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A 2025 European Journal of Clinical Nutrition commentary on the NICE guideline argued that the diagnostic threshold and clinical awareness still need to be tightened further, especially around pernicious anaemia, which is still under-recognised in primary care

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In particular, providers working in youth shelters suggested that it is unlikely that they can build trust and establish the type of relationship needed to make these girls feel safe and willing to share their stories given the current limitations on shelter stays and the inadequate screening tools available to them to uncover this type of experience