Re-emerging Vitamin D deficiency epidemic and its implications on the public health in the US

Vitamin D is essential in maintaining the bone health and Calcium homeostasis in the body. These actions are mediated through the Vitamin D receptors (VDR) present in cells through which the activated vitamin D acts [1]. In the past, it was known that these receptors existed in the intestine and bone cell. However, recent discovery of VDR in other tissues as well, has broadened the action of Vitamin D and increased its adequate intake [1].^ In the past, Vitamin D deficiency was most common among institutionalized, elderly patients and children and thought to be extinct in the healthy population. However, recent evidence has shown that, prevalence of vitamin D deficiency is increasing into an epidemic status in the overall population of the United States, including the healthy individuals [2-3]. The increased daily-recommended requirement and other multiple factors are responsible for the re-emergence of this epidemic [4-5]. Some of these factors could be used to control the epidemic. Studies have also shown the association between vitamin D deficiency and increased risk for developing chronic diseases such as diabetes, hypertension, multiple sclerosis, arthritis, and some fatal cancers like prostate, colon and breast cancers [1, 4, 6-14]. This issue results in increased disease burden, morbidity and mortality in the community [15-20].^ Methods: The literature search was conducted using the University of Texas Health Science Center at Houston (UTHSC) and University of Texas Southwestern Medical Center (UTSW) online library. The key search terms used are “vitamin D deficiency And prevalence Or epidemiology”, “vitamin D deficiency And implication And public health” using PubMed and Mesh database and “vitamin D deficiency” using systematic reviews. The search is limited to Humans and the English language. The articles considered for the review are limited to Healthy US population to avoid health conditions that predispose the population to vitamin D deficiency. Only US population is considered to narrow down the study.^ Results: There is an increased prevalence of low levels of Vitamin D levels below the normal range in the US population regardless of age and health status. Vitamin D deficiency is also associated with increased risk of chronic illnesses and fatal cancers.^ Conclusion: This increased prevalence and the association of the deficiency with increased all-cause mortality has increased the economic burden and compromised the quality of life among the population. This necessitates the health care providers to routinely screen their patients for the Vitamin D status and counsel them to avoid the harmful effects of the Vitamin D deficiency. ^

Planning and implementation efficacy as a determinant of health risk communication outcomes: Case studies of the U.S. Public Health Service (PHS)

This study was conducted under the auspices of the Subcommittee on Risk Communication and Education of the Committee to Coordinate Environmental Health and Related Programs (CCEHRP) to determine how Public Health Service (PHS) agencies are communicating information about health risk, what factors contributed to effective communication efforts, and what specific principles, strategies, and practices best promote more effective health risk communication outcomes.^ Member agencies of the Subcommittee submitted examples of health risk communication activities or decisions they perceived to be effective and some examples of cases they thought had not been as effective as desired. Of the 10 case studies received, 7 were submitted as examples of effective health risk communication, and 3, as examples of less effective communication.^ Information contained in the 10 case studies describing the respective agencies' health risk communication strategies and practices was compared with EPA's Seven Cardinal Rules of Risk Communication, since similar rules were not found in any PHS agency. EPA's rules are: (1) Accept and involve the public as a legitimate partner. (2) Plan carefully and evaluate your efforts. (3) Listen to the public's specific concerns. (4) Be honest, frank, and open. (5) Coordinate and collaborate with other credible sources. (6) Meet the needs of the media. (7) Speak clearly and with compassion.^ On the basis of case studies analysis, the Subcommittee, in their attempts to design and implement effective health risk communication campaigns, identified a number of areas for improvement among the agencies. First, PHS agencies should consider developing a focus specific to health risk communication (i.e., office or specialty resource). Second, create a set of generally accepted practices and guidelines for effective implementation and evaluation of PHS health risk communication activities and products. Third, organize interagency initiatives aimed at increasing awareness and visibility of health risk communication issues and trends within and between PHS agencies.^ PHS agencies identified some specific implementation strategies the CCEHRP might consider pursuing to address the major recommendations. Implementation strategies common to PHS agencies emerged in the following five areas: (1) program development, (2) building partnerships, (3) developing training, (4) expanding information technologies, and (5) conducting research and evaluation. ^

Relationships among epilepsy self-management, health outcomes, and socioeconomic status

The purpose of this study was to investigate the association between epilepsy self-management and disease control and socio-economic status. Study participants were adult patients at two epilepsy specialty clinics in Houston, Texas that serve demographically and socioeconomically diverse populations. Self-management behaviors- medication, information, safety, seizure, and lifestyle management were tested against emergency room visits, hospitalizations, and seizure occurrence. Overall self-management score was associated with a greater likelihood of hospitalizations over a prior twelve month time frame, but not for three months, and was not associated with seizure occurrence or emergency room visits, at all. Scores on specific self-management behaviors varied in their relationships to the different disease control indicators, over time. Contrary to expectations based on the findings of previous research, higher information management scores were associated with greater likelihood of emergency room visits and hospitalizations, over the study's twelve months. Higher lifestyle management scores were associated with lower likelihood of any emergency room visits, over the preceding twelve months and emergency room visits for the last three months. The positive associations between overall self-management scores and information management behaviors and disease control are contrary to published research. These findings may indicate that those with worse disease control in a prior period employ stronger self-management efforts to better control their epilepsy. Further research is needed to investigate this hypothesis.^

Food, nutrition and public health in contemporary Spain, 1900-1936

Within the context of the health reforms introduced in Spain in the early 20th century and the influence of international health organisations on their development, this article analyses the growing interest that surrounded nourishment and food-related problems at that time in relation to healthcare, the diagnosis provided by hygienists of such problems, and the public health measures applied to resolve them. The issue of hygienic diet and the collective aspect of nutritional problems became priorities in the field of healthcare. Two of the most prominent initiatives involved setting up a Department of Nutrition and Food Hygiene and Bromatological Technique during the early years of the Second Republic, as part of the National School of Health, as well as a Food Hygiene Service. Spanish hygienists underlined the importance of education and the dissemination of information about food hygiene, health and nutrition, in order to overcome the qualitative and quantitative deficiencies observed in the average diet of the Spanish population.

Federal government use and management of spectrum : hearing before the Committee on Commerce, Science, and Transportation, United States Senate, One Hundred Fourth Congress, second session, June 25, 1996.

Shipping list no.: 97-0097-P.

Environmental data : major effort is needed to improve NOAA's data management and archiving : report to the Chairman, Committee on Commerce, Science and Transportation, U.S. Senate /

"B-241021"--P. l.

A complete concordance to Science and health, with key to the Scriptures, together with an index to the marginal headings and a list of the Scriptural quotations contained therein;

Mode of access: Internet.

Review of the Department of Energy's health and mortality study [microform] : hearing before the Subcommittee on Investigations and Oversight of the Committee on Science and Technology, U.S. House of Representatives, Ninety-seventh Congress, second session, May 19, 1982.

"No. 146."

A complete concordance to Science and health: with a key to the Scriptures, together with an index to the marginal headings and a list of the Scriptural quotations contained therein; revised from the nineteen hundred and eight edition of Science and health as revised by its author /

Mode of access: Internet.

Reauthorization of the Magnuson-Stevens Fishery Conservation and Management Act : hearing before the Subcommittee on Oceans and Fisheries of the Committee on Commerce, Science, and Transportation, United States Senate, One Hundred Seventh Congress, first session, July 29, 1999.

"Printed for the use of the Committee on Commerce, Science, and Transportation."

Reauthorization of the Magnuson-Stevens Fishery Conservation and Management Act : field hearing before the Subcommittee on Oceans and Fisheries of the Committee on Commerce, Science, and Transportation, United States Senate, One Hundred Sixth Congress, second session, January 18, 2000.

Shipping list no.: 2003-0028-P.

Department of Energy fiscal year 1983 budget on environment, health, and safety [microform] : hearing before the Subcommittee on Natural Resources, Agriculture Research, and Environment of the Committee on Science and Technology, U.S. House of Representatives, Ninety-seventh Congress, second session, March 11, 1982.

"No. 97."

Health hazards at TNS, Inc. [microform] : hearing before the Subcommittee on Investigations and Oversight of the Committee on Science and Technology, U.S. House of Representatives, Ninety-seventh Congress, first session, December 8, 1981.

"No. 102."

NASA program management and procurement procedures and practices [microform] : hearings before the Subcommittee on Space Science and Applications of the Committee on Science and Technology, U.S. House of Representatives, Ninety-seventh Congress, first session, June 24, 25, 1981.

"No. 16."

Health information systems [microform] : hearings before the Subcommittee on Science, Research, and Technology and the Subcommittee on Natural Resources, Agriculture Research, and Environment of the Committee on Science and Technology, U.S. House of Representatives, Ninety-seventh Congress, first session, June 2, 3, 4, July 23, 1981.

"No. 54."