Booster vaccination may help with possible future avian influenza pandemic

New evidence suggests that a booster vaccination against H5N1 avian influenza given years after initial vaccination with a different strain may prove useful in controlling a potential future pandemic. The study is published in the August 1 issue of The Journal of Infectious Diseases, now available online.

H5N1 continues to pose a major health risk to birds and humans. As of mid-June, more than 60 percent of the more than 380 human cases have been fatal, and hundreds of millions of birds have died or been culled to prevent the spread of the disease. Should the virus evolve making human-to-human transmission more likely, a destructive global influenza pandemic could result.

The cornerstone of planning for such a possible pandemic is the development and distribution of effective vaccines. Several vaccines have been developed, but as the virus continues to mutate into genetically distinct lineages, or clades, the problem arises as to whether vaccines based on an older clade will be effective against newer versions. The new study is the first to report that giving one dose of a newer-clade vaccine to those who were vaccinated previously with older versions is more effective than giving only doses of the newer vaccine to unvaccinated subjects.

The study, conducted by Nega Ali Goji, MD, and colleagues from New York, Maryland, and Alabama, gave a single booster dose of a vaccine based on a clade 1 H5N1 virus circulating in Vietnam in 2004 to subjects who eight years earlier had received two doses of a vaccine based on the original, clade 0 virus that appeared in Hong Kong in 1997. Sixty-four percent had a positive immune response, which compares favorably to the results of a previous study using two doses of the clade 1 Vietnam virus, in which only 43 percent of those vaccinated had a positive immune response.

The results not only support the booster technique, but also show that even though the virus had mutated since the initial vaccination, using it to boost an earlier vaccine is more effective than simply vaccinating subjects with the most current vaccine. These findings are important given the fact that influenza viruses are mutating constantly.

"These results suggest that one strategy for pandemic control could involve prevaccination of some segments of the population prior to the emergence of a pandemic so that effective protection could be achieved with a single dose schedule if and when a pandemic emerges," the authors wrote. "If the finding that priming can result in enhanced responses to single-dose vaccination schedules were confirmed, then pre-pandemic vaccination programs could be considered, especially in populations of first responders, health care workers, or the military. Such populations might then be able to be effectively and rapidly vaccinated with a single dose of a vaccine specific for an emerging pandemic if it were to occur."

In an accompanying editorial, Gregory A. Poland, MD, of the Mayo Clinic College of Medicine, noted that some are already looking to begin such prevaccination primers against H5N1 influenza. For example, Japan is planning to immunize health care workers starting in 2009, and the U.S. Department of Defense is offering a vaccine to those in high risk specialties.

Dr. Poland pointed out that new studies are needed to investigate different types of vaccine administration, deal with vaccinations that prevent death but not infection and illness, search for more broadly cross-protective influenza vaccines, and collect data on the vaccination of those who are not healthy adults. Although, he said, "determining who should receive these vaccines, when, and in what order and under what circumstances deserves widespread debate," he agrees that the findings of the study are novel, as they "suggest that such a prime-boost strategy using vaccines derived from different H5 clades, separated by years, may be worthwhile, immunologically feasible, and safe."

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Fast Facts

1) Experts are concerned about a possible pandemic of H5N1 influenza. As of mid-June, 60 percent of the more than 380 human cases have been fatal, and half a billion birds have died or been culled to prevent the spread of the disease. Should the virus evolve making human-to-human transmission more likely, a destructive global influenza pandemic could result.

2) Giving a "booster" vaccine using a recent strain of virus to those previously vaccinated with an older strain was more effective than only vaccinating with the recent strain. Especially relevant is the fact that the primer and booster vaccines were derived from different strains of the virus and still were effective.

Founded in 1904, The Journal of Infectious Diseases is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms. Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines. JID is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing more than 8,000 physicians and scientists who specialize in infectious diseases. For more information, visit www.idsociety.org.

University of Minnesota research : Drug commonly used for alcoholism curbs urges of pathological gamblers

MINNEAPOLIS / ST. PAUL (June 13, 2008) – A drug commonly used to treat alcohol addiction has a similar effect on pathological gamblers – it curbs the urge to gamble and participate in gambling-related behavior, according to a new research at the University of Minnesota.
Seventy-seven people participated in the double-blind, placebo controlled study. Fifty-eight men and women took 50, 100, or 150 milligrams of naltrexone every day for 18 weeks. Forty percent of the 49 participants who took the drug and completed the study, quit gambling for at least one month. Their urge to gamble also significantly dropped in intensity and frequency. The other 19 participants took a placebo. But, only 10.5 percent of those who took the placebo were able to abstain from gambling. Study participants were aged 18 to 75 and reported gambling for 6 to 32 hours each week.
Dosage did not have an impact on the results, naltrexone was generally well tolerated, and men and women reported similar results.
"This is good news for people who have a gambling problem," said Jon Grant, M.D., J.D., M.P.H., a University of Minnesota associate professor of psychiatry and principal investigator of the study. "This is the first time people have a proven medication that can help them get their behavior under control."
The research is published in the June issue of the Journal of Clinical Psychiatry.
Compulsive gamblers are unable to control their behavior, and the habit often becomes a detriment in their lives, Grant said. He estimates between 1 to 3 percent of the population has a gambling problem.
While the drug is not a cure for gambling, Grant said it offers hope to many who are suffering from addiction. He also said the drug would most likely work best in combination with individual therapy.
"Medication can be helpful, but people with gambling addiction often have multiple other issues that should be addressed through therapy," he said.
Naltrexone is sold under the brand names Revia and Depade. An extended-release formulation is sold under the name Vivitrol.
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The research was funded by the National Institute of Mental Health. Grant has served as a consultant to Pfizer and has received grant/research support from GlaxoSmith Kline and Forest.

American Academy of Sleep Medicine : Women worrying about cancer are more likely to experience sleep disturbances

WESTCHESTER, Ill. – A significant number of women worrying about cancer may be experiencing sleep disturbances, even without a breast cancer diagnosis, according to a research abstract that will be presented by Amita Dharawat, MD, on Monday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).
This collaborative study, from the Brooklyn Health Disparities Center at SUNY Downstate Medical Center and Long Island University in Brooklyn, New York, focused on 1,038 community-based residents, between 50 and 70 years of age; none of whom had a history of a physician-diagnosed cancer. Sleep complaint was defined as a report of either difficulty initiating sleep, maintaining sleep, or early morning awakening.
According to the results, 65 percent of the women reported that they worried about developing breast cancer, and 49 percent reported a sleep complaint. Twenty-seven percent indicated that cancer worry affected their mood, while 25 percent indicated that it affected their daily activity. The odds of reporting sleep complaints for women who worry about cancer were nearly 50 percent greater than odds for women who reported no cancer worry, independent of several confounders.
“This is a unique and important finding because sleep-related complaints have never been studied in women who worry about cancer, without a diagnosis, and it provides practitioners with knowledge with regards to identifying and targeting women who report sleep-related complaints with cognitive behavioral therapy,” said Dr. Dharawat, who is a second year medical resident, working with Dr. Girardin Jean-Louis on an NIH funded ‘Women’s Health Project’.
Cognitive behavioral therapy (CBT) helps eliminate negative images and thoughts that compromise one’s ability to sleep well. It helps develop habits that promote a healthy pattern of sleep. CBT is most often used for people who suffer from insomnia.
Sleep plays a vital role in promoting women’s health and well being. Getting the required amount of sleep is likely to enhance women’s overall quality of life. Yet, they face many potential barriers – such as life events, depression, illness, and medication use – that often disrupt their sleep patterns. Overcoming these challenges can help women enjoy the daily benefits of feeling alert and well rested.
It is recommended that women get between seven and eight hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers the following tips for women on how to get a good night’s sleep:
Follow a consistent bedtime routine.
Establish a relaxing setting at bedtime.
Get a full night’s sleep every night.
Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
Do not bring your worries to bed with you.
Do not go to bed hungry, but don’t eat a big meal before bedtime either.
Avoid any rigorous exercise within six hours of your bedtime.
Make your bedroom quiet, dark and a little bit cool.
Get up at the same time every morning.
Those who suspect that they might be suffering from a sleep disorder are encouraged to consult with their primary care physician or a sleep specialist.
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More information about “women and sleep” is available from the AASM at http://www.SleepEducation.com/Topic.aspx?id=67.
The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

American Academy of Sleep Medicine : Excessive mobile phone use affects sleep in teens

WESTCHESTER, Ill. – Teenagers who excessively use their cell phone are more prone to disrupted sleep, restlessness, stress and fatigue, according to a research abstract that will be presented on Monday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).
The study, authored by Gaby Badre, MD, PhD, of Sahlgren’s Academy in Gothenburg, Sweden, focused on 21 healthy subjects, between 14-20 years of age, with regular working/studying hours and without sleep problems. The subjects were broken up into two groups: a control group (three men, seven women) and the experimental group (three men, eight women). The control group made less than five calls and/or sent five text messages a day, while the experimental group made more than 15 calls and/or sent 15 text messages a day. The subjects were then asked questions regarding their lifestyle and sleep habits.
According to the results, when compared to subjects with restricted use of cell phones, young people with excessive use of cell phones (both talking and text messaging) have increased restlessness with more careless lifestyles, more consumption of stimulating beverages, difficulty in falling asleep and disrupted sleep, and more susceptibility to stress and fatigue. They behave more like larks than owls, suggesting a delayed biological clock.
“Addiction to cell phone is becoming common. Youngsters feel a group pressure to remain inter-connected and reachable round the clock. Children start to use mobile phones at an early stage of their life. There seem to be a connection between intensive use of cell phones and health compromising behaviour such as smoking, snuffing and use of alcohol,” said Dr. Badre.
Dr. Badre stresses the importance of good sleep for young people.
“It is adamant/necessary to increase the awareness among youngsters of the negative effects of excessive mobile phone use on their sleep-wake patterns, with serious health risks as well as attention and cognitive problems,” said Dr. Badre.
It is recommended that adolescents get nine hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night’s sleep:
Follow a consistent bedtime routine.
Establish a relaxing setting at bedtime.
Get a full night’s sleep every night.
Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
Do not stay up all hours of the night to “cram” for an exam, do homework, etc. If after-school activities are proving to be too time-consuming, consider cutting back on these activities.
Keep computers and TVs out of the bedroom.
Do not go to bed hungry, but don’t eat a big meal before bedtime either.
Avoid any rigorous exercise within six hours of your bedtime.
Make your bedroom quiet, dark and a little bit cool.
Get up at the same time every morning.
Those who suspect that they might be suffering from a sleep disorder are encouraged to consult with their primary care physician or a sleep specialist.
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More information about “teens and sleep”, including a new questionnaire that assesses the level of sleepiness in adolescents, is available from the AASM at: http://www.SleepEducation.com/Topic.aspx?id=71.
The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

American Academy of Sleep Medicine : African-American veterans are less likely to adhere to CPAP than caucasian or Asian veterans

WESTCHESTER, Ill. – African-American war veterans are significantly less likely to adhere to continuous positive airway pressure (CPAP) than Caucasian or Asian veterans, according to a research abstract that will be presented on Monday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).
The study, authored by Skai W. Schwartz, of the University of South Florida, focused on 1,486 patients who were prescribed and tried CPAP between 2003-2007. Adherence information was captured on a data card by a CPAP micro-recording device. Patients were asked to return cards by mail at one month, one year and two years. Adherence was defined as percentage of days that the device was used for four or more hours.
According to the results, African-Americans were significantly less likely to use CPAP than Caucasians at all time points, as well as Asians.
“Given the importance of CPAP adherence, research into physical characteristics (e.g., anatomical versus obese etiology) or cultural differences may be warranted to explain the disparity,” said Schwartz.
First introduced as a treatment option for sleep apnea in 1981, CPAP is the most common and effective treatment for obstructive sleep apnea (OSA). CPAP provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing the pauses in breathing that characterize sleep apnea and restoring normal oxygen levels.
On average, most adults need seven to eight hours of nightly sleep to feel alert and well-rested.
The American Academy of Sleep Medicine AASM) offers the following tips on how to get a good night’s sleep:
Follow a consistent bedtime routine.
Establish a relaxing setting at bedtime.
Get a full night’s sleep every night.
Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
Do not go to bed hungry, but don’t eat a big meal before bedtime either.
Avoid any rigorous exercise within six hours of your bedtime.
Make your bedroom quiet, dark and a little bit cool.
Get up at the same time every morning.
Those who think they might have OSA, or another sleep disorder, are urged to consult with their primary care physician or a sleep specialist.
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CPAP Central (www.SleepEducation.com/CPAPCentral), a Web site created by the AASM, provides the public with comprehensive, accurate and reliable information about CPAP. CPAP Central includes expanded information about OSA and CPAP, including how OSA is diagnosed, the function of CPAP, the benefits of CPAP and an overview of what to expect when beginning CPAP, the position of experts on CPAP, and tools for success. CPAP Central also features an interactive slide set that educates the public about the warning signs of OSA.
The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

Boston University : Primary care visits reduce hospital utilization among Medicare beneficiaries at the end of life

Boston, MA— Researchers from Boston University School of Medicine (BUSM) have found that primary care visits reduce hospital utilization among Medicare beneficiaries at the end of life. The recently published study appears in the Journal of General Internal Medicine.
According to researchers, medical treatments for the six percent of Medicare beneficiaries who die each year comprise almost 30 percent of Medicare expenditures. In addition, the quality of end-of-life care is often poor. Problems include late referrals to hospice, undertreatment of pain, overtreatment with unwanted or ineffective procedures, poor communications regarding prognosis and treatment preferences, and in-hospital deaths that are inconsistent with stated preferences.
Researchers measured hospital utilization during the final six months of life and the number of primary care physician visits in the 12 preceding months for 78,356 Medicare beneficiaries age 66 +. Hospital days, costs, in-hospital death, and presence of two types of preventable hospital admissions also were studied.
Thirty-eight percent of adults did not have any primary care visits during their final six months of life, 22 percent had one to two primary care visits, 19 percent had three to five visits, 10 percent had six to eight visits and 11 percent had nine or more visits. More primary care visits in the preceding year were associated with fewer hospital days (15.3 days for those with no primary care visits vs. 13.4 days for those with nine or more visits) lower costs ($24,400 vs. $23,400) less in-hospital death (44 percent vs. 40 percent) and fewer preventable hospitalizations for those with congestive heart failure or chronic obstructive pulmonary disease.
"Primary care visits in the preceding year of life are associated with less, and less costly, end of life hospital utilization," said senior author Andrea Kronman, M.D., an attending physician in the Section of General Internal Medicine at Boston Medical Center and instructor of medicine at BUSM.
Researchers further concluded that providing more primary care to Medicare beneficiaries may improve the quality of end-of-life-care while reducing time spent in the hospital and overall costs. In 2001, nine primary care visits cost Medicare $3,000; nine days in the hospital cost Medicare $11,000.
"Decreasing just one hospital day for each Medicare beneficiary at the end of life could have saved millions of dollars," added Kronman. "More care at the end of life by a primary care physician could enhance quality and reduce costs, since the provider may have more opportunities to prevent medical complications, discuss patient preferences, and coordinate home palliative care."
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For more information on Boston University School of Medicine, please visit http://www.bumc.bu.edu/busm/.

New England economy 3.3 billion Dollar contributed by Veterinary medicine

Study released today highlights regional need for new veterinarians
NORTH GRAFTON, MASS., June 3, 2008 – Veterinary medicine contributes $3.3 billion to the economies of New England—and the region faces a shortage of as many as 658 veterinarians by 2014, according to a study released today by the Cummings School of Veterinary Medicine at Tufts University.
The study—undertaken by the UMass Donahue Institute and commissioned by the Cummings School, the only veterinary school in the six-state New England Region—reveals that veterinarians and associated staff comprise over 20,000 jobs in the area. Moreover, for every 100 veterinary medical jobs in the region, an additional 59 jobs are created in related industries, the study indicates.
Clinical practice—providing medical services for household pets, farm and food animals, and exotic animals—represents the largest percentage ($1.1 billion, or 65 percent) of direct veterinary expenditures in New England, which total $1.72 billion. Scientific research and development—which require animal health and husbandry services to test new drugs and devices and better understand animal and human health—comprises the next-largest category, with a total of 23 percent of veterinary medicine spending and 14 percent of the industry's total employment. Laboratory animal veterinarians are responsible for the welfare of as many as 2 million laboratory animals in New England.
The study also highlights a growing critical need for veterinarians in the region. According to Bureau of Labor Statistics (BLS) data, the study found that the region will have 1,036 vacancies for veterinarians by 2014, both through new job creation and retirement of an aging workforce. With an average of 60 percent of Cummings School graduates remaining in New England, trends suggest that 378 of the school's graduates will enter the region's workforce, leaving unfilled 658 new vacancies for veterinarians.
What's more, the study suggests that the region faces a flood of retirements among food animal veterinarians. Over a quarter of the region's more than 100 specialized food animal veterinarians will reach retirement age by 2014. With current levels of food animal graduates, the Cummings School will be positioned to replace only half of these vacancies. Overall, 43 percent of New England veterinarians are over age 50; by contrast, 56 percent of livestock veterinarians are over age 50. Until 2014, the study suggests, food animal veterinarians will retire at nearly twice the rate of their companion animal colleagues. With the critical role that food animal veterinarians play in protecting the nation's food supply, this shortage is especially alarming.
"This study confirms the importance and economic impact of veterinary medicine in Massachusetts and New England," said Deborah T. Kochevar, DVM, PhD, dean of the Cummings School of Veterinary Medicine at Tufts University. "Cummings School is proud to serve the citizens of this region by educating veterinary professionals, advancing biomedical research, and serving as a clinical and public health resource for animals and their owners."
The study was supported by the Veterinary Medical Associations of Massachusetts, Connecticut, Maine, New Hampshire, Rhode Island and Vermont, the New England Veterinary Medical Association and InTown Veterinary Group. Hill's Pet Nutrition, Inc., was the study's lead industry sponsor.
"In order to best understand the health of the animals in New England, we need to understand the industry that cares for them," said Dr. Christine Jenkins, Director of Academic Affairs at Hill's Pet Nutrition, the study's lead industry sponsor. "This study does just that—and we hope it sheds light on the growing need for veterinarians in the workforce to ensure the care and safety of animals in the region."
The study also revealed interesting findings in each state of New England. Among them:
Massachusetts has New England's biggest veterinary scientific research and development sector, with more than 5 percent of the state's veterinarians specializing in this area. The state is the fifth-largest in the nation for research animals registered under the Animal Welfare Act and veterinarians support the work of a vital life sciences industry in the state. With 8,000 employees statewide and a total economic impact of $1.3 billion in 2006, veterinary medicine is an essential part of the state economy.
In Connecticut, $83 is pumped back into the state's economy for every $100 spent by the veterinary industry, a multiplier of 1.83. For every 100 jobs in the industry, another 55 jobs in Connecticut are supported. Connecticut boasts a total veterinary economic impact of nearly $1 billion in 2006, the second largest in the region.
Maine has the nation's sixth-highest rate of pet ownership, with 70 percent of households (376,000 homes) owning one or more pets. The veterinary industry represents an economic impact of more than $290 million in the state.
New Hampshire residents spend the second-most in the region on veterinary clinical services per capita, at $94. The state also ranks second in median wages for veterinarians, at $78,180. Every $100 of veterinary industry spending in the state supports another $74 of economic activity in the state.
In Rhode Island, veterinary medicine employs an estimated 1,110 people, including 189 veterinarians. The industry invests an estimated $81 million on payroll, operating expenses and capital projects, including over $69 million in veterinary clinical practice, $5 million in scientific R&D and $6 million in academia.
Vermont has both the highest rate of pet ownership in the region and the nation—74.5 percent—and the region's highest per capita spending on veterinary clinical services ($97). Additionally, the state boasts the region's highest rate of veterinary practice ownership (52 percent of clinical practice veterinarians are self-employed).
Several leaders from the biomedical industry in Massachusetts spoke out in support of the study's findings. "In order for the biomedical and medical device fields to continue to thrive in Massachusetts, we must maintain a very high standard for ethics and care in our research divisions," said Kevin O'Sullivan, President and CEO of Massachusetts Biomedical Initiatives. "As such, veterinarians are our greatest resource, and provide a crucial element for the growth of the biotech sector."
"The economy of Massachusetts is intrinsically linked with the growth of the biotechnical, pharmaceutical, and medical device sectors—and without a ready supply of veterinarians to oversee the clinical trials for these industries, the growth would be stifled," continued Thomas J. Sommer, President of MassMEDIC. "The Commonwealth has a great resource in the Cummings School of Veterinary Medicine—not just as a excellent training ground for the next generation of veterinarians, but also as an economic incubator for small biomedical start-ups. This study brings the contributions of the Cummings School and of veterinarians in general to light."
"The Cummings School of Veterinary Medicine is an essential resource for the Massachusetts life sciences super cluster," said Robert Coughlin, President of the Massachusetts Biotechnology Council. "The close proximity of this global leader in veterinary medicine is another reason why so many companies and institutions find Massachusetts the best place in the world to do business."

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For the complete study,
please visit: www.tufts.edu/vet/about/economic_impact_08.pdf

About the Cummings School of Veterinary Medicine

Founded in 1978 in North Grafton, Mass., the Cummings School of Veterinary Medicine at Tufts University is internationally esteemed for academic programs that impact society and the practice of veterinary medicine; three hospitals that treat more than 28,000 animals each year; and groundbreaking research that benefits animal, public, and environmental health. The school has secured more than $23 million in NIH funding to build a level-3 Regional Biosafety Laboratory for work with infectious disease organisms, the anchor tenant of a life sciences industrial development known as Grafton Science Park.

vitamin D insufficiency in pediatric patients with low bone density

Study published in Pediatrics suggests examining vitamin D status in patients with history of fractures or low bone density
Vitamin D insufficiency is common in adults and is emerging in the world of pediatrics. A mild degree of vitamin D deficiency, also known as vitamin D insufficiency, causes rickets in children and can be treated with increased amount of nutritional vitamin D intake as well as increased sun exposure.
A new study conducted by physicians and researchers at Nationwide Children's Hospital, is the first study to investigate vitamin D insufficiency in pediatric patients with low bone density.
According to the study, published in the June issue of Pediatrics, among the 85 patients studied, 80 percent had a vitamin D insufficiency. All the patients had a history of bone fragility or underlying chronic medical conditions that put them at a risk of osteoporosis, which is not just an adult disease, but is seen in children and can originate during childhood. Vitamin D insufficiency may contribute to low bone mass or even make the underlying metabolic bone disease worsen if not treated. Vitamin D is essential in bone growth and mineralization in children and adults.
The study's lead author, Sasigarn Bowden, MD, a pediatric endocrinologist and attending physician in the Metabolic Bone Clinic at Nationwide Children's explains, "We need to check vitamin D levels in all patients with history of multiple fractures or low bone density and treat the vitamin D problem if the levels are low. The supplementation of vitamin D should be a priority in the management of pediatric patients with osteoporosis or osteopenia in order to optimize their bone health and potentially prevent fractures."
Potential factors that may account for vitamin D insufficiency in various chronic medical conditions include low vitamin D intake and decreased sun exposure. Four studies in Europe found that 80 percent of healthy children and adolescents had insufficient vitamin D levels in the winter.
"Due to the number of recent studies of healthy children or adolescents with a high prevalence of vitamin D insufficiency, the public should be aware of the fact that it is common, especially living in high altitude," said Bowden, also an assistant professor of Pediatrics at The Ohio State University College of Medicine. "Sometimes our vitamin D levels get low at the end of winter due to less exposure to sunlight, but if we take a multivitamin D supplement, or consume an adequate amount of vitamin D from dietary sources such as vitamin D fortified milk or orange juice, we should be okay throughout the entire year."
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