean subjects with and without NAFLD ( P < 0.05)., Conclusion: NAFLD is not uncommon in lean Chinese adults even with a normal WC. Metabolic factors, rather than genetic factors, may play important roles in the development of NAFLD in this population. A lower cut-off value of the FLI score in screening for NAFLD should be used for lean Chinese adults with a normal WC., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
11. Well-Being, Obesity and Motricity Observatory in Childhood and Youth (WOMO): A Study Protocol.
- Author
-
Mendoza-Muñoz M, Adsuar JC, Pérez-Gómez J, Muñoz-Bermejo L, Garcia-Gordillo MÁ, and Carlos-Vivas J
- Subjects
- Adolescent, Bullying, Child, Cross-Sectional Studies, Exercise, Follow-Up Studies, Happiness, Humans, Motor Activity, Nature, Personal Satisfaction, Physical Fitness, Research Design, Self Concept, Spain epidemiology, Sports, Overweight epidemiology, Pediatric Obesity epidemiology, Quality of Life
- Abstract
Background: Childhood obesity is one of the greatest public health problems facing advanced societies, and Spain is one of the countries with the highest incidence. There are many studies that monitor at the national level, but given the lack of specificity, lack of updating and scarcity of epidemiological data on overweight, obesity, physical condition and well-being of children and adolescents in Extremadura, it seems necessary to create a Well-being, Obesity and Motricity Observatory in Childhood and Youth (WOMO) in Extremadura in order to follow up on the evolution of this problem and to propose strategies to combat it. Therefore, this project aims (1) to obtain information on the physical condition, body composition and well-being of children and youth in Extremadura every year and (2) to evaluate the relationship between obesity, overweight, physical condition, well-being, self-perceived physical fitness, physical activity adherence, physical literacy, health-related quality of life (HRQoL), happiness and satisfaction with life, connection with nature, barriers to sports practice, self-concept and bullying in children and youth., Methods: An annual monitoring cross-sectional and follow-up study will be performed. Primary outcome measures will be (1) personal data and anthropometric measurements, (2) family and school information, (3) physical condition, (4) obesity and overweight level, and (5) well-being. Secondary outcome measures will be (1) self-perceived physical fitness, (2) physical activity adherence, (3) physical literacy, (4) HRQoL, (5) happiness and satisfaction with life, (6) connection with nature, (7) barriers to sports practice, (8) self-concept and (9) bullying., Discussion: This project will provide valuable information to adopt appropriate strategies to reduce the level of overweight and obesity in children and youth. Furthermore, orientations will be given to transfer the results obtained to the business sector or to the public sector to evaluate or change the policies adopted.
- Published
- 2020
- Full Text
- View/download PDF
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