Objective-To review critically the scientific literature on multiple chemical sensitivity (MCS). Definitions of MCS vary but, for this review, a broad definition of MCS was adopted as symptoms in more than one organ system elicited by various unrelated chemicals at very low levels of exposure. Methods-A systematic literature search identified several hundred references from which key papers were selected. Two questions are considered, does MCS exist and what causes MCS. Results and conclusions-Despite extensive literature on the existence of MCS, there is no unequivocal epidemiological evidence; quantitative exposure data are singularly lacking; and qualitative exposure data are, at best, patchy. There is also some evidence to suggest that MCS is sometimes used as an indiscriminate diagnosis for undiagnosed disorders. Despite this, the collated evidence suggests that MCS does exist although its prevalence generally seems to be exaggerated. Many causal mechanisms have been proposed, some suggesting a physical originsuch as MCS reflecting an immunological overload (total body load)-others favouring a psychological basis-such as MCS symptoms being evoked as part of a conditioned response to previous trauma. The available evidence seems most strongly to support a physical mechanism involving sensitisation of part of the midbrain known as the limbic system. However, it is increasingly being recognised that the psychological milieu of a person can considerably influence physical illness, either through generating a predisposition to disease or in the subsequent prognosis. Work is needed to establish the prevalence of MCS and to confirm or refute selected causal mechanisms. (Occup Environ Med 1999;56:73-85)

Calorie posting is now policy in hospitals in Ireland and restaurants will be required to display calorie counts on menus by end of 2019. The Health Promotion, Dietetics and Catering teams worked together to introduce calorie posting and a traffic light system (TLS) for all foodstuffs available in the staff canteen of a large University teaching hospital in Dublin, Ireland. A calorie posting launch took place in September 2018. The aim of this study was to determine staff perception of calorie posting and TLS. One month after the launch, 343 staff members were surveyed using a short pre-designed Sphynx-software questionnaire at 3 time points daily over one week, at breakfast, lunch and evening mealtimes. SPSS was used for analysis. Of the 353 respondents (65.3% female; 18-44 years 65.3%, 45+ 32.1%, unknown 2.6%), more staff found calorie posting helpful compared to TLS (66.5% vs 43.7%; p = 0.001). Staff stated they made themselves aware of calorie count always/mostly (46%) and sometimes (26.2%). More females than men found both calorie posting (72.3% vs 53.3%; p = 0.001) and TLS (49.1% vs 31.8%; p = 0.001) helpful. More respondents identified calorie posting than TLS as influencing food choice at least sometimes (60.3% vs 36%; p = 0.0001). Females were more likely to make a food choice change based on TLS (39.7 vs 20.6%; p = 0.01). Age and frequency of canteen use were not associated with either. The results suggest calorie posting is used rather than TLS by all hospital staff and female hospital staff are likelier to use both. Learning from this study, the positioning of TLS in relation to individual foodstuffs has been reviewed, further promotion of TLS/calorie posting has taken place in the hospital and a regular audit has been established. Notwithstanding the challenges, important moves towards healthier choices were seen. Key messages Introduction of traffic light system and calorie posting needs evaluation. Females appear more likely to avail of traffic light systems and calorie posting in relation to food choices.

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mothers during pregnancy; children both pre-alcohol use around ages 7-10, and post-alcohol use around ages 13-23). Results The PRS were associated with multiple alcohol consumption phenotypes (strongest signal for alcohol amount at 18 weeks gestation: p=1.01×10 -5 ) in pregnant mothers. There was an effect of maternal PRS for alcohol use on mother's perinatal depression (p=0.02), offspring intellect (p=0.016), and ADHD (p=0.04). Discussion The effects of alcohol PRS previously found in the general population are also shown during pregnancy. We found an intrauterine effect of alcohol PRS on offspring intellect and ADHD. The effects shown are not due to offspring's own alcohol use, as these effects were not found within the child's analyses.

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