Vitamin D Facts

1.     In building bone, calcium has an indispensable assistant: vitamin D.

2.     Vitamin D helps the body absorb calcium,

3.     Increasing vitamin D can help prevent osteoporosis.

4.      A small amount of sun exposure can help the body manufacture its own vitamin D

5.     Five to 30 minutes of sunlight between 10 a.m. and 3 p.m. twice a week to your face, arms, legs, or back without sunscreen will enable you to make enough of the vitamin.

6.     People with fair skin that burns easily should protect themselves from skin cancer by limiting sun exposure to 10 minutes or less.

7.      Food and sun exposure should suffice, but if not, get 2,000 IU of vitamin D daily from a supplement.

http://pedianews.emedinews.in/index.php/2012/10/vitamin-d-facts/

Commentary: There is a lot of "pharma interest" in Vit D, and we have had a large number of preparations (drops, tablets, powders etc.) in multiple strengths being marketed for preventing and treating Vit D Deficiency. While conventional wisdom was that due to sunlight tropical countries are unlikely to suffer from serious Vit D Deficiencies, the reality has turned out to be different. Due to many factors, including pollution, dark skin, our aversion to sunlight exposure, lifestyle changes etc. there is an apparent epidemic of Vit D deficiency. Even though experts are still debating about the normal values of Vit D for Indian population, the large number of people with Osteoporosis (weak bones) and fractures occurring in even youngsters points to a definite problem related to poor calcium absorption that occurs in the absence / deficiency of Vit D.
The above mentioned tips are important for preventing & treating Vit D deficiency, it is probably more practicable to take supplements of Vit D (not the usual Calcium pill) after consulting your doctor. A weekly course of Vit D packets (costing 20-25 rupees each) for 8-12 weeks is helpful for most people, and then they may need to take this monthly for an even longer period of time. However, this & any other treatment should ONLY be started after talking to your doctor.

Preventing preterm births - Lancet 2012

Preventing preterm births

Wider implementation of evidence-based interventions could reduce preterm birth rates by 5% by 2015, say researchers.

Background

Every year, 1·1 million babies die from prematurity, and many survivors are disabled. Worldwide, 15 million babies are born preterm (<37 a="a" all="all" almost="almost" analysis="analysis" and="and" benefit="benefit" births="births" born="born" countries="countries" data.="data." decades="decades" development="development" drivers="drivers" estimate="estimate" evidence-based="evidence-based" examined="examined" font="font" for="for" gestation="gestation" high="high" human="human" if="if" implemented.="implemented." in="in" increasing="increasing" index="index" inform="inform" interventions="interventions" is="is" of="of" poor.="poor." potential="potential" present="present" preterm="preterm" preventive="preventive" rate="rate" rates="rates" reduction="reduction" reliable="reliable" soon.="soon." target="target" the="the" this="this" to="to" too="too" trends="trends" two="two" understanding="understanding" very="very" we="we" weeks="weeks" were="were" widely="widely" with="with">

Methods

Countries were assessed for inclusion based on availability and quality of preterm prevalence data (2000—10), and trend analyses with projections undertaken. We analysed drivers of rate increases in the USA, 1989—2004. For 39 countries with VHHDI with more than 10 000 births, we did country-by-country analyses based on target population, incremental coverage increase, and intervention efficacy. We estimated cost savings on the basis of reported costs for preterm care in the USA adjusted using World Bank purchasing power parity.

Findings

From 2010, even if all countries with VHHDI achieved annual preterm birth rate reductions of the best performers for 1990—2010 (Estonia and Croatia), 2000—10 (Sweden and Netherlands), or 2005—10 (Lithuania, Estonia), rates would experience a relative reduction of less than 5% by 2015 on average across the 39 countries. Our analysis of preterm birth rise 1989—2004 in USA suggests half the change is unexplained, but important drivers include non-medically indicated labour induction and caesarean delivery and assisted reproductive technologies. 

For all 39 countries with VHHDI, five interventions modelling at high coverage predicted a 5% relative reduction of preterm birth rate from 9·59% to 9·07% of live births: 

smoking cessation (0·01 rate reduction), 

decreasing multiple embryo transfers during assisted reproductive technologies (0·06), 

cervical cerclage (0·15),

progesterone supplementation (0·01), 

and reduction of non-medically indicated labour induction or caesarean delivery (0·29).

These findings translate to roughly 58,000 preterm births averted and total annual economic cost savings of about US$3 billion.

Interpretation

We recommend a conservative target of a relative reduction in preterm birth rates of 5% by 2015. Our findings highlight the urgent need for research into underlying mechanisms of preterm births, and development of innovative interventions. Furthermore, the highest preterm birth rates occur in low-income settings where the causes of prematurity might differ and have simpler solutions such as birth spacing and treatment of infections in pregnancy than in high-income countries. Urgent focus on these settings is also crucial to reduce preterm births worldwide.

Chang HH, Larson J, Blencowe H, et al. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. The Lancet. 2012;doi:10.1016/S0140-6736(12)61856-X.

Source

Obstetricians' Attitudes on Maternal and Infant Immunization - A survey in USA

Maternal and Child Health Journal

Missed Opportunities

Abstract

The recent reoccurrence of several vaccine-preventable diseases demonstrates the need for new techniques to promote childhood vaccination. Many mothers make decisions regarding vaccination of their children during pregnancy. As a result, obstetricians have a unique opportunity to influence maternal decisions on this crucial component of child health. Our objective was to understand OB/GYNs' attitudes, beliefs, and current practices toward providing vaccinations to pregnant patients and providing information about routine childhood immunizations during standard prenatal care. We surveyed OB/GYNs in the United States about their vaccination practices and perceptions during the 2009 H1N1 outbreak. Most (84%) respondents indicated their practice would be administering H1N1 vaccines to pregnant patients. While a majority (98%) of responding providers felt childhood vaccination is important, relatively few (47%) felt that they could influence mothers' vaccination choices for their children. Discussion of routine childhood immunization between obstetricians and their patients is an area for future improvements in childhood vaccination.

Read the entire article at Medscape

Comments: What I find fascinating is the interplay between Ob/gyn and the Pediatrician that is being increasingly realized in the West. While problems exist, they are taking steps to try to come together in the best interests of the patients. Here in India though, the situation is unfortunately quite different. There is hardly any professional interaction between Pediatricians & Ob/gyn. There are many reasons for this, including problems related to fees sharing (many Ob/gyn still deliver without pediatric support, and only call the pediatrician when the child is born distressed after birth). Other problems include lack of updated knowledge regarding newer recommendations for vaccines like Influenza in pregnancy, or cervical cancer vaccination. Finally, in smaller towns, many Ob/gyn also do the pediatric vaccination & OPD consultations themselves, thus creating further conflict of interest. Of course, I am speaking predominantly from a pediatrician perspective, but I am sure most doctors would agree that further cooperation would be in the best interest of the patients. Perhaps our professional bodies, FOGSI & IAP in India, can take further steps in this regard.