interventions

干预措施
  • 文章类型: Journal Article
    目的:虽然以前已经描述了导致牙科抗生素过度处方的因素,先前的工作缺乏任何可以指导未来干预发展的理论行为改变框架。这项研究的目的是使用基于证据的概念模型来确定牙医适当抗生素处方的障碍和促进因素,作为旨在修改抗生素处方的未来干预措施的指南。
    方法:对国家牙科实践研究网络(PBRN)的牙医进行了半结构化访谈,探讨了患者和实践因素对抗生素处方的影响。录音电话采访由三名研究人员转录并独立编码。围绕COM-B模型组织主题,为前瞻性干预提供信息。
    结果:对104名牙医中的73名(70.1%)进行了访谈。大多数是普通牙医(86.3%),男性(65.7%),和白色(69.9%)。编码确定了三个广泛的目标,以支持牙医中适当的牙科抗生素处方:(1)提高指南的知名度和可及性,(2)在没有明确指南的情况下,提供有关牙科情况下抗生素处方的额外指导,(3)教育和沟通技巧的建立,重点是与患者和医生讨论适当的抗生素使用。
    结论:我们的研究结果与其他关注牙医抗生素处方行为的研究结果一致。了解牙科抗生素处方的促进者和障碍对于告知有针对性的干预措施以改善适当的抗生素处方是必要的。未来的干预措施应侧重于实施多式联运策略,为牙医提供必要的支持,以明智地开处方抗生素。
    OBJECTIVE: While factors contributing to dental antibiotic overprescribing have previously been described, previous work has lacked any theoretical behavior change framework that could guide future intervention development. The purpose of this study was to use an evidence-based conceptual model to identify barriers and facilitators of appropriate antibiotic prescribing by dentists as a guide for future interventions aimed at modifying antibiotic prescribing.
    METHODS: Semi-structured interviews were conducted with dentists from the National Dental Practice Based Research Network (PBRN) exploring patient and practice factors perceived to impact antibiotic prescribing. Audio-recorded telephone interviews were transcribed and independently coded by three researchers. Themes were organized around the COM-B model to inform prospective interventions.
    RESULTS: 73 of 104 dentists (70.1%) were interviewed. Most were general dentists (86.3%), male (65.7%), and white (69.9%). Coding identified three broad targets to support appropriate dental antibiotic prescribing among dentists: (1) increasing visibility and accessibility of guidelines, (2) providing additional guidance on antibiotic prescribing in dental scenarios without clear guidelines, and (3) education and communication skills-building focused on discussing appropriate antibiotic use with patients and physicians.
    CONCLUSIONS: The findings from our study are consistent with other studies focusing on antibiotic prescribing behavior in dentists. Understanding facilitators and barriers to dental antibiotic prescribing is necessary to inform targeted interventions to improve appropriate antibiotic prescribing. Future interventions should focus on implementing multimodal strategies to provide the necessary support for dentists to judiciously prescribe antibiotics.
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  • 文章类型: Journal Article
    Given the unpleasant nature of social isolation and loneliness (SIL) and their negative effects on health and wellbeing, interventions are needed. However, persistent issues in the design, evaluation, and reporting of SIL interventions preclude conclusive evidence and commentary on the effectiveness of SIL interventions. Here, we propose guidelines for evaluating SIL interventions, firstly by operationalising them into two categories: (1) interventions aiming to reduce SIL as a primary outcome and (2) interventions aiming to improve non-SIL outcomes in the lives of individuals experiencing SIL. Secondly, we evaluate instruments for measuring SIL and research designs for studying intervention effectiveness. Thirdly, guidelines for reporting information about the intervention, study design, results, and discussion in SIL intervention studies are presented. These guidelines will help researchers to better and more consistently report on SIL interventions and improve comparability of SIL interventions, ultimately contributing to the improvement of interventions and to the mitigation of SIL.
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  • 文章类型: Journal Article
    The cardiac computed tomography (CT) practice guidelines provide an updated review of the technological improvements since the publication of the first Canadian Association of Radiologists (CAR) cardiac CT practice guidelines in 2009. An overview of the current evidence supporting the use of cardiac CT in the most common clinical scenarios, standards of practice to optimize patient preparation and safety as well as image quality are described. Coronary CT angiography (CCTA) is the focus of Part I. In Part II, an overview of cardiac CT for non-coronary indications that include valvular and pericardial imaging, tumour and mass evaluation, pulmonary vein imaging, and imaging of congenital heart disease for diagnosis and treatment monitoring are discussed. The guidelines are intended to be relevant for community hospitals and large academic centres with established cardiac CT imaging programs.
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  • 文章类型: Journal Article
    背景:在调查对光的非视觉反应的研究中,报告光特征没有共识。该项目旨在为基于实验室的调查制定报告清单,以研究光线对非视觉生理学的影响。
    方法:进行了国际专家参与的四步改进的Delphi过程(三轮基于问卷的反馈和一次面对面的小组讨论),以就清单中的项目达成共识。在达成共识之后,由此产生的清单在试点阶段由独立专家进行了测试。
    结果:与报告基于光的干预措施有关的61个项目的初始列表浓缩为包含25个项目的最终清单,基于专家的共识(最终n=60)。无论研究问题或背景如何,都认为有九个项目需要报告。每个项目的描述在随附的解释和详细说明(E&E)文档中提供。独立的试点测试阶段导致检查表和E&E文档中的少量文字说明。
    结论:ENLIGHT清单是第一个基于共识的清单,用于记录和报告人类研究中基于眼部光线的干预措施。核对表的实施将通过确保全面的文件,增强基于光的研究的影响,增强再现性,并实现跨研究的数据聚合。
    背景:欧洲高级研究所(NETIAS)建设性高级思维(CAT)计划网络;亨利·惠康爵士博士后奖学金(惠康信托,204686/Z/16/Z);荷兰卫生研究与发展组织VENI研究金(2020-09150161910128);美国国防部赠款(W81XWH-16-1-0223);新加坡国立大学(NUHSRO/2022/038/Startup/08);和新加坡国家研究基金会(NRF2022-THE004-0002)。
    BACKGROUND: There is no consensus on reporting light characteristics in studies investigating non-visual responses to light. This project aimed to develop a reporting checklist for laboratory-based investigations on the impact of light on non-visual physiology.
    METHODS: A four-step modified Delphi process (three questionnaire-based feedback rounds and one face-to-face group discussion) involving international experts was conducted to reach consensus on the items to be included in the checklist. Following the consensus process, the resulting checklist was tested in a pilot phase with independent experts.
    RESULTS: An initial list of 61 items related to reporting light-based interventions was condensed to a final checklist containing 25 items, based upon consensus among experts (final n = 60). Nine items were deemed necessary to report regardless of research question or context. A description of each item is provided in the accompanying Explanation and Elaboration (E&E) document. The independent pilot testing phase led to minor textual clarifications in the checklist and E&E document.
    CONCLUSIONS: The ENLIGHT Checklist is the first consensus-based checklist for documenting and reporting ocular light-based interventions for human studies. The implementation of the checklist will enhance the impact of light-based research by ensuring comprehensive documentation, enhancing reproducibility, and enabling data aggregation across studies.
    BACKGROUND: Network of European Institutes for Advanced Study (NETIAS) Constructive Advanced Thinking (CAT) programme; Sir Henry Wellcome Postdoctoral Fellowship (Wellcome Trust, 204686/Z/16/Z); Netherlands Organisation for Health Research and Development VENI fellowship (2020-09150161910128); U.S. Department of Defense Grant (W81XWH-16-1-0223); National University of Singapore (NUHSRO/2022/038/Startup/08); and National Research Foundation Singapore (NRF2022-THE004-0002).
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  • 文章类型: Systematic Review
    目标:虽然癌症治疗的进步增加了育龄女性幸存者的数量,它们会损害生殖功能。尽管有国家指导方针,生育服务吸收仍然很低。这篇综述探讨了与美国临床肿瘤学会(ASCO)指南保持一致的生育力保护干预措施,并考虑了多层次框架。
    方法:我们在四个数据库中系统回顾了2006年至2022年的文献。根据CONSORT和TREND陈述清单,对确定的干预措施进行评估和质量评分。综合结果以评估与ASCO指南和四个多水平干预框架特征的干预措施一致性:目标影响水平,概念清晰,方法论实用主义,和可持续性。
    结果:在确定的407篇文章中,本综述包括9种独特的干预措施.平均质量评分为11分的7.7分。没有任何干预是以理论为指导的。根据ASCO指南,大多数(n=8)干预措施包括提供者主导的关于治疗损害生育力的讨论.关于生育力保护方法的讨论较少(n=5)和指定的讨论时间(n=4)。大多数(n=8)将患者转诊给生殖专家,很少(n=2)包括心理社会服务转介。大多数(n=8)是多层次的,五个针对三个层面的影响。尽管瞄准了多个层面,所有分析均在个体水平进行.干预策略包括:教育成分(n=5),辅助决策(n=2),和护士导航员(n=2)。五项干预措施考虑了利益相关者的观点。所有干预措施都是在现实世界中实施的,只有三个人讨论了可持续性。
    结论:本综述确定了ASCO指南-一致的生育力保留方面的关键差距,可以通过更新和遵守标准化的临床实践指南并考虑多层次的实施框架要素来填补这些差距。
    OBJECTIVE: While cancer treatment advancements have increased the number of reproductive-aged women survivors, they can harm reproductive function. Despite national guidelines, oncofertility service uptake remains low. This review explores interventions for fertility preservation alignment with American Society of Clinical Oncology (ASCO) guidelines and consideration of a multilevel framework.
    METHODS: We systematically reviewed literature from 2006 to 2022 across four databases. Identified interventions were assessed and scored for quality based on CONSORT and TREND statement checklists. Results were synthesized to assess for intervention alignment with ASCO guidelines and four multilevel intervention framework characteristics: targeted levels of influence, conceptual clarity, methodologic pragmatism, and sustainability.
    RESULTS: Of 407 articles identified, this review includes nine unique interventions. The average quality score was 7.7 out of 11. No intervention was guided by theory. Per ASCO guidelines, most (n=8) interventions included provider-led discussions of treatment-impaired fertility. Fewer noted discussions on fertility preservation approaches (n=5) and specified discussion timing (n=4). Most (n=8) referred patients to reproductive specialists, and few (n=2) included psychosocial service referrals. Most (n=8) were multilevel, with five targeting three levels of influence. Despite targeting multiple levels, all analyses were conducted at the individual level. Intervention strategies included: educational components (n=5), decision aids (n=2), and nurse navigators (n=2). Five interventions considered stakeholders\' views. All interventions were implemented in real-world contexts, and only three discussed sustainability.
    CONCLUSIONS: This review identifies key gaps in ASCO guideline-concordant fertility preservation that could be filled by updating and adhering to standardized clinical practice guidelines and considering multilevel implementation frameworks elements.
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  • 文章类型: Journal Article
    目的:戒烟干预试验的报告不足是常见的,并给研究人员带来了巨大的挑战。这项研究的目的是定制CONSORT(综合报告试验标准)-SPI(社会和心理干预)指南,以改善行为干预试验的报告,以促进戒烟。
    方法:由IC-SMOKE(SMOKingcEssation中提供的干预和比较组支持)系统综述项目的缺失数据告知,这项研究使用多阶段Delphi方法来检查哪些项目可以添加或修改以改善戒烟试验的报告.第一阶段涉及对17名戒烟和试验方法方面的国际专家进行在线调查,对纳入最新指南的项目的重要性进行投票。随后举行了由其中15名专家参加的面对面专家共识会议,商定最终纳入和排除新项目和修改。使用了9点李克特量表来建立共识,建议的修改需要75%或更多的协议。第一阶段的分歧在第二阶段再次提出,供讨论和第二轮投票。仅包括达到协议门槛的项目。
    结果:专家同意纳入10个新项目和12个现有项目的规格。这包括可以更广泛地适用于试验的修改(例如比较器的理由),但也有对戒烟试验非常具体的修改(例如戒烟结局的报告).
    结论:一项Delphi研究开发了一项改良的CONSORT-SPI指南(CONSORT-SPI-SMOKE),以改善促进戒烟行为干预试验的报告。
    Inadequate reporting of smoking cessation intervention trials is common and leads to significant challenges for researchers. The aim of this study was to tailor CONSORT (Consolidated Standards of Reporting Trials)-SPI (Social and Psychological Interventions) guidelines to improve reporting of trials of behavioural interventions to promote smoking cessation.
    Informed by missing data from the IC-SMOKE (Intervention and Comparison group support provided in SMOKing cEssation) systematic review project, this study used a multi-stage Delphi process to examine which items could be added or modified to improve the reporting of smoking cessation trials. The first stage involved an on-line survey of 17 international experts in smoking cessation and trial methodology voting on the importance of items for inclusion in the updated guidelines. This was followed by a face-to-face expert consensus meeting attended by 15 of these experts, where the final inclusion and exclusion of new items and modifications were agreed upon. A nine-point Likert scale was used to establish consensus, with suggested modifications requiring agreement of 75% or more. Disagreements in the first stage were presented again at the second stage for discussion and a second round of voting. Only items which reached the threshold for agreement were included.
    The experts agreed on the inclusion of 10 new items and the specification of 12 existing items. This included modifications that could apply to trials more widely (e.g. the rationale for the comparator), but also modifications that were very specific to smoking cessation trials (e.g. the reporting of smoking cessation outcomes).
    A Delphi study has developed a modified CONSORT-SPI guideline (CONSORT-SPI-SMOKE) to improve the reporting of trials of behavioural interventions to promote smoking cessation.
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  • 文章类型: Journal Article
    血糖控制不良是一个多因素且复杂的问题,具有严重的临床和经济影响。在刚果民主共和国,最近的研究表明,控制率令人震惊。没有指导纠正行动的政策框架。
    为了就改善金沙萨2型糖尿病患者血糖控制的干预措施达成共识,刚果民主共和国。
    这是一项两轮电子德尔福研究,涉及31名本地专家和5名国际专家。专家在4-Likert量表问卷上对撒哈拉以南非洲和金沙萨先前关于血糖控制的研究中提出的干预措施进行了评估。此外,专家们被要求提出其他有用的建议。模式,每轮计算每个报表的平均值和标准差.
    与会者在五个领域达成共识,其中包括关于如何改善金沙萨血糖控制的39项声明:加强卫生系统,提高对糖尿病的认识,减轻糖尿病的经济负担,加强生活方式的改变,减少未确诊糖尿病的比例。
    需要在更广泛的非传染性疾病管理框架内考虑改善血糖控制,协调和资金更好的医疗保健系统。需要进一步的研究来实施为成功实施而确定的干预措施。
    Poor glycaemic control is a multifactorial and complex problem with dire clinical and economic implications. In the Democratic Republic of the Congo, recent studies have shown alarming poor control rates. There is no policy framework to guide corrective actions.
    To build a consensus on interventions to improve glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo.
    This was a two-round electronic Delphi study involving 31 local and 5 international experts. The experts rated proposed interventions from previous studies on glycaemic control in sub-Saharan Africa and Kinshasa on a 4-Likert scale questionnaire. Additionally, the experts were asked to suggest other recommendations useful for the purpose. The mode, mean and standard deviation of each statement were calculated for each round.
    Participants reached consensus in five domains that included 39 statements on how to improve glycaemic control in Kinshasa: strengthening the health system, enhancing the awareness of diabetes, alleviating the financial burden of diabetes, enhancing the adoption of lifestyle modifications, and reducing the proportion of undiagnosed diabetes.
    Improved glycaemic control needs to be considered within the broader framework of managing noncommunicable diseases in a more integrated, coordinated and better financed healthcare system. Further studies are needed to operationalise the interventions identified for successful implementation.
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  • 文章类型: Journal Article
    研究人员和政策制定者强调,有组织的体育运动促进健康的潜力尚未得到充分开发。体育俱乐部由于其自愿性质,促进健康的能力有限,并呼吁其国家体育联合会提供支持。本文提供了指导方针,基于健康促进体育俱乐部的理论原则以及对实用工具和行之有效的策略的分析,支持国家体育联合会投资于健康促进(HP)。
    进行了定性迭代研究,根据惠普体育俱乐部15名国际研究人员的五次2小时会议。会议记录和会议记录,以及基于健康促进体育俱乐部框架的共享产出进行了分析。
    为国家体育联合会制定的促进健康的指南包括健康促进体育联合会(HPSF)的定义,描述惠普基于设置的方法如何适应国家体育联合会,以及健康促进体育俱乐部干预策略的实际应用。对现有工具的分析还表明,大多数工具都集中在健康的单一维度(社会,心理,物理,精神或社区),通常涉及特定的健康主题。此外,它们不包括HP作为一个连续的持久过程,但通常是短期计划。HPSF澄清了理论概念,他们通过案例研究的实际实施,并概述了对体育联合会实施惠普有用的干预组件和工具。
    本研究制定的指南旨在促进国家体育联合会承认/理解,加强/支持和促进对惠普的当前和进一步投资。
    UNASSIGNED: Researchers and policy-makers have highlighted that the potential for organized sports to promote health has been underexploited. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines, based on the theoretical principles of health promoting sports clubs and an analysis of practical tools and proven strategies, to support national sports federations to invest in health promotion (HP).
    UNASSIGNED: A qualitative iterative study was undertaken, based on five 2-h meetings of a group of 15 international researchers in HP in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework.
    UNASSIGNED: Guidelines developed for national sports federations to promote health includes a definition of a health promoting sports federation (HPSF), a description of how the settings-based approach to HP adapts to national sports federations, as well as practical applications of health promoting sports club\'s intervention strategies. The analysis of existing tools also demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous long-lasting process, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP.
    UNASSIGNED: The guidelines developed in this study are intended to facilitate national sports federations to acknowledge/understand, reinforce/underpin and foster current and further investment in HP.
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  • 文章类型: Journal Article
    背景:乳腺癌临床实践指南(CPGs)提供了以证据为基础的建议,以提高患者的医疗保健质量。对乳腺癌指南建议的次优依从性仍然很常见,并与生存率下降有关。本系统评价的目的是表征和确定可用干预措施的影响,以支持医疗保健提供者在乳腺癌医疗保健中遵守CPG建议。
    方法:我们搜索了PubMed和Embase(从成立到2021年5月)的系统评价和初步研究。我们纳入了实验和观察性研究,报告了使用干预措施来支持乳腺癌CPGs的依从性。资格评估,数据提取和批判性评估由一名审阅者进行,并由第二个审阅者交叉检查。使用相同的方法,我们按干预类型综合了干预的特征和效果(根据EPOC分类法),并应用等级框架来评估证据的确定性。
    结果:我们确定了35项主要研究报告24种不同的干预措施。最常描述的干预措施包括计算机化决策支持系统(12项研究);教育干预措施(7项),审计和反馈(二),和多方面的干预措施(九)。有低质量的证据表明,针对医疗保健专业人员的教育干预措施可能会提高对乳腺癌筛查建议的依从性。诊断和治疗。有中等质量的证据表明,医疗保健专业人员的提醒系统可以提高对乳腺癌筛查建议的依从性。有低质量的证据表明,多方面的干预措施可以提高对乳腺癌筛查建议的依从性。已确定的其余干预措施的有效性尚未通过适当的研究设计进行评估。关于实施这些干预措施的成本的数据非常有限。
    结论:有不同类型的干预措施来支持乳腺癌CPGs建议的依从性,大多数都表现出积极的影响。需要更有力的试验来加强有关其疗效的现有证据基础。需要收集有关实施拟议干预措施的成本的数据,以告知有关其广泛实施的决定。
    背景:CRD42018092884(PROSPERO)。
    Breast cancer clinical practice guidelines (CPGs) offer evidence-based recommendations to improve quality of healthcare for patients. Suboptimal compliance with breast cancer guideline recommendations remains frequent, and has been associated with a decreased survival. The aim of this systematic review was to characterize and determine the impact of available interventions to support healthcare providers\' compliance with CPGs recommendations in breast cancer healthcare.
    We searched for systematic reviews and primary studies in PubMed and Embase (from inception to May 2021). We included experimental and observational studies reporting on the use of interventions to support compliance with breast cancer CPGs. Eligibility assessment, data extraction and critical appraisal was conducted by one reviewer, and cross-checked by a second reviewer. Using the same approach, we synthesized the characteristics and the effects of the interventions by type of intervention (according to the EPOC taxonomy), and applied the GRADE framework to assess the certainty of evidence.
    We identified 35 primary studies reporting on 24 different interventions. Most frequently described interventions consisted in computerized decision support systems (12 studies); educational interventions (seven), audit and feedback (two), and multifaceted interventions (nine). There is low quality evidence that educational interventions targeted to healthcare professionals may improve compliance with recommendations concerning breast cancer screening, diagnosis and treatment. There is moderate quality evidence that reminder systems for healthcare professionals improve compliance with recommendations concerning breast cancer screening. There is low quality evidence that multifaceted interventions may improve compliance with recommendations concerning breast cancer screening. The effectiveness of the remaining types of interventions identified have not been evaluated with appropriate study designs for such purpose. There is very limited data on the costs of implementing these interventions.
    Different types of interventions to support compliance with breast cancer CPGs recommendations are available, and most of them show positive effects. More robust trials are needed to strengthen the available evidence base concerning their efficacy. Gathering data on the costs of implementing the proposed interventions is needed to inform decisions about their widespread implementation.
    CRD42018092884 (PROSPERO).
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  • 文章类型: Journal Article
    目的:为建立关于粮食安全定义的国际共识,高收入国家的措施和宣传优先事项。
    方法:两轮在线Delphi调查,于2020年3月和2021年12月结束。共识被先验地设定为75%。综合了定性数据,并对优先级进行了排名。
    方法:高收入国家。
    方法:学术界的家庭食品安全专家,过去五年出版的政府和非政府组织。
    结果:来自14个高收入国家的多达32名参与者对Delphi做出了回应,在第1轮反应率为25%,在第2轮反应率为38%。就技术性粮食安全定义及其范围达成了共识。没有就适合公众的定义达成共识。所有与会者一致认为,粮食安全监测系统为国内决策提供了宝贵的数据。受青睐的干预措施是那些侧重于影响收入的上游社会政策的干预措施。受访者一致认为,需要国家和地方社区一级的战略来改善粮食不安全,加强问题的复杂性。
    结论:本研究进一步加深了对食品安全及其构成维度的常用定义的概念理解。需要大力宣传,以确保粮食安全监测,政策和缓解策略得到实施。来自富裕国家的领域专家关于优先采取行动解决家庭粮食安全的基本决定因素的重要性的共识为集中宣传工作和引发公众辩论提供了证据。
    To establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries.
    A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked.
    High-income countries.
    Household food security experts in academia, government and non-government organisations who had published in the last 5 years.
    Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem.
    This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.
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