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This rapid review summarizes the most up to date evidence about the risk factors for severe food-induced allergic reactions. We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88 studies and synthesized the evidence narratively, undertaking meta-analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking, although food-dependent exercise-induced anaphylaxis may be an exception. Some medications such as beta-blockers or ACE inhibitors may increase severity, but appear less important than age as a factor in life-threatening reactions. The relationship between dose of exposure and severity is unclear. Delays in symptom recognition and anaphylaxis treatment have been associated with more severe outcomes. An absence of prior anaphylaxis does not exclude its future risk.

The treatment of choice for cutaneous squamous cell carcinoma is complete surgical excision. Incomplete excision of cutaneous squamous cell carcinoma has an increased risk of local recurrence, deep subclinical progression, and metastasis. This study aimed to investigate the proportion and risk factors of incomplete excised cutaneous squamous cell carcinoma. A systematic review of the literature was performed. Incomplete excision rates for cutaneous squamous cell carcinoma ranged from 0.4% to 35.7%. The pooled incomplete excision risk estimate was 13% (95% confidence interval 9-17%). Risk factors noted in more than one study for incomplete excision included tumor depth and size, type of operator, head and neck localization, and former incomplete excision. We found an overall incomplete excision rate of 13% for cutaneous squamous cell carcinoma. Risk factors should be taken into account in the management of cutaneous squamous cell carcinoma surgical treatment.

To date, social sciences have devoted little attention to the processes of expert knowledge production related to the exploitation of unconventional hydrocarbon resources. In this article, we examine an epistemic experiment led by the European Commission, the European Science and Technology Network on Unconventional Hydrocarbon Extraction, which was aimed at producing authoritative knowledge claims on shale energy development. By developing the idiom of ‘co-production’, the article provides a more fine-grained understanding of the processes through which competing knowledge claims, forms of epistemic authority, and new energy publics co-evolve in a situation of highly-politicized controversy. Drawing on our first-hand observations as participants representing the social sciences in the expert network, this article provides an in-depth ethnographic account of the struggles of the European Union authorities to manage and delimit the controversy. In this way, the analysis develops our understanding of the challenges in improving the deliberation of shale gas as a transnational energy policy issue.

Lyme borreliosis (LB) is an important tick-borne disease which can cause a broad range of symptoms mainly affecting the skin, the nervous system and the joints. This study aims to estimate the incidence of the different clinical manifestations of LB in Belgium. The incidence of erythema migrans (EM) was estimated through the network of sentinel general practices at 97.6/100,000 inhabitants (uncertainty interval [UI] 82.0–113.0) for the period 2015–2017. This result was used to estimate the incidence of other LB manifestations based on their proportional distribution (ratios) to EM reported in the neighboring countries of Belgium. To estimate these ratios, we performed a systematic review of studies published between February 1, 2008 and January 31, 2018 and pooled the results using a random effects meta-analysis. Six studies were retained in the systematic review, and the meta-analysis estimated the occurrence ratios for Lyme neuroborreliosis/EM, Lyme arthritis/EM and other manifestations/EM at 0.024 (95% confidence interval [CI] 0.016–0.037), 0.022 (95% CI 0.020–0.024) and 0.014 (95% CI 0.012–0.016) respectively. Applying these ratios to the EM incidence in Belgium resulted in an incidence estimation of 2.4/100,000 inhabitants (95% UI 1.5–3.7) for Lyme neuroborreliosis, 2.1/100,000 (95% UI 1.7–2.6) for Lyme arthritis and 1.4/100,000 (95% UI 1.1–1.7) for other less frequent manifestations. Some of these LB manifestations, other than EM, are more severe, hence these estimates are essential to assess the health burden and economic cost of LB which would be highly relevant for patients, healthcare providers and policymakers. As both over- and underestimation of different clinical LB manifestations remain possible due to characteristics of the primary surveillance systems and the disease itself, future studies to validate these estimates would be of great value.

Background: anaphylaxis is a severe, systemic hypersensitivity reaction that can be potentially life-threatening. Anaphylaxis during oral food challenge is not uncommon and can usually be effectively managed with intramuscular adrenaline as first line treatment. Although very rare, fatal anaphylaxis during in-hospital food challenge has been reported. Objective: we describe our experience of cases of refractory anaphylaxis at in-hospital challenge and propose a framework for escalation of treatment in such cases using intravenous infusion of adrenaline which has been adopted for widespread use elsewhere. Methods: we present four patients who all experienced severe life-threatening anaphylaxis, refractory to intramuscular adrenaline treatment, during supervised oral food challenges. Patient data were collected from contemporaneous notes, and patient consent was obtained. Results: in all four cases, the anaphylaxis reactions were amenable to treatment with low-dose intravenous adrenaline, with no reported adverse effects. Conclusion and clinical relevance: these cases demonstrate the need for clinicians undertaking higher risk allergen challenges to be able to manage cases of severe anaphylaxis refractory to intramuscular adrenaline, and to consider a framework for managing these reactions. While peripheral intravenous adrenaline infusions should always be initiated only in conjunction with expert input, the protocol suggested is simple enough to be undertaken within the hospital environment while more experienced support is obtained.

Abstract Background With more than 20,000 asylum seekers arriving every year, healthcare for this population has become an important issue. Pregnant asylum seekers seem to be at risk of poor pregnancy outcomes. This study aimed to assess the difference in pregnancy outcomes between asylum seekers and the local Dutch population and to identify potential substandard factors of care. Methods Using a retrospective study design we compared pregnancy outcomes of asylum-seeking and Dutch women who gave birth in a northern region of the Netherlands between January 2012 and December 2016. The following data were compared: perinatal mortality, maternal mortality, gestational age at delivery, preterm delivery, birth weight, small for gestational age children, APGAR score, intrauterine foetal death, mode of delivery and the need for pain medication. Cases of perinatal mortality in asylum seekers were reviewed for potential substandard factors. Results A total of 344 Asylum-seeking women and 2323 Dutch women were included. Asylum seekers had a higher rate of perinatal mortality (3.2% vs. 0.6%, p = 0.000) including a higher rate of intrauterine foetal death (2.3% vs. 0.2%, p = 0.000), higher gestational age at birth (39 + 4 vs. 38 + 6 weeks, p = 0.000), labour was less often induced (36.9 vs. 43.8, p = 0.016), postnatal hospitalization was longer (2.24 vs. 1.72 days p = 0.006) and they received more opioid analgesics (27.3% vs. 22%, p = 0.029). Babies born from asylum-seeking women had lower birth weights (3265 vs. 3385 g, p = 0.000) and were more often small for gestational age (13.9% vs. 8.4%, p = 0.002). Multivariate analysis showed that the increased risk of perinatal mortality in asylum-seeking women was independent of parity, birth weight and gestational age at birth. Review of the perinatal mortality cases in asylum seekers revealed possible substandard factors, such as late initiation of antenatal care, missed appointments because of transportation problems, not recognising alarm symptoms, not knowing who to contact and transfer to other locations during pregnancy. Conclusion Pregnant asylum seekers have an increased risk of adverse pregnancy outcomes. More research is needed to identify which specific risk factors are involved in poor perinatal outcomes in asylum seekers and to identify strategies to improve perinatal care for this group of vulnerable women.

Background Primary health care (PHC), of which preventive medicine (PM) is a subspecialty, will have to cope with a deficiency of staff in the future, which makes the retention of graduates urgent. This study was conducted in Vietnam, where PM is an undergraduate degree in parallel to medical training. It aims to identify facilitating and hindering factors that impact recruitment and retention of PM graduates in the specialty. Methods A cross-sectional study enrolled 167 graduates who qualified as PM doctors from a Vietnamese medical school, between 2012 and 2018. Data were collected via an online questionnaire that asked participants about their motivation and continuation in PM, the major life roles that they were playing, and their satisfaction with their job. Multiple regression analyses were used to identify which life roles and motivational factors were related to the decision to take a PM position and to stay in the specialty, as well as how these factors held for subgroups of graduates (men, women, graduates who studied PM as their first or second study choice). Results Half of the PM graduates actually worked in PM, and only one fourth of them expressed the intention to stay in the field. Three years after qualification, many graduates had not yet decided whether to pursue a career in PM. Satisfaction with opportunities for continuous education was rated as highly motivating for graduates to choose and to stay in PM. Responsibility for taking care of parents motivated male graduates to choose PM, while good citizenship and serving the community was associated with the retention of graduates for whom PM was their first choice. Conclusions The findings demonstrate the importance of social context and personal factors in developing primary care workforce policy. Providing opportunities for continued education and enhancing the attractiveness of PM as an appropriate specialty to doctors who are more attached to family and the community could be solutions to maintaining the workforce in PM. The implications could be useful for other less popular specialties that also struggle with recruiting and retaining staff.

The treatment of choice for cutaneous squamous cell carcinoma is complete surgical excision. Incomplete excision of cutaneous squamous cell carcinoma has an increased risk of local recurrence, deep subclinical progression, and metastasis. This study aimed to investigate the proportion and risk factors of incomplete excised cutaneous squamous cell carcinoma. A systematic review of the literature was performed. Incomplete excision rates for cutaneous squamous cell carcinoma ranged from 0.4% to 35.7%. The pooled incomplete excision risk estimate was 13% (95% confidence interval 9-17%). Risk factors noted in more than one study for incomplete excision included tumor depth and size, type of operator, head and neck localization, and former incomplete excision. We found an overall incomplete excision rate of 13% for cutaneous squamous cell carcinoma. Risk factors should be taken into account in the management of cutaneous squamous cell carcinoma surgical treatment.

Background Although local treatments for cervical intraepithelial neoplasia (CIN) are highly effective, it has been reported that treated women remain at increased risk of cervical and other cancers. Our aim is to explore the risk of developing or dying from cervical cancer and other human papillomavirus (HPV)- and non-HPV-related malignancies after CIN treatment and infer its magnitude compared with the general population. Materials and methods Design: Systematic review and meta-analysis. Eligibility criteria: Studies with registry-based follow-up reporting cancer incidence or mortality after CIN treatment. Data synthesis: Summary effects were estimated using random-effects models. Outcomes Incidence rate of cervical cancer among women treated for CIN (per 100 000 woman-years). Relative risk (RR) of cervical cancer, other HPV-related anogenital tract cancer (vagina, vulva, anus), any cancer, and mortality, for women treated for CIN versus the general population. Results Twenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100 000 woman-years (95% confidence interval 22–69). The RR of cervical cancer was elevated compared with the general population (3.30, 2.57–4.24; P

Occupational health has become a major issue in the context of Western economies, marked by the ageing of the labour force. In most European countries, the legal retirement age has been significantly reduced since the beginning of the 2000s. At the same time, the number of early retirements for health reasons is tending to increase. This issue has become particularly sensitive in the UK, where the reforms of 2006-07 resulted in the elimination of most of the early retirement opportunities that existed, particularly in the public sector. In the postal sector, where Royal Mail employees enjoyed one of the most advantageous pension schemes, numerous reforms have been introduced since the end of the 2000s with serious consequences for workers. In particular, changes in calculation methods deprived them of a significant proportion of the amounts they should have received. However, a number of rights were restored at the time of privatisation in 2013, thanks to the signing of the Agenda for Growth agreement. And at the time of our research, the main postal workers' union, the CWU, had just secured a new agreement to maintain the benefits of the Royal Mail's special pension scheme, a reduction in working hours and an increase in pay., La santé au travail est devenue un enjeu majeur dans le contexte des économies occidentales, marquées par le vieillissement de la population active. Dans la plupart des pays européens, l'âge légal de la retraite a été significativement reculé depuis le début des années 2000. Dans le même temps, le nombre de cessations anticipées d'activité pour raisons de santé tend à s'accroître. Cette problématique est devenue particulièrement sensible au Royaume-Uni où les réformes des années 2006-2007 ont abouti à éliminer la plupart des possibilités de départs anticipés à la retraite qui existaient, notamment dans le secteur public. Dans le secteur postal où les employés de Royal Mail bénéficiaient de l'un des régimes de retraite les plus avantageux, de nombreuses réformes ont été introduites depuis la fin des années 2000, aux conséquences lourdes pour les salariés. Notamment, l'évolution des modes de calcul les privait d'une partie significative des montants qu'ils auraient dû percevoir. Un certain nombre de droits ont toutefois pu être rétablis au moment de la privatisation, en 2013, grâce à la signature de l'accord Agenda for Growth. Et au moment où notre recherche s'achevait, le principal syndicat de postiers, le CWU, venait d'obtenir un nouvel accord en faveur du maintien des avantages du régime de retraite spécifique des salariés de Royal Mail, d'une réduction du temps de travail et d'une augmentation des salaires.

Quantitative risk assessment (QRA) for food allergens has made considerable progress in recent years, yet acceptability of its outcomes remains stymied because of the limited extent to which it has been possible to incorporate severity as a variable. Reaction severity, particularly following accidental exposure, depends on multiple factors, related to the allergen, the host and any treatments, which might be administered. Some of these factors are plausibly still unknown. Quantitative risk assessment shows that limiting exposure through control of dose reduces the rates of reactions in allergic populations, but its impact on the relative frequency of severe reactions at different doses is unclear. Food challenge studies suggest that the relationship between dose of allergenic food and reaction severity is complex even under relatively controlled conditions. Because of these complexities, epidemiological studies provide very limited insight into this aspect of the dose-response relationship. Emerging data from single-dose challenges suggest that graded food challenges may overestimate the rate of severe reactions. It may be necessary to generate new data (such as those from single-dose challenges) to reliably identify the effect of dose on severity for use in QRA. Success will reduce uncertainty in the susceptible population and improve consumer choice.

Quantitative risk assessment (QRA) for food allergens has made considerable progress in recent years, yet acceptability of its outcomes remains stymied because of the limited extent to which it has been possible to incorporate severity as a variable. Reaction severity, particularly following accidental exposure, depends on multiple factors, related to the allergen, the host and any treatments, which might be administered. Some of these factors are plausibly still unknown. Quantitative risk assessment shows that limiting exposure through control of dose reduces the rates of reactions in allergic populations, but its impact on the relative frequency of severe reactions at different doses is unclear. Food challenge studies suggest that the relationship between dose of allergenic food and reaction severity is complex even under relatively controlled conditions. Because of these complexities, epidemiological studies provide very limited insight into this aspect of the dose-response relationship. Emerging data from single-dose challenges suggest that graded food challenges may overestimate the rate of severe reactions. It may be necessary to generate new data (such as those from single-dose challenges) to reliably identify the effect of dose on severity for use in QRA. Success will reduce uncertainty in the susceptible population and improve consumer choice.

Background and Aims Although clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision-makers need tools to assess the Return on Investment (ROI)/cost-effectiveness of programmes. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, the Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe themethods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking. Methods EQUIPTMOD uses a Markov model to estimate life-time costs, quality-adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tool's potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country-specific rates. Results For illustration, over a life-time horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in 4961 pound higher disease-related health care costs than if the smoker ceased smoking in the next 12months. For all age-sex categories, costs were lower and QALYs higher for those who quit smoking in the 12 months than those who continued. Conclusions EQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level.

© 2018 The Author(s). Transcriptional profiles and host-response biomarkers are used increasingly to investigate the severity, subtype and pathogenesis of disease. We now describe whole-blood mRNA signatures and concentrations of local and systemic immunological mediators in 131 adults hospitalized with influenza, from whom extensive clinical and investigational data were obtained by MOSAIC investigators. Signatures reflective of interferon-related antiviral pathways were common up to day 4 of symptoms in patients who did not require mechanical ventilator support; in those who needed mechanical ventilation, an inflammatory, activated-neutrophil and cell-stress or death ('bacterial') pattern was seen, even early in disease. Identifiable bacterial co-infection was not necessary for this 'bacterial' signature but was able to enhance its development while attenuating the early 'viral' signature. Our findings emphasize the importance of timing and severity in the interpretation of host responses to acute viral infection and identify specific patterns of immune-system activation that might enable the development of novel diagnostic and therapeutic tools for severe influenza.

Background: Stillbirth is a global health problem. The World Health Organization (WHO) application of the International Classification of Diseases for perinatal mortality (ICD-PM) aims to improve data on stillbirth to enable prevention.Objectives: To identify globally reported causes of stillbirth, classification systems, and alignment with the ICD-PM.Search strategy: We searched CINAHL, EMBASE, Medline, Global Health, and Pubmed from 2009 to 2016.Selection criteria: Reports of stillbirth causes in unselective cohorts.Data collection and analysis: Pooled estimates of causes were derived for country representative reports. Systems and causes were assessed for alignment with the ICD-PM. Data are presented by income setting (low, middle, and high income countries; LIC, MIC, HIC).Main results: Eighty-five reports from 50 countries (489089 stillbirths) were included. The most frequent categories were Unexplained, Antepartum haemorrhage, and Other (all settings); Infection and Hypoxic peripartum (LIC), and Placental (MIC, HIC). Overall report quality was low. Only one classification system fully aligned with ICD-PM. All stillbirth causes mapped to ICD-PM. In a subset from HIC, mapping obscured major causes.Conclusions: There is a paucity of quality information on causesof stillbirth globally. Improving investigation of stillbirthsand standardisation of audit and classification is urgently needed and should be achievable in all well-resourced settings. Implementation of the WHO Perinatal Mortality Audit and Review guide is needed, particularly across high burden settings.

This article provides a time series of coin and money supply estimates for six hundred years of English history. Two main estimation methods are proposed. The first (the direct method) is used to measure the value of government-provided, legal-tender coin supply only. Two varieties of the direct method are proposed. Additionally, an indirect method is proposed which relies on a combination of information about nominal GDP with an assumption regarding the evolution of velocity in time, and which can be used to calculate coin supply and M2. Both methods rely on benchmark values known for certain years, but no particular benchmark is determinant for the results. The new methodologies set out here may serve as a blueprint for a similar reconstruction of coin and money supply series for other economies for which analogous data are available.

Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases Perinatal Mortality (ICD-PM), and next steps. During the period from 2009 to 2014, a total of 81 new or modified classification systems were identified with the majority developed in high-income countries (HICs). Structure, definitions and rules and therefore data on causes vary widely and implementation is suboptimal. Whereas system testing is limited, none appears ideal. Several systems result in a high proportion of unexplained stillbirths, prompting HICs to use more detailed systems that require data unavailable in low-income countries. Some systems appear to perform well across these different settings. ICD-PM addresses some shortcomings of ICD-10 for perinatal deaths, but important limitations remain, especially for stillbirths. A global approach to classification is needed and seems feasible. The new. ICD-PM system is an important step forward and improvements will be enhanced by wide-scale use and evaluation. Implementation requires national-level support and dedicated resources. Future research should focus on implementation strategies and evaluation methods, defining placental pathologies, and ways to engage parents in the process. (C) 2017 Elsevier Ltd. All rights reserved.

SUMMARYSeasonal respiratory illnesses present a major burden on primary care services. We assessed the burden of respiratory illness on a national telehealth system in England and investigated the potential for providing early warning of respiratory infection. We compared weekly laboratory reports for respiratory pathogens with telehealth calls (NHS 111) between week 40 in 2013 and week 29 in 2015. Multiple linear regression was used to identify which pathogens had a significant association with respiratory calls. Children aged

Tuberculosis (TB)-related stigma is an important social determinant of health. Research generally highlights how stigma can have a considerable impact on individuals and communities, including delays in seeking health care and adherence to treatment. There is scant research into the assessment of TB-related stigma in low incidence countries. This study aimed to systematically map out the research into stigma. A particular emphasis was placed on the methods employed to measure stigma, the conceptual frameworks used to understand stigma, and whether structural factors were theorized. Twenty-two studies were identified; the majority adopted a qualitative approach and aimed to assess knowledge, attitudes, and beliefs about TB. Few studies included stigma as a substantive topic. Only one study aimed to reduce stigma. A number of studies suggested that TB control measures and representations of migrants in the media reporting of TB were implicated in the production of stigma. The paucity of conceptual models and theories about how the social and structural determinants intersect with stigma was apparent. Future interventions to reduce stigma, and measurements of effectiveness, would benefit from a stronger theoretical underpinning in relation to TB stigma and the intersection between the social and structural determinants of health. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license.

Highlights\ud •Tuberculosis (TB)-related stigma is an important social determinant of health that can impact health-seeking practices and illness management.\ud •Much research on TB-related stigma has been conducted in high incidence countries.\ud •This study aimed to systematically map out the research in low incidence countries.\ud •Few studies included stigma as a substantive topic; only one study aimed to reduce stigma.\ud •Both TB control programmes and media reporting were implicated in the production of stigma.\ud •Few studies theorized how stigma intersects with the social and structural determinants of health.\ud •Future interventions to reduce stigma would benefit from a stronger theoretical underpinning in relation to stigma and the intersection with the social determinants.\ud \ud Summary\ud Tuberculosis (TB)-related stigma is an important social determinant of health. Research generally highlights how stigma can have a considerable impact on individuals and communities, including delays in seeking health care and adherence to treatment. There is scant research into the assessment of TB-related stigma in low incidence countries. This study aimed to systematically map out the research into stigma. A particular emphasis was placed on the methods employed to measure stigma, the conceptual frameworks used to understand stigma, and whether structural factors were theorized. Twenty-two studies were identified; the majority adopted a qualitative approach and aimed to assess knowledge, attitudes, and beliefs about TB. Few studies included stigma as a substantive topic. Only one study aimed to reduce stigma. A number of studies suggested that TB control measures and representations of migrants in the media reporting of TB were implicated in the production of stigma. The paucity of conceptual models and theories about how the social and structural determinants intersect with stigma was apparent. Future interventions to reduce stigma, and measurements of effectiveness, would benefit from a stronger theoretical underpinning in relation to TB stigma and the intersection between the social and structural determinants of health.

Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product's value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making.

Objective: To explore dietary differences according to socio-economic andsociocultural characteristics of adolescents and young adults.Design: A systematic review was conducted.Setting: The main search source was MEDLINE, consulted between January 2012and March 2017. Quality of selected studies was assessed based on dietarymeasurement method, sample selection, socio-economic indicator choice andstatistical modelling.Participants: Cross-sectional and longitudinal studies, assessing relationshipsbetween socio-economic status and dietary intake (patterns, scores and foodgroups) in the 10- to 40-year-old general population of high-income countries,were selected.Results: Among the 7250 reports identified, forty were selected, seventeen of whichwere of high quality; their conclusions, related only to adolescents, were combinedand presented. The most favourable dietary patterns, higher dietary scores, greaterconsumption of fruits, vegetables and dairy products, and lower consumption ofsugary sweetened beverages and energy-dense foods, were associated with betterparental socio-economic status, particularly in terms of higher education. Migrantstatus was associated with plant-based patterns, greater consumption of fruits andvegetables and of sugary sweetened beverages and energy-dense foods. For theother food groups, and for young adults, very few high-quality studies were found.Conclusions: The socio-economic gradient in adolescent diets requires confirmationby higher-grade studies of a wider set of food groups and must be extended toyoung adult populations. Future nutritional interventions should involve the mostvulnerable adolescent populations, taking account of socio-economic status andmigration., info:eu-repo/semantics/published

À l’issue d’une croissance effrénée et particulièrement saluée au début des années 2000, le droit antidiscriminatoire semble arrivé en France à l’heure du bilan. Outre sa difficile effectivité, qui questionne les modalités de sa réalisation, une analyse rétrospective et critique laisse surtout poindre un sentiment de confusion. Tant et si bien que la doctrine s’interroge : considérant l’« amateurisme des députés, et la gadgétisation, voire le mépris, dont fait l'objet en France le droit de la non-discrimination », serait-il devenu « un droit pour rire » ? (Calvès, G). Cette confusion mise en cause, engendrée par une profusion mal maîtrisée des dispositions et le développement de protections hétérogènes, pourrait être appréhendée via le concept de fragmentation du droit. Il serait même possible de formuler l’hypothèse d’une double fragmentation du droit antidiscriminatoire, matérielle et formelle. Face à ce constat, la perspective d’une défragmentation mériterait d’être envisagée, principalement axée autour d’une technique de rationalisation du dispositif législatif : la consolidation. After a frenzied growth that has been particularly welcomed in the early 2000s, the appraisal of antidiscrimination law in France is now required. Obviously, its lack of effectiveness poses a challenge in order to conceive its realization process. Besides this issue, a retrospective and critical analysis reveals first and foremost a huge sense of confusion of antidiscrimination law. Scholars start to wonder : considering the "amateurism of some deputies, the gadgetisation, or even the contempt that affect ATD law in France”, has it become "a law to laugh about" ? (Calves, G). This harmful confusion, caused by a poorly controlled profusion of provisions as well as by the development of variable protections, could be grasped through the concept of fragmentation (i.e. splintering) of the law. It’s even possible to argue a double fragmentation of ATD law, material and formal. Consequently, the prospect of defragmentation should be considered and mainly focused on consolidation as a technique of legal writing rationalization.

Despite seeming superficially paradoxical, palliative care and survivorship care may have more in common than in opposition. An increased focus on collaboration and a pursuit of shared strategies may foster significant opportunities to both fields.

To prevent protein energy malnutrition (PEM) and accumulation of waste products, dialysis patients require diet adjustments. Dietary intake assessed by self-reported intakes often provides biased information and standard 24-h urinary excretion is inapplicable in dialysis patients. We aimed to assess dietary intake via a complementary, less biased biomarker method, and to compare this to dietary diaries. Additionally, we investigated the prospective association of creatinine excretion rate (CER) reflecting muscle mass with mortality. Complete intradialytic dialysate and interdialytic urinary collections were used to calculate 24-h excretion of protein, sodium, potassium, phosphate and creatinine in 42 chronic dialysis patients and compared with protein, sodium, potassium, and phosphate intake assessed by 5-day dietary diaries. Cox regression analyses were employed to investigate associations of CER with mortality. Mean age was 64 &plusmn, 13 years and 52% were male. Complementary biomarker assessed (CBA) and dietary assessed (DA) protein intake were significantly correlated (r = 0.610, p &lt, 0.001), but there was a constant bias, as dietary diaries overestimated protein intake in most patients. Correlations were found between CBA and DA sodium intake (r = 0.297, p = 0.056), potassium intake (r = 0.312, p = 0.047) and phosphate uptake/intake (r = 0.409, p = 0.008). However, Bland-Altman analysis showed significant proportional bias. During a median follow-up of 26.6 (25.3&ndash, 31.5) months, nine dialysis patients (23%) died. CER was independently and inversely associated with survival (HR: 0.59 (0.42&ndash, 0.84), p = 0.003). Excretion measurements may be a more reliable assessment of dietary intake in dialysis patients, as this method is relatively free from biases known to exist for self-reported intakes. CER seems to be a promising tool for monitoring PEM.

Background: Hepatitis E virus (HEV) is endemic in large parts of the developing world. Waterborne transmission of genotypes 1 or 2 commonly causes acute hepatitis, which is usually self-limited in healthy individuals. In addition, acute HEV infections also occur outside endemic areas, mostly related to foodborne transmission of HEV genotype 3. A growing number of publications in the last decade have reported chronic infection progressing to cirrhosis in immunosuppressed patients. It has also been suggested that HEV transmission may occur via contaminated blood products. This publication aims to provide recommendations for diagnosis, prevention, and treatment of HEV infection, particularly in children after solid organ transplantation.Methods: A systematic PubMed literature search on HEV infection from 1990 to January 2016 was performed focusing on pediatric studies. The existing body of evidence was reviewed and recommendations were agreed upon following discussion and unanimous agreement by all members of the ESPGHAN Hepatology Committee during a consensus meeting in January 2016. In the absence of randomized controlled studies these recommendations were considered to be expert opinions.Key Recommendations: Immunocompetent children with increased transaminases and/or extrahepatic manifestations should be considered for testing for evidence of HEV infection. Immunocompromised children with increased aminotransferases should be repeatedly tested for HEV and may require therapeutic intervention.

The 1984 Bhopal accident in India resulted in severe consequences with more than a thousand people dying in the immediate vicinity of the Union Carbide facility. After this tragedy, the implementation of landuse and zoning restrictions around hazardous installations got accepted worldwide as an important strategy reducing consequences from potential industrial accidents. Many European countries have already formulated specific landuse planning policies taking industrial risks into account. However, till date India is yet to effectively employ risk assessment techniques for landuse planning decisions around industrial clusters, as well as the relevant acceptability or tolerability criteria are yet to be formulated. In this paper, we have applied the classical quantitative risk assessment method to map cumulative risk levels arising from a number of hazardous installations located in Haldia, a densely populated area where several industrial plants storing and processing dangerous substances are located. The risk maps were prepared using common GIS tools and functions, and their sensitivity to various factors ascertained using uncertainty analysis techniques. Through the analysis of some reference plants, the aim of the paper is to underline the current difficulties an analyst has to face to determine confident risk maps as a basis for planning the uses of land due to deficiencies in the Indian legislation and the lack of guidelines. (C) 2015 Elsevier Ltd. All rights reserved.

A key element of quantifying both the hazard and risk due to induced earthquakes is a suite of appropriate ground‐motion prediction equations (GMPEs) that encompass the possible shaking levels due to such events. Induced earthquakes are likely to be of smaller magnitude and shallower focal depth than the tectonic earthquakes for which most GMPEs are derived. Furthermore, whereas GMPEs for moderate‐to‐large magnitude earthquakes are usually derived to be transportable to different locations and applications, taking advantage of the limited regional dependence observed for such events, the characteristics of induced earthquakes warrant the development of application‐specific models. A preliminary ground‐motion model for induced seismicity in the Groningen gas field in The Netherlands is presented as an illustration of a possible approach to the development of these equations. The GMPE is calibrated to local recordings of small‐magnitude events and captures the epistemic uncertainty in the extrapolation to larger magnitude considered in the assessment of the resulting hazard and risk.

Jusqu’où sommes-nous prêts à aller pour encourager les justiciables à régler leurs conflits à l’amiable ? Ce mémoire s’intéresse au phénomène de la médiation obligatoire comme outil pour favoriser l’accès à la justice. Par une étude comparée des différents modèles mis en place, notamment au Canada, en Australie, en Italie et au Royaume-Uni, nous cherchons à déboulonner certains mythes liés à la médiation obligatoire. Répondant aux critiques qui sont souvent portées à ce phénomène, ce mémoire étudie l’effet de la contrainte à intégrer le processus sur les bénéfices traditionnellement associés à la médiation. Il aborde aussi les dangers de cette obligation, notamment quant à l’équilibre des pouvoirs entre les parties. De manière plus concrète, il questionne aussi les avantages économiques de la médiation obligatoire et les effets qu’une telle obligation peut avoir sur les délais judiciaires. Enfin, en s’inspirant des différents programmes mis en place, l’étude repère les conditions de réussite d’une obligation de médiation, notamment quant au choix du modèle, aux modalités d’exclusions prévues, à la prise en charge des honoraires du médiateur, à la place des avocats dans la médiation et aux différents éléments culturels qui peuvent influencer la réussite d’un programme de médiation obligatoire., How far are we willing to go to encourage litigants to settle their disputes amicably? This thesis focuses on the phenomenon of mandatory mediation as a tool to promote access to justice. Through a comparative study of the various mandatory schemes in place, notably in Canada, Australia, Italy and the United Kingdom, the author seeks to debunk certain myths regarding mandatory mediation. Responding to criticisim that is often made of this phenomenon, this thesis studies the effect of the coercion to integrate the process on the benefits traditionally associated with mediation. It also addresses the dangers of this obligation, including the balance of power between the parties. Moreover, it questions the economic benefits of mandatory mediation and the effects that such an obligation may have on judicial delays. Finally, inspired by the various programs already in place, it identifies the conditions for success of a mandatory mediation scheme, particularly with regard to the choice of model, the possibilities to be exempted of it, the payment of the mediator's fees, the lawyers place in the mediation process and the cultural elements that can influence the success of a mandatory mediation program.

We examine ‘fracking’ for shale gas extraction in England, France, and Algeria, framed from the perspective of level of acceptance by communities and general public. We explore the extent to which public participation in decision-making should play a role in fracking regulation, and evaluate whether the level of public participation matches the legal requirements. Our position on the adequacy of fracking regulation is from the perspective of the public dissenter, outlining a legal and normative basis for public participation in decision-making on fracking. We highlight relevant laws and policies to understand and evaluate adequacy of relevant regulatory processes. We offer strong yet nuanced argumentation, creating space for further discussion by academics, the public, regulators, local decision-makers, fracking companies and others. This is not a typical social-psychology, legal, sociology, or human geography research paper, as we take a position from the beginning: that the public ought to be involved in decisions related to the regulation of fracking, and argue that we validate our approach by supporting our claims throughout the work.

Suite à la crise de 2008 et aux décisions politiques prises pour y répondre, le Royaume-Uni est confronté à une géopolitique de l’austérité. Certains enjeux interdépendants, parfois préexistants, sont alors renforcés et reconfigurés : émergence d’un vote protestataire, montée des nationalismes et des régionalismes, Brexit, rivalités locales ou revendications de décentralisation. Cette géopolitique de l’austérité révèle les lignes de faille du Royaume-Uni, Etat multi-nations, dont l’équilibre institutionnel et identitaire semble fragilisé. Après une analyse multiscalaire de la montée des votes protestataires depuis 2008, cet article étudie les stratégies de résistance face à la politique d’austérité dans des territoires spécifiques, notamment l’Ecosse et le Nord de l’Angleterre. The United Kingdom is confronted with a geopolitics of austerity, following the 2008 crisis and governments’ policies. Several interdependent issues, sometimes pre-existing, are then strengthened and reconfigured: emergence of a protest vote, rise of nationalisms and regionalisms, Brexit, local rivalries or claims for decentralisation. This geopolitics of austerity reveals the fault lines of the United Kingdom, a multi-nation state, whose institutional stability and unity seems weakened. After a multiscalar analysis of the rise of protest votes since 2008, this paper examines the strategies of resistance to the austerity policy in specific territories, especially Scotland and Northern England.

Objective The analysis of ill-health related job loss may be a relevant indicator for the prioritization of actions in the workplace or in the field of public health, as well as a target for health promotion. The aim of this study was to analyze the medical causes, the incidence, and the characteristics of employees medically unfit to do their job. Methods This one-year prospective study included all workers followed by occupational physicians in an occupational health service in the south of France. The incidence of unfitness for work have been grouped according to the main medical causes and analyzed. We performed a multivariate analysis in order to adjust the observed risk of job loss based on the age groups, sex, occupation and the activity sectors. Results A total of 17 occupational physicians followed up 51,132 workers. The all-cause incidence of being unfit to return to one’s job was 7.8‰ (n = 398). The two main causes of being unfit for one’s job were musculoskeletal disorders (47.2%, n = 188) and mental ill-health (38.4%, n = 153). Being over 50 years old (Odds ratio (OR) 2.63, confidence interval 95% CI [2.13–3.25]) and being a woman (OR 1.52, 95% CI [1.21–1.91]) were associated with the all-cause unfitness, independent of occupation and activity sector. Conclusions Identification of occupational and demographic determinants independently associated with ill-health related job loss may provide significant and cost-effective arguments for health promotion and job loss prevention.

BACKGROUND AND AIMS: Although clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision makers need tools to assess the return on investment (ROI)/cost effectiveness of programs. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe the methods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking. METHODS: EQUIPTMOD uses a Markov model to estimate lifetime costs, quality adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tool’s potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country specific rates. RESULTS: For illustration, over a lifetime horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in £4,961 higher disease related health care costs - than if the smoker ceased smoking in the next 12 months. For all age-sex categories, costs were lower and QALYs higher for those who quit smoking in the twelve months than those who continued. CONCLUSIONS: EQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level.

There are several key unsolved issues relating to the clinical use of next generation sequencing, such as: should laboratories report variants of uncertain significance (VUS) to clinicians and/or patients? Should they reinterpret VUS in response to growing knowledge in the field? And should patients be recontacted regarding such results? We systematically analyzed 58 consent forms in English used in the diagnostic context to investigate their policies for (a) reporting VUS, (b) reinterpreting variants, including who should initiate this, and (c) recontacting patients and the mechanisms for undertaking any recontact. One-third (20/58) of the forms did not mention VUS in any way. Of the 38 forms that mentioned VUS, only half provided some description of what a VUS is. Approximately one-third of forms explicitly stated that reinterpretation of variants for clinical purposes may occur. Less than half mentioned recontact for clinical purposes, with variation as to whether laboratories, patients, or clinicians should initiate this. We suggest that the variability in variant reporting, reinterpretation, and recontact policies and practices revealed by our analysis may lead to diffused responsibility, which could result in missed opportunities for patients or family members to receive a diagnosis in response to updated variant classifications. Finally, we provide some suggestions for ethically appropriate inclusion of policies for reporting VUS, reinterpretation, and recontact on consent forms. ispartof: EUROPEAN JOURNAL OF HUMAN GENETICS vol:26 issue:12 pages:1743-1751 ispartof: location:England status: published

Background Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The meanings of the phrase “social exclusion”, and the closely associated term “social inclusion”, are contested in the literature. Both of these concepts are important in relation to health and the area of primary healthcare in particular. Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed. Methods A scoping review of the peer-reviewed and grey literature was conducted to examine tools developed since 2000 that measure social exclusion or social inclusion. We focused on those measurement tools developed for use with individual patients in healthcare settings. Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. All tools retrieved were compared in tables, and the specific domains that were included in each measure were tabulated. Results Twenty-two measurement tools were included in the final scoping review. The majority of these had been specifically developed for the measurement of social inclusion or social exclusion, but a small number were created for the measurement of other closely aligned concepts. The majority of the tools included were constructed for engaging with patients in mental health settings. The tools varied greatly in their design, the scoring systems and the ways they were administered. The domains covered by these tools varied widely and some of the tools were quite narrow in the areas of focus. A review of the definitions of both social inclusion and social exclusion also revealed the variations among the explanations of these complex concepts. Conclusions There are several definitions of both social inclusion and social exclusion in use and they differ greatly in scope. While there are many tools that have been developed for measuring these concepts in healthcare settings, these do not have a primary healthcare focus. There is a need for the development of a tool for measuring social inclusion or social exclusion in primary healthcare settings. Electronic supplementary material The online version of this article (10.1186/s12939-018-0732-1) contains supplementary material, which is available to authorized users.

Rapid advances in microarray and sequencing technologies are making genotyping and genome sequencing more affordable and readily available. There is an expectation that genomic sequencing technologies improve personalized diagnosis and personalized drug therapy. Concurrently, provision of direct-to-consumer genetic testing by commercial providers has enabled individuals’ direct access to their genomic data. The expanded availability of genomic data is perceived as influencing the relationship between the various parties involved including healthcare professionals, researchers, patients, individuals, families, industry, and government. This results in a need to revisit their roles and responsibilities. In a 1-day agenda-setting meeting organized by the COST Action IS1303 “Citizen’s Health through public-private Initiatives: Public health, Market and Ethical perspectives,” participants discussed the main challenges associated with the expanded availability of genomic information, with a specific focus on public-private partnerships, and provided an outline from which to discuss in detail the identified challenges. This paper summarizes the points raised at this meeting in five main parts and highlights the key cross-cutting themes. In light of the increasing availability of genomic information, it is expected that this paper will provide timely direction for future research and policy making in this area. Funding Deborah Mascalzoni is supported under Grant Agreement number 305444. Álvaro Mendes is supported by the FCT—The Portuguese Foundation for Science and Technology under postdoctoral grant SFRH/BPD/88647/2012. Isabelle Budin-Ljøsne receives support from the National Research and Innovation Platform for Personalized Cancer Medicine funded by The Research Council of Norway (NFR BIOTEK2021/ES495029) and Biobank Norway funded by The Research Council of Norway—grant number 245464. Heidi Carmen Howard is partly supported by supported by the Swedish Foundation for Humanities and Social Science under grant M13-0260:1), the Biobanking and Molecular Resource Infrastructure of Sweden (BBMRI.se) and the BBMRI-ERIC. Brígida Riso is supported by the Portuguese Foundation for Science and Technology (FCT) under the PhD grant SFRH/BD/100779/2014. Heidi Beate Bentzen receives support from the project Legal Regulation of Information Processing relating to Personalized Cancer Medicine funded by The Research Council of Norway BIOTEK2021/238999.

Foot-and-mouth disease (FMD) is a highly contagious disease of livestock affecting animal production and trade throughout Asia and Africa. Understanding FMD virus (FMDV) global movements and evolution can help to reconstruct the disease spread between endemic regions and predict the risks of incursion into FMD-free countries. Global expansion of a single FMDV lineage is rare but can result in severe economic consequences. Using extensive sequence data we have reconstructed the global space-time transmission history of the O/ME-SA/Ind-2001 lineage (which normally circulates in the Indian sub-continent) providing evidence of at least 15 independent escapes during 2013–2017 that have led to outbreaks in North Africa, the Middle East, Southeast Asia, the Far East and the FMD-free islands of Mauritius. We demonstrated that sequence heterogeneity of this emerging FMDV lineage is accommodated within two co-evolving divergent sublineages and that recombination by exchange of capsid-coding sequences can impact upon the reconstructed evolutionary histories. Thus, we recommend that only sequences encoding the outer capsid proteins should be used for broad-scale phylogeographical reconstruction. These data emphasise the importance of the Indian subcontinent as a source of FMDV that can spread across large distances and illustrates the impact of FMDV genome recombination on FMDV molecular epidemiology.

We examined the association between statin use and the risk of rheumatoid arthritis (RA), with special focus on describing the patterns of risks of RA during statin exposure in a large population-based cohort in the United Kingdom. In the Clinical Practice Research Datalink, patients aged ≥40 years with at least one prescription of statins (1995–2009) were selected, and matched by age (+/-5 years), sex, practice and date of first prescription of statins to non-users. The follow-up period of statin use was divided into periods of current, recent and past exposure, with patients moving between these three exposure categories over time. Time-dependent Cox models were used to derive hazard ratios (HRs) of RA, adjusted for disease history and previous drug use. The study population included 1,023,240 patients, of whom 511,620 were statin users. No associations were found between RA and current (HRadj,1.06;99%CI:0.88–1.27) or past statin users (HRadj,1.18;99%CI:0.88–1.57). However, in patients who currently used statins, hazard rates were increased shortly after the first prescription of statins and then gradually decreased to baseline level. The risk of developing RA was increased in recent statin users, as compared to non-users (HRadj,1.39;99% CI:1.01–1.90). The risk of RA is substantially increased in the first year after the start of statins and then diminishes to baseline level. These findings may suggest that statins might accelerate disease onset in patients susceptible to develop RA, but in other patients, statins are probably safe and well tolerated, even after prolonged use. Alternatively, we cannot rule out that confounding by cardiovascular risk factors and ascertainment bias may have influenced the findings.

This article provides a time series of coin and money supply estimates for six hundred years of English history. Two main estimation methods are proposed. The first (the direct method) is used to measure the value of government-provided, legal-tender coin supply only. Two varieties of the direct method are proposed. Additionally, an indirect method is proposed which relies on a combination of information about nominal GDP with an assumption regarding the evolution of velocity in time, and which can be used to calculate coin supply and M2. Both methods rely on benchmark values known for certain years, but no particular benchmark is determinant for the results. The new methodologies set out here may serve as a blueprint for a similar reconstruction of coin and money supply series for other economies for which analogous data are available.

Objective Our objectives were to explore the changes in the level of interest in risk-sharing agreements (RSAs) in the EU during the last 15 years and the underlying reasons for these changes. Methods A systematic literature review was conducted using PubMed, Scopus, Web of Science, and Embase. Articles identified were divided into ‘quantitative articles’ used to establish the level of interest and ‘qualitative articles’ used to identify the underlying trends in RSAs. Results The literature search retrieved 2144 scientific articles. Data were extracted from 238 articles. Of these, 100 contained quantitative data and 138 contained qualitative data. The pace of articles being published about RSAs grew significantly in 2015, which related to the increase in interest in and knowledge about RSAs. The underlying reasons for the fluctuations were condensed into four overall themes: (1) push for value-based pricing, (2) economic crisis and further push to contain costs, (3) criticism of RSAs in the real world, and (4) diversification of RSAs to fit the purpose. Conclusion The overall level of interest in RSAs in the EU has been increasing since 2000; therefore, articles reporting the number of RSAs implemented and case studies have been steadily growing as evidence is becoming more readily available. The number of qualitative articles reporting and discussing the underlying reasons for these changes in interest has largely fluctuated over the last 15 years. Despite these fluctuations, interest in RSAs remains high. Electronic supplementary material The online version of this article (doi:10.1007/s41669-017-0044-1) contains supplementary material, which is available to authorized users.

Background:Dietary assessment is complex, and strategies to select the most appropriate dietary assessment tool (DAT) in epidemiological research are needed. The DIETary Assessment Tool NETwork (DIET@NET) aimed to establish expert consensus on Best Practice Guidelines (BPGs) for dietary assessment using self-report.Methods:The BPGs were developed using the Delphi technique. Two Delphi rounds were conducted. A total of 131 experts were invited, and of these 65 accepted, with 48 completing Delphi round I and 51 completing Delphi round II. In all, a total of 57 experts from North America, Europe, Asia and Australia commented on the 47 suggested guidelines.Results:Forty-three guidelines were generated, grouped into the following four stages: Stage I. Define what is to be measured in terms of dietary intake (what? who? and when?); Stage II. Investigate different types of DATs; Stage III. Evaluate existing tools to select the most appropriate DAT by evaluating published validation studies; Stage IV. Think through the implementation of the chosen DAT and consider sources of potential biases.Conclusions:The Delphi technique consolidated expert views on best practice in assessing dietary intake. The BPGs provide a valuable guide for health researchers to choose the most appropriate dietary assessment method for their studies. These guidelines will be accessible through the Nutritools website, www.nutritools.org.