ABSTRACT
It is assumed that long-established research findings and internationally accepted evidence should, and will, be translated into policy and practice. Knowledge about what prevents harm and promotes health has, in fact, guided and resulted in numerous beneficial public health actions. However, such is not always the case. The authors examine three notable, and unwelcome, exceptions in the UK—all in the field of
reproductive health and all focused on the period prior to pregnancy. The three examples of counterproductive inaction discussed are: fortifying flour with Vitamin B9 (folic acid); preventing foetal alcohol spectrum disorders; and reducing risks and better regulating a highly teratogenic medication (valproate). The adverse consequences, as well as the causes, of inaction are analysed for each example. Reasons for optimism, and recommendations for overcoming inaction, are also offered, in particular, greater priority should be accorded to preconception health, education and care.
Public Health, Politics, and the Creation of Meaning: A Public Health of Cons...Jim Bloyd, DrPH, MPH
"The creation of meaning may be an unfamiliar role for public health, but one whose import comes into sharp relief when we recognize the inevitability of the political at the heart of what we do."
This document reviews the rationale for vitamin D food fortification. It finds that vitamin D deficiency is common worldwide due to low dietary intake and sun exposure. While guidelines recommend vitamin D intakes of 10-20 μg per day, most populations fail to meet this. Food fortification is an effective way to improve vitamin D status at a population level. The document outlines vitamin D metabolism, effects, guidelines on status and intake, and the gap between guidelines and actual intake. It reviews the safety of vitamin D and examples of food fortification programs. The conclusion is that food fortification could help close the gap and improve public health in a cost-effective way.
This document summarizes a report on Scotland's health deficit and how increasing vitamin D levels could help address it. The report finds that Scotland has lower vitamin D levels than England due to less sun exposure. Insufficient vitamin D increases risk for several chronic diseases like cancer, heart disease, and diabetes. While other factors like smoking and diet play a role, Scotland's low vitamin D levels help explain its higher rates of chronic illness compared to other countries. The report recommends increasing vitamin D through supplements, fortified foods, and updated sun exposure advice to potentially improve public health in Scotland.
This document discusses obesity as a global health issue and examines some of the ethical considerations around obesity. It provides background on obesity, including definitions and measurements. Some key areas of debate discussed include whether individuals have autonomy over their own health decisions or if governments/healthcare providers should take a more active role; issues of stigma and responsibility around obesity; and debates around paternalism and intervention. The document explores these complex ethical issues around balancing individual rights with societal obligations to address the growing obesity epidemic.
Chemical Trespass - A Toxic Legacy - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
Lauren Campbell Industrial Design Thesis Process BookLauren Campbell
The document discusses research on culturally competent strategies for addressing and preventing obesity among African American and Latino children and youth. It provides an analysis of over 80 research articles on successful interventions targeting these groups, which are presented according to strategies that promote healthy eating, physical activity, and healthy lifestyles. The document also recommends specific roles for occupational therapists in order to promote the implementation of culturally competent obesity prevention strategies.
Scotland has an extreme climate with very little sunshine compared to England. This results in low vitamin D levels among the Scottish population, as over 90% of vitamin D comes from sun exposure. Insufficient vitamin D has been linked to increased risk of numerous chronic diseases that are highly prevalent in Scotland like cancer, heart disease, diabetes, and autoimmune disorders. Despite evidence that improving vitamin D status could help address Scotland's health deficit, successive reports by the Scottish government have failed to recognize low vitamin D as a risk factor. Implementing measures to increase vitamin D levels, such as supplements, food fortification, and updated sun exposure advice, could potentially achieve significant health gains in Scotland at low cost.
Public Health, Politics, and the Creation of Meaning: A Public Health of Cons...Jim Bloyd, DrPH, MPH
"The creation of meaning may be an unfamiliar role for public health, but one whose import comes into sharp relief when we recognize the inevitability of the political at the heart of what we do."
This document reviews the rationale for vitamin D food fortification. It finds that vitamin D deficiency is common worldwide due to low dietary intake and sun exposure. While guidelines recommend vitamin D intakes of 10-20 μg per day, most populations fail to meet this. Food fortification is an effective way to improve vitamin D status at a population level. The document outlines vitamin D metabolism, effects, guidelines on status and intake, and the gap between guidelines and actual intake. It reviews the safety of vitamin D and examples of food fortification programs. The conclusion is that food fortification could help close the gap and improve public health in a cost-effective way.
This document summarizes a report on Scotland's health deficit and how increasing vitamin D levels could help address it. The report finds that Scotland has lower vitamin D levels than England due to less sun exposure. Insufficient vitamin D increases risk for several chronic diseases like cancer, heart disease, and diabetes. While other factors like smoking and diet play a role, Scotland's low vitamin D levels help explain its higher rates of chronic illness compared to other countries. The report recommends increasing vitamin D through supplements, fortified foods, and updated sun exposure advice to potentially improve public health in Scotland.
This document discusses obesity as a global health issue and examines some of the ethical considerations around obesity. It provides background on obesity, including definitions and measurements. Some key areas of debate discussed include whether individuals have autonomy over their own health decisions or if governments/healthcare providers should take a more active role; issues of stigma and responsibility around obesity; and debates around paternalism and intervention. The document explores these complex ethical issues around balancing individual rights with societal obligations to address the growing obesity epidemic.
Chemical Trespass - A Toxic Legacy - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
Lauren Campbell Industrial Design Thesis Process BookLauren Campbell
The document discusses research on culturally competent strategies for addressing and preventing obesity among African American and Latino children and youth. It provides an analysis of over 80 research articles on successful interventions targeting these groups, which are presented according to strategies that promote healthy eating, physical activity, and healthy lifestyles. The document also recommends specific roles for occupational therapists in order to promote the implementation of culturally competent obesity prevention strategies.
Scotland has an extreme climate with very little sunshine compared to England. This results in low vitamin D levels among the Scottish population, as over 90% of vitamin D comes from sun exposure. Insufficient vitamin D has been linked to increased risk of numerous chronic diseases that are highly prevalent in Scotland like cancer, heart disease, diabetes, and autoimmune disorders. Despite evidence that improving vitamin D status could help address Scotland's health deficit, successive reports by the Scottish government have failed to recognize low vitamin D as a risk factor. Implementing measures to increase vitamin D levels, such as supplements, food fortification, and updated sun exposure advice, could potentially achieve significant health gains in Scotland at low cost.
This document provides an overview of nutritional epidemiology. It defines epidemiology as the study of health-related phenomena in human populations. Nutritional epidemiology specifically studies the nutritional determinants of disease. It has contributed to understanding the etiology of many diseases and identifying relationships between diet and health outcomes. However, nutritional epidemiology also faces challenges like determining causality due to the complex nature of diet and potential for bias. Modern diseases often have multiple determinants including both insufficient and excessive nutrient intake.
Food, Nutrition and Health is a complex and interdisciplinary research area with key public health and economic relevance. This document aims to provide the academic and wider stakeholder communities
with a clear roadmap for BBSRC’s strategic support for the area over the next five years, complementing the joint vision of BBSRC, MRC
and ESRC for integrative research across Council remits. It focuses on those aspects which form part of BBSRC’s Strategic Research Priority
in Bioscience for Health, but clearly recognises and seeks to foster synergies with the Agriculture and Food Security priority in supporting research to inform the sustainable provision of safe and nutritious food.
The document examines the World Health Organization's (WHO) endorsement of food irradiation, finding that the WHO abandoned its original research agenda on irradiation safety and ceded authority to the International Atomic Energy Agency (IAEA), whose mission is to promote nuclear technology rather than public health, influencing the WHO's determination that irradiated food is safe for human consumption without sufficient independent review.
4 TUFTS UNIVERSITY HEALTH & NUTRITION LETTER www.tuftshealthl.docxgilbertkpeters11344
4 TUFTS UNIVERSITY HEALTH & NUTRITION LETTER <www.tuftshealthletter.com> : NOVEMBER 2011
SpecialReport
Though “probiotics” have only recently passed the 8 million mark in Google hits, these “good bacte-
ria” have been touted for their health
benefits in many cultures for more than
a century. An early 20th-century scien-
tist, Russian biologist and Nobel Prize
winner Elie Metchnikoff, first studied
them after noticing that Bulgarians and
Russians lived exceptionally long lives
on diets including fermented dairy.
In the late 20th and early 21st cen-
tury, interest in probiotics has boomed.
From 1994 to 2003, US sales of prio-
botic supplements nearly tripled. Food
products containing probiotics have
proliferated throughout the supermar-
ket, including yogurt, fermented and
unfermented milk, miso, tempeh, juices
and soy beverages. Some of these foods
get their “good bacteria” naturally,
while others have the bacteria added in
processing.
It’s important to keep in mind that,
whether probiotics come in pill form or
added to foods, they are regulated as
foods, not medicines. As a result, when
probiotic health claims have gone too far
out on a limb, the manufacturers usually
run afoul of the Federal Trade Commis-
sion, which regulates false advertising,
not the Food and Drug Administration.
So what should you make of these
claims? Are probiotics right for you?
Friendly Bacteria
Though “bacteria” sounds like some-thing to stay far away from, the human body relies on “friendly”
bacteria for healthy operation. The
human gastrointestinal tract alone
contains more than 400 different bacte-
rial species. They work to maintain a
healthy gut lining; we depend on them
to produce vitamins and to suppress
bad bacteria. They’re also used to break
down food and produce the lactase en-
zyme necessary to digest milk. (People
who are lactose intolerant are deficient
in this enzyme.)
Probiotics, according to the World
Health Organization, are “live micro-
organisms, which, when administered
in adequate amounts, confer a health
benefit on the host.” There are four
main families of probiotics: Lactobacil-
lus and Bifidobacterium provide the
most commonly used “good bacteria,”
while others belong to the Saccharo-
myces (actually yeasts, a different type
of microorganism) and Streptococcus
groups. Despite the scary associations
with the term “Streptococcus,” a form
of that bacteria—Streptococcus ther-
mophilus—was the original probiotic,
a yogurt starter popularized by Metch-
nikoff in a book on longevity research,
The Prolongation of Life.
Within each family are individual
strains of microorganisms—the names
you might see when looking on the back
of a yogurt cup, for instance. Among
the more common are Lactobacillus
acidophilus, Bifidobacterium bifidum
and Lactobacillus reuteri. Strains of
Lactobacillus and Bifidobacterium have
especially been highlighted in studies as
therapeutic for various gastrointest.
Editorial: Evidence based policy or policy based evidence? by Michael MarmotJim Bloyd, DrPH, MPH
A simple prescription would be to review the scientific evidence of what would make a difference, formulate policies, and implement them—evidence based policy making. Unfor- tunately this simple prescription, applied to real life, is simplistic. The relation between science and policy is more complicated. Scientific findings do not fall on blank minds that get made up as a result. Science engages with busy minds that have strong views about how things are and ought to be.
The document discusses different types of diabetes. It notes that type 1 diabetes occurs when the pancreas does not produce enough insulin, while type 2 diabetes occurs when the body cannot effectively use the insulin it produces. The incidence of both type 1 and type 2 diabetes is rising, with type 2 increasingly affecting children. Impaired glucose tolerance and impaired fasting glycaemia are also discussed as risk factors for diabetes and cardiovascular disease.
- World Cancer Research Fund (WCRF UK) is a charity focused on cancer prevention through diet, physical activity, and weight management. About a third of common cancers could be prevented in this way.
- WCRF UK funds research and interprets scientific evidence to develop recommendations for reducing cancer risk. Their 10 recommendations include maintaining a healthy weight, being physically active, eating a plant-based diet low in processed and red meats, and limiting alcohol and salty foods.
- WCRF UK educates the public about lifestyle choices that can lower cancer risk based on their evidence-based recommendations.
The Status of the Regulatory and Economic Landscape for Innovation in Big Pha...Lindsay Meyer
The purpose of engaging this topic is to: examine the current regulatory environment for new drugs, gain an understanding of breakthrough innovation in pharmaceuticals, evaluate the efforts of key players, and make projections about the future of this industry. As therapeutics has evolved away from their theistic origins, natural products, synthetic chemistry, and biopharmaceuticals have emerged. Yet many difficulties remain for this specialized industry. The approval process for a new drug can take upwards of eight years and cost $800 million. The progression from test tube to commercial distribution includes preclinical trials followed by three phases of clinical (human) trials, marked by ongoing dialogue between the Food and Drug Administration (“FDA”). Five of largest American pharmaceutical companies have intensified their efforts in Research and Development (“R&D”) in recent years. But in a space marked with competition from generic manufacturers and maturing biotech companies, understanding the dynamics of this highly scrutinized market requires an awareness of the political and economic climate these key players face. Where this industry is headed is much less clear than where it is coming from. Careful analysis is one lens through which to examine all of these intricate elements and is the focus of this research paper.
This document is a report from the Joint Committee on Health in Ireland that examines vitamin D deficiency as a public health issue. It discusses the importance of vitamin D for health, the high rates of deficiency in Ireland, approaches in other countries, and recommendations for reforming public health policy in Ireland to address deficiency. The report recommends daily vitamin D supplements for adults, a public awareness campaign, reducing VAT on supplements, and targeted measures for at-risk groups like nursing home residents.
This document discusses the relationship between type 2 diabetes and the gut microbiome. It notes that the prevalence of metabolic syndrome is increasing rapidly globally, especially in developing countries where people are developing diabetes at younger ages. The gut microbiome can influence whole body metabolism and is impacted by factors like nutrition and lifestyle. Studies have found differences in the gut microbiome of people with obesity and type 2 diabetes, but more research is needed on populations in developing countries. The gut microbiome may impact metabolic health through effects on nutrient processing, gut permeability, inflammation, and signaling molecule production.
The public's health and the public health systemJohn Middleton
Presentation on current issues for the UK Faculty of Public Health, for the North East Faculty Local Area Committee, May 31st 2018. 180531 middletonj durham final
This document debunks common health myths and provides the facts about them. It addresses the myths that drinking 8 glasses of water per day is necessary for hydration, that consuming foods high in cholesterol raises blood cholesterol levels and increases heart disease risk, and that eggs, shrimp, and cheese should be avoided due to their cholesterol content. The document finds that while some health organizations recommend around 8 glasses, the body regulates hydration on its own and thirst is a good indicator. It also determines that dietary cholesterol has little effect on blood cholesterol and heart disease risk compared to other factors like saturated fat intake. Finally, it notes that eggs, shrimp, and cheese all provide health benefits from nutrients like omega-3s, vitamins, and prob
New Policies Needed to Reduce the Global Burden of Ageing Related PathologiesIndia Future Society
This document discusses the need for new policies to address the global burden of age-related diseases. It notes that longevity research is highly specialized across different countries. It also shows that non-communicable diseases account for a large share of deaths globally, especially in higher income countries, and this share is projected to increase further by 2030. The document advocates for three main policy changes: 1) increasing funding for research on the biology of aging, 2) providing beneficial regulation for biotechnologies aimed at preventing aging, and 3) reforming clinical trial processes to make them less costly and better support the development of preventive medicines and anti-aging interventions.
This document summarizes a Cochrane Database of Systematic Reviews article that found giving corticosteroids along with antibiotics to patients with bacterial meningitis can significantly reduce hearing loss in children and save lives in both children and adults. The review found corticosteroid therapy more than halves severe hearing loss in children from 8% to 3% and lowers the risk of death and brain damage. It recommends a four-day course of dexamethasone be given to patients in developed countries.
The document discusses the importance of medical research into aging given population aging trends. It notes that while lifespans have doubled in recent centuries, aging is associated with increased risk of disease and disability. However, evidence suggests healthy lifespans are also increasing. Understanding aging processes could help tackle multiple age-related diseases and extend healthy years. The report examines the UK's aging research performance and priorities. It finds the UK compares unfavorably to countries like the US in basic aging research. It identifies priorities like attracting senior scientists, developing more aging research centers of excellence, emphasizing aging research within disciplines, and improving understanding of current UK investments. Barriers to developing interventions include small aging clinical trials, a disease-focused regulatory system
This document outlines the UK government's plan to improve nutrition and public health in England through encouraging healthier eating. It recognizes that while many in England eat well, poor diet is a major cause of health issues like cancer and heart disease. The plan aims to increase consumption of fruits and vegetables and decrease intake of fat, salt, and sugar to help reduce obesity, diseases, and health inequalities. It will coordinate efforts across different sectors and levels of government to support healthier choices and make nutrition information more available. The overall goal is to improve population health and reduce diet-related deaths and health costs in England.
This study analyzed data from over 15,000 infants in the UK Millennium Cohort Study to examine the relationship between breastfeeding and hospitalization for diarrhea and respiratory infections in the first 8 months of life. The results showed that exclusive breastfeeding, compared to no breastfeeding, was associated with a lower risk of hospitalization for both diarrhea and respiratory infections after adjusting for various confounding factors. Partial breastfeeding also showed a protective effect, but it was weaker than exclusive breastfeeding. The protective effects of breastfeeding decreased after breastfeeding cessation. The study suggests that increased rates of exclusive and prolonged breastfeeding could significantly reduce hospitalizations in the UK.
The document discusses the Codex Alimentarius Commission, which was established to set food standards and protect consumer health. However, it is argued that Codex has been covertly altered to prioritize corporate profits over public health. Future Codex standards proposed include classifying nutrients as toxins and limiting them to negligible amounts, requiring the irradiation of all food, and allowing growth hormones, antibiotics, and GMOs in food production on a global scale. Critics believe these standards threaten health freedom and could harm billions of people if implemented worldwide through the World Trade Organization.
This document analyzes and compares four major diets: Low-carb (Atkins), Low-Calorie (Weight Watchers), Low-Sodium (Dr. Ornish), and Diabetic. It finds that the Ornish diet is the safest and most medically proven, as it focuses on preventative lifestyle changes like a very low-fat vegetarian diet and has received funding and endorsements from major health organizations. However, dieting is difficult for most Americans to maintain long-term. Sustainable and local food is important to support health, and films like The Meatrix can raise awareness of these issues.
The document discusses a recent Saturday Night Live sketch titled "Winter Formal" that portrayed a character with fetal alcohol spectrum disorder (FASD) in a derisive manner. The author, as a parent, shares the hurt that those with FASD will feel upon viewing the sketch. They question the knowledge and motivations of those involved in its production, as well as the positions of NBC and its parent company Comcast regarding prenatal alcohol exposure and FASD given advertising revenue from the alcohol industry. The production was seen as contributing to further marginalization of those with FASD rather than comedy or satire.
This document provides an overview of nutritional epidemiology. It defines epidemiology as the study of health-related phenomena in human populations. Nutritional epidemiology specifically studies the nutritional determinants of disease. It has contributed to understanding the etiology of many diseases and identifying relationships between diet and health outcomes. However, nutritional epidemiology also faces challenges like determining causality due to the complex nature of diet and potential for bias. Modern diseases often have multiple determinants including both insufficient and excessive nutrient intake.
Food, Nutrition and Health is a complex and interdisciplinary research area with key public health and economic relevance. This document aims to provide the academic and wider stakeholder communities
with a clear roadmap for BBSRC’s strategic support for the area over the next five years, complementing the joint vision of BBSRC, MRC
and ESRC for integrative research across Council remits. It focuses on those aspects which form part of BBSRC’s Strategic Research Priority
in Bioscience for Health, but clearly recognises and seeks to foster synergies with the Agriculture and Food Security priority in supporting research to inform the sustainable provision of safe and nutritious food.
The document examines the World Health Organization's (WHO) endorsement of food irradiation, finding that the WHO abandoned its original research agenda on irradiation safety and ceded authority to the International Atomic Energy Agency (IAEA), whose mission is to promote nuclear technology rather than public health, influencing the WHO's determination that irradiated food is safe for human consumption without sufficient independent review.
4 TUFTS UNIVERSITY HEALTH & NUTRITION LETTER www.tuftshealthl.docxgilbertkpeters11344
4 TUFTS UNIVERSITY HEALTH & NUTRITION LETTER <www.tuftshealthletter.com> : NOVEMBER 2011
SpecialReport
Though “probiotics” have only recently passed the 8 million mark in Google hits, these “good bacte-
ria” have been touted for their health
benefits in many cultures for more than
a century. An early 20th-century scien-
tist, Russian biologist and Nobel Prize
winner Elie Metchnikoff, first studied
them after noticing that Bulgarians and
Russians lived exceptionally long lives
on diets including fermented dairy.
In the late 20th and early 21st cen-
tury, interest in probiotics has boomed.
From 1994 to 2003, US sales of prio-
botic supplements nearly tripled. Food
products containing probiotics have
proliferated throughout the supermar-
ket, including yogurt, fermented and
unfermented milk, miso, tempeh, juices
and soy beverages. Some of these foods
get their “good bacteria” naturally,
while others have the bacteria added in
processing.
It’s important to keep in mind that,
whether probiotics come in pill form or
added to foods, they are regulated as
foods, not medicines. As a result, when
probiotic health claims have gone too far
out on a limb, the manufacturers usually
run afoul of the Federal Trade Commis-
sion, which regulates false advertising,
not the Food and Drug Administration.
So what should you make of these
claims? Are probiotics right for you?
Friendly Bacteria
Though “bacteria” sounds like some-thing to stay far away from, the human body relies on “friendly”
bacteria for healthy operation. The
human gastrointestinal tract alone
contains more than 400 different bacte-
rial species. They work to maintain a
healthy gut lining; we depend on them
to produce vitamins and to suppress
bad bacteria. They’re also used to break
down food and produce the lactase en-
zyme necessary to digest milk. (People
who are lactose intolerant are deficient
in this enzyme.)
Probiotics, according to the World
Health Organization, are “live micro-
organisms, which, when administered
in adequate amounts, confer a health
benefit on the host.” There are four
main families of probiotics: Lactobacil-
lus and Bifidobacterium provide the
most commonly used “good bacteria,”
while others belong to the Saccharo-
myces (actually yeasts, a different type
of microorganism) and Streptococcus
groups. Despite the scary associations
with the term “Streptococcus,” a form
of that bacteria—Streptococcus ther-
mophilus—was the original probiotic,
a yogurt starter popularized by Metch-
nikoff in a book on longevity research,
The Prolongation of Life.
Within each family are individual
strains of microorganisms—the names
you might see when looking on the back
of a yogurt cup, for instance. Among
the more common are Lactobacillus
acidophilus, Bifidobacterium bifidum
and Lactobacillus reuteri. Strains of
Lactobacillus and Bifidobacterium have
especially been highlighted in studies as
therapeutic for various gastrointest.
Editorial: Evidence based policy or policy based evidence? by Michael MarmotJim Bloyd, DrPH, MPH
A simple prescription would be to review the scientific evidence of what would make a difference, formulate policies, and implement them—evidence based policy making. Unfor- tunately this simple prescription, applied to real life, is simplistic. The relation between science and policy is more complicated. Scientific findings do not fall on blank minds that get made up as a result. Science engages with busy minds that have strong views about how things are and ought to be.
The document discusses different types of diabetes. It notes that type 1 diabetes occurs when the pancreas does not produce enough insulin, while type 2 diabetes occurs when the body cannot effectively use the insulin it produces. The incidence of both type 1 and type 2 diabetes is rising, with type 2 increasingly affecting children. Impaired glucose tolerance and impaired fasting glycaemia are also discussed as risk factors for diabetes and cardiovascular disease.
- World Cancer Research Fund (WCRF UK) is a charity focused on cancer prevention through diet, physical activity, and weight management. About a third of common cancers could be prevented in this way.
- WCRF UK funds research and interprets scientific evidence to develop recommendations for reducing cancer risk. Their 10 recommendations include maintaining a healthy weight, being physically active, eating a plant-based diet low in processed and red meats, and limiting alcohol and salty foods.
- WCRF UK educates the public about lifestyle choices that can lower cancer risk based on their evidence-based recommendations.
The Status of the Regulatory and Economic Landscape for Innovation in Big Pha...Lindsay Meyer
The purpose of engaging this topic is to: examine the current regulatory environment for new drugs, gain an understanding of breakthrough innovation in pharmaceuticals, evaluate the efforts of key players, and make projections about the future of this industry. As therapeutics has evolved away from their theistic origins, natural products, synthetic chemistry, and biopharmaceuticals have emerged. Yet many difficulties remain for this specialized industry. The approval process for a new drug can take upwards of eight years and cost $800 million. The progression from test tube to commercial distribution includes preclinical trials followed by three phases of clinical (human) trials, marked by ongoing dialogue between the Food and Drug Administration (“FDA”). Five of largest American pharmaceutical companies have intensified their efforts in Research and Development (“R&D”) in recent years. But in a space marked with competition from generic manufacturers and maturing biotech companies, understanding the dynamics of this highly scrutinized market requires an awareness of the political and economic climate these key players face. Where this industry is headed is much less clear than where it is coming from. Careful analysis is one lens through which to examine all of these intricate elements and is the focus of this research paper.
This document is a report from the Joint Committee on Health in Ireland that examines vitamin D deficiency as a public health issue. It discusses the importance of vitamin D for health, the high rates of deficiency in Ireland, approaches in other countries, and recommendations for reforming public health policy in Ireland to address deficiency. The report recommends daily vitamin D supplements for adults, a public awareness campaign, reducing VAT on supplements, and targeted measures for at-risk groups like nursing home residents.
This document discusses the relationship between type 2 diabetes and the gut microbiome. It notes that the prevalence of metabolic syndrome is increasing rapidly globally, especially in developing countries where people are developing diabetes at younger ages. The gut microbiome can influence whole body metabolism and is impacted by factors like nutrition and lifestyle. Studies have found differences in the gut microbiome of people with obesity and type 2 diabetes, but more research is needed on populations in developing countries. The gut microbiome may impact metabolic health through effects on nutrient processing, gut permeability, inflammation, and signaling molecule production.
The public's health and the public health systemJohn Middleton
Presentation on current issues for the UK Faculty of Public Health, for the North East Faculty Local Area Committee, May 31st 2018. 180531 middletonj durham final
This document debunks common health myths and provides the facts about them. It addresses the myths that drinking 8 glasses of water per day is necessary for hydration, that consuming foods high in cholesterol raises blood cholesterol levels and increases heart disease risk, and that eggs, shrimp, and cheese should be avoided due to their cholesterol content. The document finds that while some health organizations recommend around 8 glasses, the body regulates hydration on its own and thirst is a good indicator. It also determines that dietary cholesterol has little effect on blood cholesterol and heart disease risk compared to other factors like saturated fat intake. Finally, it notes that eggs, shrimp, and cheese all provide health benefits from nutrients like omega-3s, vitamins, and prob
New Policies Needed to Reduce the Global Burden of Ageing Related PathologiesIndia Future Society
This document discusses the need for new policies to address the global burden of age-related diseases. It notes that longevity research is highly specialized across different countries. It also shows that non-communicable diseases account for a large share of deaths globally, especially in higher income countries, and this share is projected to increase further by 2030. The document advocates for three main policy changes: 1) increasing funding for research on the biology of aging, 2) providing beneficial regulation for biotechnologies aimed at preventing aging, and 3) reforming clinical trial processes to make them less costly and better support the development of preventive medicines and anti-aging interventions.
This document summarizes a Cochrane Database of Systematic Reviews article that found giving corticosteroids along with antibiotics to patients with bacterial meningitis can significantly reduce hearing loss in children and save lives in both children and adults. The review found corticosteroid therapy more than halves severe hearing loss in children from 8% to 3% and lowers the risk of death and brain damage. It recommends a four-day course of dexamethasone be given to patients in developed countries.
The document discusses the importance of medical research into aging given population aging trends. It notes that while lifespans have doubled in recent centuries, aging is associated with increased risk of disease and disability. However, evidence suggests healthy lifespans are also increasing. Understanding aging processes could help tackle multiple age-related diseases and extend healthy years. The report examines the UK's aging research performance and priorities. It finds the UK compares unfavorably to countries like the US in basic aging research. It identifies priorities like attracting senior scientists, developing more aging research centers of excellence, emphasizing aging research within disciplines, and improving understanding of current UK investments. Barriers to developing interventions include small aging clinical trials, a disease-focused regulatory system
This document outlines the UK government's plan to improve nutrition and public health in England through encouraging healthier eating. It recognizes that while many in England eat well, poor diet is a major cause of health issues like cancer and heart disease. The plan aims to increase consumption of fruits and vegetables and decrease intake of fat, salt, and sugar to help reduce obesity, diseases, and health inequalities. It will coordinate efforts across different sectors and levels of government to support healthier choices and make nutrition information more available. The overall goal is to improve population health and reduce diet-related deaths and health costs in England.
This study analyzed data from over 15,000 infants in the UK Millennium Cohort Study to examine the relationship between breastfeeding and hospitalization for diarrhea and respiratory infections in the first 8 months of life. The results showed that exclusive breastfeeding, compared to no breastfeeding, was associated with a lower risk of hospitalization for both diarrhea and respiratory infections after adjusting for various confounding factors. Partial breastfeeding also showed a protective effect, but it was weaker than exclusive breastfeeding. The protective effects of breastfeeding decreased after breastfeeding cessation. The study suggests that increased rates of exclusive and prolonged breastfeeding could significantly reduce hospitalizations in the UK.
The document discusses the Codex Alimentarius Commission, which was established to set food standards and protect consumer health. However, it is argued that Codex has been covertly altered to prioritize corporate profits over public health. Future Codex standards proposed include classifying nutrients as toxins and limiting them to negligible amounts, requiring the irradiation of all food, and allowing growth hormones, antibiotics, and GMOs in food production on a global scale. Critics believe these standards threaten health freedom and could harm billions of people if implemented worldwide through the World Trade Organization.
This document analyzes and compares four major diets: Low-carb (Atkins), Low-Calorie (Weight Watchers), Low-Sodium (Dr. Ornish), and Diabetic. It finds that the Ornish diet is the safest and most medically proven, as it focuses on preventative lifestyle changes like a very low-fat vegetarian diet and has received funding and endorsements from major health organizations. However, dieting is difficult for most Americans to maintain long-term. Sustainable and local food is important to support health, and films like The Meatrix can raise awareness of these issues.
Similar to Perspectives failures in reproductive health policy overcoming the consequences and causes of inaction (20)
The document discusses a recent Saturday Night Live sketch titled "Winter Formal" that portrayed a character with fetal alcohol spectrum disorder (FASD) in a derisive manner. The author, as a parent, shares the hurt that those with FASD will feel upon viewing the sketch. They question the knowledge and motivations of those involved in its production, as well as the positions of NBC and its parent company Comcast regarding prenatal alcohol exposure and FASD given advertising revenue from the alcohol industry. The production was seen as contributing to further marginalization of those with FASD rather than comedy or satire.
Conclusions reached from my involvement with the Canadian criminal justice system. 2011.
amd- 2021
References of papers published by Dr Mansfield Mela, and others regarding FASD, PAE, Mental Health, and the Justice System.
Dr Mela is one of the very few Forensic Psychiatrists who understands and advocates for those with FASD.
The Nomenclature of the Consequences of Prenatal Alcohol Exposure: PAE, and t...BARRY STANLEY 2 fasd
An historical account of the nomenclature relating to the effects of alcohol on the developing fetus.
The significance of facial features; the dose/threshold question; epigenetics, transgenerational consequences, and adult health issues, are raised.
The inadequacy of the present nomenclature is detailed
The AQUA study involved almost 1600 Victorian women who provided information during pregnancy about alcohol consumption, diet, supplements and lifestyle. Samples were collected from placentas, cord blood and cheek swabs to test for genetic markers and over 500 babies had 3D photos of their faces at age 1 to look for signs of prenatal alcohol exposure. At ages 1 and 2, children received developmental assessments and mothers reported on development. Researchers are examining outcomes like facial shape and child development and how genes and metabolism may impact alcohol's effects. The study found over half took supplements before pregnancy and most took them during pregnancy. However, 70% of women did not meet recommended iron intake by the third trimester despite many increasing intake. Researchers will further
Effects of Hyperbaric Oxygen Therapy on Brain Perfusion, Cognition and Behavi...BARRY STANLEY 2 fasd
Abstract
A 15-year-old girl diagnosed with FASD underwent 100 courses of hyperbasic oxygen therapy (HBOT). Prior to HBOT, single motion emission compute tomographic begin imaging (SPECT)
revealed areas of hypo-perfusion bilaterally in the orbitofrontal region, temporal lobes and right dorsolateral—frontal, as well the medial aspect of the left cerebellum. Following two sets of HBOT treatments (60 plus 40), over 6 months, there was improvement in perfusion to the left cerebellum as well as the right frontal lobe. This was paralleled by improvement in immediate cognitive tests and an increase in functional brain volume. A follow-up 18 months after HBOT showed sustained
improvement in attention with no need for methylphenidate, as well as in math skills and writing.
This year as a priority of Proof Alliance’s legislative platform, major legislation that requires all children entering foster care be screened for prenatal exposure to alcohol in Minnesota was passed and signed into law. It is believed Minnesota is the first state in the nation to pass this legislation.
Four year follow-up of a randomized controlled trial of choline for neurodeve...BARRY STANLEY 2 fasd
Abstract
Background
Despite the high prevalence of fetal alcohol spectrum disorder (FASD), there are few interventions targeting its core neurocognitive and behavioral deficits. FASD is often conceptualized as static and permanent, but interventions that capitalize on brain plasticity and critical developmental windows are emerging. We present a long-term follow-up study evaluating the neurodevelopmental effects of choline supplementation in children with FASD 4 years after an initial efficacy trial
Abstract
This presentation includes a brief review of research into boredom, normal brain resting state and corresponding default mode[s].
The possible equivalence to the brain activity of those with FASD in relation to “being bored” is explored, with reference to brain anatomy and function.
Actual FASD clinical cases are presented to illustrate what individuals with FASD mean by “boredom”: describing the role of perseveration as a relief process.
Finally, the manner in which these processes are misinterpreted is explored, with implications for Psychiatry and the Justice System.
Mandatory pregnancy warning labels on alcohol could save Canada significant costs associated with fetal alcohol spectrum disorder (FASD). While producers argue labels would cost $400 million to implement, the economic burden of FASD in Canada is much greater. Estimates show the cost of FASD diagnoses is $3.6-5.2 million annually, and the total national cost of FASD is $1.3-2.3 billion including lost productivity and child welfare costs. Warning labels could help reduce FASD incidence and its substantial economic impacts.
Work requirements for individuals with fasd, in the time of covid 19BARRY STANLEY 2 fasd
This document discusses work challenges for individuals with fetal alcohol spectrum disorder (FASD) during the COVID-19 pandemic. It outlines principles for job requirements based on the author's son's experiences, including avoiding unexpected changes, only reporting to one supervisor who can communicate visually, and finding an environment with minimal sensory overload. The son was able to find stable work as a tow truck driver and Uber driver when his positions met these principles, but circumstances like injury and the pandemic intervened. Currently, he runs a web business printing logos that allows him to work independently. The author hopes these principles can help others with FASD find appropriate jobs during this difficult time.
This editorial discusses the risks of increased alcohol consumption during the COVID-19 pandemic. It notes that alcohol sales increased significantly when lockdowns began. Two groups are especially at risk - those already struggling with alcohol dependence who may lose access to support services, and those at risk of developing dependence due to job losses or relationship issues during the pandemic. The article calls for addressing alcohol harms to be part of recovery efforts from COVID-19.
Association Between Prenatal Exposure to Alcohol and Tobacco and Neonatal Bra...BARRY STANLEY 2 fasd
IMPORTANCE Research to date has not determined a safe level of alcohol or tobacco use during pregnancy. Electroencephalography (EEG) is a noninvasive measure of cortical function that has previously been used to examine effects of in utero exposures and associations with
neurodevelopment.
OBJECTIVE To examine the association of prenatal exposure to alcohol (PAE) and tobacco smoking (PTE) with brain activity in newborns.
CONCLUSIONS AND RELEVANCE These findings suggest that even low levels of PAE or PTE are
associated with changes in offspring brain development.
New insight on maternal infections and neurodevelopmental disorders: mouse st...BARRY STANLEY 2 fasd
The immune responses of female mice before pregnancy can predict how likely their offspring will be to have behavioral deficits if the mother's immune system is activated during pregnancy, according to a new mouse study. Researchers found that measuring a mouse's inflammatory response to a viral mimic before pregnancy allowed them to determine if the offspring would develop problems if the mother was exposed to the mimic during gestation. This could help identify pregnancies that are more at risk from maternal infections and lead to ways to prevent neurodevelopmental disorders in children.
Submitted to –
National Institute for Health and Care Excellence Fetal alcohol spectrum disorder
Consultation on draft quality standard – deadline for comments 5pm on 03/04/20
Clinical course and risk factors for mortality of adult inpatients with covid...BARRY STANLEY 2 fasd
Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help
clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale
for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Preconceptual alcohol and the need for a diagnostic classification of alcoho...BARRY STANLEY 2 fasd
The document discusses the need for a new diagnostic classification to address disabilities related to preconceptual and prenatal alcohol exposure. It notes that existing definitions of fetal alcohol spectrum disorder (FASD) do not account for preconceptual alcohol exposure. A wider definition, such as Alcohol Related Developmental Disabilities, is proposed to include subgroups for neurological and immunological impairments caused by prenatal and preconceptual alcohol, with or without additional environmental factors. This would help facilitate understanding of the long-term impacts of preconceptual and prenatal alcohol in combination with other modern environmental toxins.
The importance and significance of the diagnosis the personal testimony of r...BARRY STANLEY 2 fasd
R.J. Formanek shares their personal experience receiving an FASD diagnosis at age 47 after a lifetime of struggles. They felt like an "alien" and could get by but never truly understood social norms or why they struggled in certain areas. The diagnosis provided an explanation for their experiences and differences, allowing them to forgive themselves and accept themselves as uniquely wired rather than "broken". It named an invisible "monster" they had feared their whole life, reducing its power over them and allowing them to fully live their own life.
Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive SymptomsA Randomized Clinical Trial
Zindel V. Segal, PhD1; Sona Dimidjian, PhD2; Arne Beck, PhD3; et alJennifer M. Boggs, PhD3; Rachel Vanderkruik, MA2; Christina A. Metcalf, MA2; Robert Gallop, PhD4; Jennifer N. Felder, PhD5; Joseph Levy, BA2
Author Affiliations
JAMA Psychiatry. Published online January 29, 2020. doi:10.1001/jamapsychiatry.2019.4693
Significance for fasd
This document discusses the need to expand the definition of fetal alcohol spectrum disorder (FASD) to include preconceptual alcohol exposure from both parents. Currently, the definition of FASD only considers prenatal alcohol exposure from the mother during pregnancy. However, recent research suggests paternal preconception alcohol use and other environmental toxins can also impact fetal development and increase vulnerability to stress and alcohol drinking behaviors later in life through epigenetic mechanisms. The document lists several relevant research papers that studied the effects of preconceptual exposures from both parents on offspring development, behavior, and health outcomes. There is a call to raise more awareness about how preconception lifestyle factors can influence fetal and child development.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
2. of inaction are much more frequent and more profound
than acknowledged.
Profiles in procrastination
Case 1: Not fortifying flour with vitamin B9
Ironies abound in this example. A total of 80 countries
around the world mandate the fortification of flour, or
another staple grain, with vitamin B9
(folic acid)—but not
the UK.7
This is true even though the British Medical
Research Council funded the still-lauded, 1991 randomized
control trial that provided the scientific foundation for inter-
national fortification.8
Following 2 decades of closely moni-
tored implementation, no country has ever had cause to
discontinue mandatory vitamin B9
food fortification.
The justification for significantly increasing women’s
blood folate levels prior to conception is beyond scientific
doubt. An adequate level of folate (primarily from folic acid)
prevents more than two-thirds of neural tube defects
(NTDs). But, the preventative benefit is achieved only if that
higher level is reached during the months before conception
and at least the first month of pregnancy (when the neural
tube forms).9
NTDs include not only spina bifida and four
forms of disordered brain development among live births,
but also lead to miscarriages, voluntary terminations, still-
births and infant deaths.
Only a minority of prospective mothers have adequate
folate levels at the start of their pregnancy—almost always
the result of an extended, daily, individual regimen of vita-
min B9
(folic acid) supplementation.10
Among women of
childbearing potential, the prevention benefits are realized
less frequently by those with low socioeconomic status. This
inequality is exacerbated by the fact that roughly half of all
UK pregnancies are unintended or mistimed. Twenty years
of actively promoting ‘voluntary supplementation’ has not
succeeded.11
For the sake of both primary prevention and reducing
inequalities, the solution is to mandate vitamin B9
fortifica-
tion of all wheat (but not wholegrain) flour and/or other
grains. This still allows consumers to choose non-fortified
products and voluntary supplementation, if they prefer.
The lead researcher for the original 1991 RCT is Dr
Nicholas Wald, later honoured with a knighthood for his
contributions to global public health. And yet, Professor Sir
Nicholas’ advice to mandate fortification of flour with vita-
min B9
—as a matter of urgency—has been ignored for
more than 25 years within the UK.12
Major new research from Wald et al.13
removes the last
medical-minority doubt about folic acid fortification. It
reveals that fears of an ‘overdose’ are groundless, as there
are no ill effects from ingesting any plausible level of vitamin
B9
—bodies merely eliminate any excess.
Repeatedly, and in great detail, the UK’s Food Standards
Agency’s own Scientific Advisory Council on Nutrition
(SACN) has examined the evidence on the pros and cons of
fortification. It also assessed the evidence from all the coun-
tries mandating fortification. Each time, SACN has publicly
endorsed adding vitamin B9
to flour without reservation—
but also without success.14
The final irony is that the UK has already mandated and
implemented the fortification of (non-wholegrain) wheat
flour with four health-promoting ingredients—including
both vitamin B1
(thiamine) and B3
(niacin)—for more than
half a century.15
Case 2: Minimizing the existence and importance
of foetal alcohol harm
Starting with the 18th century Gin Act, UK governments and
campaigners have tried to reduce alcohol harm. However, this
general aspiration rarely extended to discouraging alcohol
consumption during pregnancy. In fact, alcohol was used to
offset some gestational symptoms.16,17
The term ‘Fetal Alcohol Syndrome’ first appeared in ‘The
Lancet’ in 1973.18
Following up in Scotland, Dr Forrester
Cockburn, Professor of Child Health at Glasgow University/
Yorkhill Hospital, co-authored a 1983 article in the ‘British
Medical Journal’ on the dozens of FAS cases quickly con-
firmed locally.19
The entire topic then virtually disappeared
from the medical literature and health policy for more than 2
decades in Scotland/UK.20
Over the next 35 years, full-blown FAS came to be under-
stood as constituting only ~10% of cases of the much broader
entity, FASD.21
There is longstanding scientific agreement that
alcohol is a teratogenic agent, passing easily through the pla-
centa, un-metabolized by the foetus. Among those affected, the
harm typically includes irreversible neurodevelopmental, cogni-
tive and behavioural impairment.22,23
Amidst recent attention to ‘Scotland’s unhealthy relation-
ship with alcohol’—including landmark minimum unit pricing
legislation implemented in Scotland in 2018—FASD is men-
tioned only in passing.24,25
This FASD policy vacuum is espe-
cially noteworthy given that women in Scotland and the rest
of the UK are equal consumers of alcohol in the heaviest-
drinking World Health Organization region.26
FASD remains
a cultural, professional and governmental ‘blind spot’ allowing
foetal alcohol harm and its lifelong consequences to continue
unabated. Even minimum unit pricing may not solve the
problem.27
2 JOURNAL OF PUBLIC HEALTH
Downloaded from https://academic.oup.com/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdy131/5076112
by guest
on 30 August 2018
3. Case 3: Failing to control access to, and gain informed
consent about, valproate prescribing for women of
reproductive age
French scientists serendipitously discovered in the early 1960s
that valproate had anti-seizure properties. The US Food and
Drug Administration (FDA) first approved it as an epilepsy
medication 40 years ago (1978). The reality was confirmed
in the 1980s that valproate was an especially powerful ter-
atogen—with up to 40% of exposures during pregnancy
resulting in significant physical and neurodevelopmental birth
defects.28
Thus, the basis for informing, counselling and con-
trolling access to valproate among women of childbearing
potential has been known for at least 25 years.29
Across the UK, many women having epilepsy and pre-
scribed valproate have received ‘preconception’ counselling
(including switching medications pre-pregnancy). Similarly,
no competent doctor would ‘start’ prescribing valproate to a
visibly pregnant woman. There are automatic warnings and
contraindications built into the prescribing system.
Recently, a widespread, clear warning has been issued
across the UK against prescribing valproate, for any reason,
to women of childbearing potential.30
And yet, in recent
years, 92 000 valproate prescriptions annually have been
given to young girls and women of childbearing age, in
England alone.31
Recent public outcry in France has now reached the
European Medicines Agency (EMA).31,32
The EMA held its
first-ever Public Hearing in September 2017 to address pro-
blems and possible solutions related to valproate.33
In 2018,
the EMA, and subsequently the UK Government and Irish
legislature, finally recommended significantly stronger mea-
sures to reduce exposure to valproate during pregnancy
(ranging from clearer warnings to better informed consent
procedures) and prior to conception (e.g. risk assessments,
counselling and contraception as needed, while taking val-
proate).34–36
These are welcome steps forward, but they beg the ques-
tion: ‘Why were not such sensible public health measures
implemented over the past 3 decades, since the requisite sci-
entific knowledge was already firmly in place?’37
The price of passivity
It is one thing to refrain from initiating public health and
clinical actions when credible evidence and understanding
are sparse or contradictory. But, it is quite another to have
had so much certainty for so long, and yet fail to act.
Major and enduring damage was done in the UK over the
past decades to the thousands of people (both living and
dead) who have been affected by preventable NTDs, FASD
and exposure to valproate in utero.38–40
There is no cure for
spina bifida, anencephaly or other NTDs; no one ‘outgrows’
foetal alcohol harm; and, none of the valproate-induced birth
defects are fully rectifiable.
Adding insult to injury, ‘secondary effects’ associated with
each of these birth defects compromise lives and life
chances.41
For instance, victims can experience stigmatiza-
tion, bullying, or exclusion from school. Their parents, sib-
lings, family members and carers have also had their work,
personal and economic lives radically changed by their
responsibilities toward those with FASD, NTDs or foetal
valproate harm. Adverse pregnancy outcomes (e.g. miscar-
riages) also come with a significant human cost.
The high financial/economic burdens associated with
NTDs, FASD and valproate-harm have been formally but
incompletely estimated—e.g. the familiar reference to ‘mil-
lion dollar FASD babies’ in Canada.42
Beyond these tangible
burdens on the public purse and the human costs noted
above, there is a broader professional and societal price tag
for inaction, including loss of confidence in public health
policymakers and practitioners, and questioning their com-
mitment to reproductive health and primary prevention.
The causes of inaction
We suggest that prolonged inaction on these pregnancy-
related public health measures can best be explained by cul-
tural factors in Scotland and the rest of the UK. ‘Cultural’ in
this context refers to the ‘prevailing’ beliefs, values, assump-
tions, social norms, traditions, language, attitudes and social-
ization processes that shape collective thinking, reactions
and actions.
‘First, the UK’s public policy apparatus operates in a fun-
damentally reactive, crisis-driven manner—and FASD,
NTDs and valproate misuse have not been perceived by the
“powers that be” as crises.’ A hallmark of the current era is
a recurring series of inquiries to apologize for, and ‘learn les-
sons’ from, numerous crises—from child sexual abuse to
the Grenfell Tower fire—that were predicted, but not pre-
vented. The UK’s cultural definition of ‘heroism’ and ‘lead-
ership’ is deeply rooted in the idea of taking bold actions to
deal with an out-of-control crisis.43
There is plenty of rhetorical support in favour of primary
prevention and preventative spending, but that is neither
honoured nor reflected in the actual distribution of human,
institutional and financial resources and rewards. Scotland’s
respected 2011 Christie Commission on the Future Delivery
of Public Services concluded that 40% of all public expendi-
tures were driven by ‘failure demand’, i.e. reacting after the
fact when prevention would have been wiser and less
FAILURES IN REPRODUCTIVE HEALTH POLICY 3
Downloaded from https://academic.oup.com/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdy131/5076112
by guest
on 30 August 2018
4. expensive.44
Due to the combination of austerity and recession
—two crisis-provoking events—that percentage has subse-
quently risen.45
‘Second, there is an abiding cultural discomfort with sex-
ual/reproductive matters; the UK has not fully disentangled
itself from a global tendency of not prioritizing things related
to pregnancy/parenthood—perhaps because they are con-
sidered as “women’s business”.’46
This reflects intrinsic sex-
ism and the remnants of a patriarchal society (e.g. the
inclination to blame women, rather than empower and sup-
port them in relation to their own reproductive goals/lives).
It is neither inevitable, nor a coincidence, that roughly
50% of UK pregnancies are unintended or mistimed—and
that nearly one in six pregnancies are terminated (higher in
England than Scotland).47
Most UK babies are conceived in
the context of ambivalence about, and/or lack of prepar-
ation for, parenthood. This means fundamental questions
frequently go both unasked and unanswered. As a culture,
the UK exhibits an extraordinarily ‘laissez faire’ attitude
toward preparing and supporting the next generation of
mothers and fathers.
‘Third, our three illustrations shine different lights on
how language can undermine desirable outcomes.’ Wording
matters in the flour ‘fortification’ debate. ‘Folic acid’ may
not have been as good a choice for reassuring policymakers
and the public as ‘vitamin B9
’. Adding a vitamin to our food
sounds more benign than adding an acid. That may help
explain why ‘niacin’ (vitamin B3
)—rather than the more
ominous-sounding chemical name for it, ‘nicotinic acid’—
has been added uncontroversially to UK baked goods for
half a century.
Valproate also offers a lesson about terminology. Current
attempts to alert the public about significant, proven risks of
taking valproate during pregnancy often forget that women of
childbearing potential are rarely prescribed generic ‘valproate’.
Instead, women in Europe perceive themselves as taking one
of the 30+ brand-name versions of valproate (from Absenor
to Hexaquin). For many people, it is challenging to remember
brand names, let alone the active ingredient(s). This represents
a crucial and dangerous linguistic disconnect.
‘Fourth, the UK’s relatively non-litigious culture—while a
blessing in many respects—may have removed one powerful
motivation for implementing these three public health mea-
sures.’ Samuel Johnson’s famous 18th century observation
—‘Depend upon it, sir, when a man knows he is to be
hanged in a fortnight, it concentrates his mind wonderfully.’—
may be applicable here today. If the chances of being sued,
charged with an offence, publicly shamed or held accountable
in other meaningful ways for failing to act are minimal, then
the impetus to implement is significantly diminished.
‘Fifth, there continues to be ‘wilful ignorance’ across
Scotland and the rest of the UK about the prevalence of
FASD, NTD-affected pregnancies and valproate-related
birth defects.’ The absence of Scottish/UK epidemiological
evidence—and other data about the consequences/costs—
of all three problems is a choice, not an inevitability.
Ignorance has not been ‘bliss’ for those harmed by this
choice.48
Replacing inaction with accomplishment
If cultural factors best explain why these three public health
measures should have been implemented—but have not—
then focusing on the cultural side seems the most likely way
to achieve a different, better result.
We see several reasons for optimism.
• Citizens’/victims groups have very recently persuaded
both the mass media and politicians to take seriously the
prevention of valproate exposure during pregnancy. Some
of the language from top politicians suggests an under-
lying cultural shift. The UK’s Health Secretary in
February 2018 told the Westminster Parliament that: ‘We
must acknowledge that the response to these issues from
those in positions of authority has not always been good
enough. Sometimes the reaction has felt too focused on
defending the status quo.’49
• Scotland’s Chief Medical Officer has been championing
the concept of ‘Realistic Medicine’ with widespread
national/international agreement and a growing number
of examples in practice.50
This is explicitly a cultural shift
based upon six principles, including: ‘shared decision-
making’; a ‘whole person approach’; and, ‘better managing
risks’. The CMO notes: ‘… just as opinion coalesced
around the advent of professionalism in the 19th century,
there exists a broad international movement… to co-
create health between practitioners and citizens as an
inviolable standard.’51
• Scotland’s Minister of Public Health launched an explor-
ation of using devolved powers to ‘go it alone’, if the UK
continues to refuse mandatory vitamin B9
fortification.
Acknowledging that UK-wide legislation is best, this
Minister (and her Welsh counterpart) jointly urged the
UK Health Secretary to act in late 2017 and again in
2018.52,53
An earlier Member’s Bill to fortify flour was
passed by the House of Lords, but disappeared when the
Prime Minister dissolved Parliament for a snap election.54
A 2018 Westminster debate may revive its prospects.55
• Particularly in Scotland, modest steps have been taken,
and more are underway to prevent, identify and treat
4 JOURNAL OF PUBLIC HEALTH
Downloaded from https://academic.oup.com/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdy131/5076112
by guest
on 30 August 2018
5. FASD. These range from the only online NHS course/
resource for all professionals on foetal alcohol harm—
through the planned 2018 publication on FASD clinical
practice from the Scottish Intercollegiate Guidelines
Network (SIGN)—to the first recognition of FASD in
statutory guidance since Scotland enacted the Additional
Support for Learning Act 2004.56,57
• There are Scottish/UK models of building broad coalitions
to resolve other key public health issues. These brought
together government, voluntary, academic, media and pri-
vate sectors, as well as individual champions in effective
and sustained ways. These successful precedents achieved
major changes in culture, law, policy and practice—such as
reducing drink driving, the smoking ban and violence
reduction (especially knife crime)—and should encourage
and inform similar public health efforts around NTDs,
FASD and valproate exposure.
• The relevant precedents are not limited to public health,
as there is a great deal to learn, and adapt, from other
profound social/cultural movements that sparked change.
These include lessons from the history of science and
medicine, but especially from the women’s rights move-
ment and the children’s rights movement. The whole
‘rights’ ethos provides a useful foundation for building
both an individual sense of agency and a collective sense
of responsibility to prevent harm and promote wellbeing/
equity.
Prioritizing preconception health
The biggest still-missing element in overcoming long-
standing inaction on these three public health measures is
a movement in favour of—and culture changes that give
priority to—preconception health, education and care
across the life course.58–60
There is an antenatal compo-
nent to each of the three examples, but they all require
much more attention to what happens (or fails to happen)
prior to pregnancy.
That, in turn, requires a cultural change beyond the trad-
itional binary choice between either avoiding pregnancy or
being pregnant. There are two additional, often-overlooked
stages between ‘not pregnant’ and ‘pregnant’. One is being
ready, willing and able to make empowered, informed
choices about whether and when to become a parent. The
other is preparing for pregnancy.61
A society that takes pre-
conception (before the first pregnancy) and interconception
(before the next pregnancy) seriously is one in which
inaction on NTDs, FASD and valproate would not be tol-
erated or perpetuated.62
Achieving safer pregnancies and thriving babies is within
reach here and now. The key is finally taking robust action
on these public health measures. The next generation
deserves no less.
Funding
This work was funded by the Scottish Collaboration for Public
Health Policy and Research (SCPHRP) core grant from the
Medical Research Council (Grant number MR/K023209/1)
and the Chief Scientist Office of Scotland. The views
expressed in this publication are those of the authors and not
necessarily those of the funders. The funders played no role in
the conceptualization of the article or in the decision to submit
it for publication.
Conflict of interest
The authors declare they have no conflicts of interest.
References
1 Koppaka R. Ten Great Public Health Achievements—Worldwide,
2001–2010. Atlanta: Centers for Disease Control and Prevention
(CDC), 2011. https://www.cdc.gov/mmwr/preview/mmwrhtml/
mm6024a4.htm (18 June 2018, date last accessed).
2 Vu YA, London WM. Precautionary Principle. Oxford: Oxford
Bibliographies, 2015. http://www.oxfordbibliographies.com/view/
document/obo-9780199756797/obo-9780199756797-0046.xml (18
June 2018, date last accessed).
3 Frank JW, Lomax G. Public health action to control hazards: how
good should the evidence be? New Solut 2002;12(1):17–25.
4 Frank JW. Public health policy and the quality of epidemiological
evidence: how good is good enough? J Public Health Policy 1985;6(3):
313–21.
5 Frank JW, Jepson R, Williams A. Disease Prevention: A Critical Toolkit.
Oxford: Oxford University Press, 2015.
6 Gluckman P. The Role of Evidence in Policy Formation and
Implementation: A Report From the Prime Minister’s Chief Science Advisor.
Auckland: New Zealand Government, 2013. http://www.pmcsa.
org.nz/wp-content/uploads/The-role-of-evidence-in-policy-formation-
and-implementation-report.pdf (18 June 2018, date last accessed).
7 Food Fortification Initiative. Global Progress. Atlanta: FFI Network,
2017. http://www.ffinetwork.org/global_progress/index.php (18
June 2018, date last accessed).
8 Wald N, Sneddon J. Prevention of neural tube defects: results of the
Medical Research Council Vitamin Study. Lancet 1991;338(8760):
131–37.
9 Cawley S, McCartney D, Woodside JV. Optimization of folic acid
supplementation in the prevention of neural tube defects. J Public
Health (Bangkok) 2017;Oct 20:1–8.
FAILURES IN REPRODUCTIVE HEALTH POLICY 5
Downloaded from https://academic.oup.com/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdy131/5076112
by guest
on 30 August 2018
6. 10 Turner M, Woodside JV, Cawley S. The Folate Status of Pregnant Women in
the Republic of Ireland; The Current Position. Dublin: safefood, 2017. http://
www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/
Publications/Research%20Reports/Folate-Status-in-Pregnant-
Women-Current-Status-in-Republic-of-Ireland.pdf (18 June 2018,
date last accessed).
11 Kahoshnood B, Loane M, de Walle H. Long term trends in preva-
lence of neural tube defects in Europe: population based study. Br
Med J 2015;351:h5949.
12 Zimmerman SL. Researcher Reflects on Fortification Progress 25 Years
After Landmark Study: Interview With Professor Sir Nicholas Wald.
Atlanta: FFI Network, 2016. http://www.ffinetwork.org/about/
stay_informed/releases/EU_Folic_Acid.html (18 June 2018, date
last accessed).
13 Wald NJ, Morris JK, Blakemore C. Public health failure in the pre-
vention of neural tube defects: time to abandon the tolerable upper
intake level of folate. Public Health Rev 2018;39:2.
14 Scientific Advisory Committee on Nutrition (SACN). Update on Folic
Acid. London: Public Health England, 2017 https://www.gov.uk/
government/publications/folic-acid-updated-sacn-recommendations
(18 June 2018, date last accessed).
15 Federation of Bakers. Factsheet No. 24: Flour Fortification. London:
FoB UK, 2016. https://www.fob.uk.com/wp-content/uploads/2017/
01/FS25-Flour-Fortification.pdf (18 June 2018, date last accessed).
16 Golden J. Message in a Bottle: The Making of Fetal Alcohol Syndrome.
Cambridge: Harvard University Press, 2005.
17 Mukherjee R. Review of ‘Message in a Bottle’. Br Med J 2005;331:
850.
18 Jones KL, Smith DW. Recognition of the fetal alcohol syndrome in
early infancy. Lancet 1973;302(7836):983–1042.
19 Beattie J, Day R, Cockburn F et al. Alcohol and the fetus in the
west of Scotland. Br Med J 1983;287:17–20.
20 Sher J. Zika Virus is not the Birth Defect Risk Scotland Should be Most
Worried About. Holyrood, 2016. https://www.holyrood.com/
articles/comment/zika-virus-not-birth-defect-risk-scotland-should-
be-most-worried-about (18 June 2018, date last accessed).
21 Benz J, Rasmussen C, Andrew G. Diagnosing fetal alcohol spec-
trum disorders: history, challenges and future directions. Paediatr
Child Health 2009;14(4):231–7.
22 BMA Board of Science. Alcohol and Pregnancy: Preventing and Managing
Fetal Alcohol Spectrum Disorders. London: British Medical Association,
2016. https://www.bma.org.uk/collective-voice/policy-and-research/
public-and-population-health/alcohol/alcohol-and-pregnancy (18
June 2018, date last accessed).
23 Scottish Government. Changing Scotland’s Relationship with Alcohol: A
Framework for Action. Edinburgh: Scottish Government, 2009
http://www.gov.scot/Resource/Doc/262905/0078610.pdf (18 June
2018, date last accessed).
24 Alcohol Focus Scotland. My Family & Alcohol: Are My Children
Affected? Glasgow: AFS, 2018. http://www.myfamilyandalcohol.org.
uk/alcohol-information/my-children/ (18 June 2018, date last
accessed).
25 Hope A, Curran J, Bell G. Unrecognized and Under-reported: The Impact
of Alcohol on People Other Than the Drinker in Scotland. Glasgow:
Alcohol Focus Scotland, 2013. http://www.alcohol-focus-scotland.
org.uk/media/59866/Unrecognised-and-under-reported-full-report.
pdf (18 June 2018, date last accessed).
26 World Health Organization. Global Status Report on Alcohol and Health
2014. Geneva: WHO, 2014. http://www.who.int/substance_abuse/
publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1 (18
June 2018, date last accessed).
27 Sher J. Will minimum unit pricing reduce fetal alcohol harm? Int J
Birth Parent Educ 2018;5(4):28.
28 Dalens B, Raynaud EJ, Gaulme J. Teratogenicity of valproic acid.
J Pediatr 1980;97(2):332–33.
29 Meador KJ. Valproic acid: reducing the risks of pre-natal exposure.
Lancet Neurol 2016;15(2):132–3.
30 Medicines and Healthcare products Regulatory Agency (MHRA).
Valproate and Risk of Abnormal Pregnancy Outcomes: New Communication
Materials. London: UK Government, 2016. https://www.gov.uk/
drug-safety-update/valproate-and-of-risk-of-abnormal-pregnancy-
outcomes-new-communication-materials (18 June 2018, date last
accessed).
31 NHS England. Sodium Valproate Prescribing. London: NHS England,
2017. https://www.england.nhs.uk/publication/prescribing-for-
sodium-valproate/ (18 June 2018, date last accessed).
32 Agence nationale de securite du medicament et des produits de
santé. Strengthening the Prescription and Dispensing Conditions of Valproate
and Derived Medicinal Products Due to the Risks Associated With Their Use
During Pregnancy. Paris: ANSM, 2017. http://ansm.sante.fr/content/
download/111303/1410275/version/1/file/Enquete-Valproate-Synthese-
ANSM.pdf (3 April 2018, date last accessed).
33 European Medicines Agency. Full EMA Public Hearing on Valproate.
London: EMA, 2017. https://www.youtube.com/watch?v=
CzeJSzkrygM (18 June 2018, date last accessed).
34 European Medicines Agency. PRAC Recommends New Measures to
Avoid Valproate Exposure in Pregnancy. London: EMA, 2018. http://
www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/
news/2018/02/news_detail_002903.jsp&mid=WC0b01ac058004d5c1
(18 June 2018, date last accessed).
35 Medicines and Healthcare products Regulatory Agency (MHRA).
Valproate Medicines: Contraindicated in Women and Girls of Childbearing
Potential Unless Conditions of Pregnancy Prevention Programme are Met.
London: UK Government, 2018. https://www.gov.uk/drug-safety-
update/valproate-medicines-epilim-depakote-contraindicated-in-women-
and-girls-of-childbearing-potential-unless-conditions-of-pregnancy-
prevention-programme-are-met (18 June 2018, date last accessed).
36 Joint Committee on Health. Report on Foetal Anti-Convulsant Syndrome.
Dublin: Houses of the Oireachtas, 2018. http://opac.oireachtas.ie/
AWData/Library3/Joint_Committee_on_Health_Report_on_Foetal_
Anti-Convulsant_Syndrome_310518_124838.pdf (18 June 2018, date
last accessed).
37 Sher J. Taking valproate during pregnancy is a serious risk: an
update on practice implications. Int J Birth Parent Educ 2018;5(3):
11–4.
38 Yi Y, Lindemann M, Colligs A et al. Economic burden of neural
tube defects and impact of prevention with folic acid: a literature
review. Eur J Pediatr 2011;170(11):1391–1400.
6 JOURNAL OF PUBLIC HEALTH
Downloaded from https://academic.oup.com/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdy131/5076112
by guest
on 30 August 2018
7. 39 Bowles D, Wasiak R, Kissner M. Economic burden of neural tube
defects in Germany. Public Health 2014;128(3):274–81.
40 Blamont M. France Sets up Fund for Sanofi Epilepsy Drug Victims.
Reuters, 2016. https://www.reuters.com/article/us-sanofi-france-
compensation/france-sets-up-fund-for-sanofi-epilepsy-drug-victims-
idUSKBN13B1FN (18 June 2018, date last accessed).
41 Petrenko CLM, Tahir N, Mahoney EC et al. Prevention of second-
ary conditions in fetal alcohol spectrum disorders: identification of
systems-level barriers. Matern Child Health J 2014;18(6):1496–1505.
42 Poplova S, Lange S, Burd L et al. The economic burden of fetal
alcohol spectrum disorder in Canada in 2013. Alcohol Alcohol 2016;
51(3):367–75.
43 Sher J. Prevention Means Never Having to Say You’re Sorry. Holyrood,
2017. https://www.holyrood.com/articles/comment/prevention-
means-never-having-say-you%E2%80%99re-sorry (18 June 2018,
date last accessed).
44 Christie C, Mitchell J, Wishart R. Commission on the Future Delivery of
Public Services. Edinburgh: Scottish Government, 2011. http://www.gov.
scot/resource/doc/352649/0118638.pdf (18 June 2018, date last
accessed).
45 Carnochan J, Mitchell J, Sher J. Our Prevention Crisis. Holyrood, 2015.
https://www.holyrood.com/articles/comment/our-prevention-crisis
(18 June 2018, date last accessed).
46 Mercer CH, Tanton C, Prah P. Changes in sexual attitudes and life-
styles in Britain throughout the life course and over time: findings
from the National Surveys of Sexual Attitudes and Lifestyles
(NATSAL). Lancet 2013;382(9907):1781–94.
47 Information Services Division. Termination of Pregnancy Statistics
(Table A: Terminations in Great Britain). Edinburgh: NHS Scotland
National Services, 2017. http://www.isdscotland.org/Health-Topics/
Sexual-Health/Publications/2017-05-30/2017-05-30-Terminations-
2016-Report.pdf (18 June 2018, date last accessed).
48 Moore SJ, Turnpenny P, Quinn A. A clinical study of 57 children
with fetal anticonvulsant syndromes. J Med Genet 2000;37:489–97.
https://jmg.bmj.com/content/37/7/489. (18 June 2018, date last
accessed).
49 Hunt J. Parliamentary Debate on Medicines Safety Review. London: UK
Parliament, 2018. https://hansard.parliament.uk/commons/2018-
02-21/debates/7DA2E2F3-E1E6-40CB-8061-680E0399CA97/
MedicinesAndMedicalDevicesSafetyReview (18 June 2018, date
last accessed).
50 Calderwood C. Realistic Medicine: Chief Medical Officer’s Annual Report
2014-15. Edinburgh: Scottish Government, 2016. http://www.gov.
scot/Resource/0049/00492520.pdf (18 June 2018, date last accessed).
51 Calderwood C. Realising Realistic Medicine: Chief Medical Officer’s Annual
Report 2015-16. Edinburgh: Scottish Government, 2017. http://
www.gov.scot/Resource/0051/00514513.pdf (18 June 2018, date
last accessed).
52 de Caestecker L, Sher J. Folic Acid in Bread: Barn Gates and Neural
Tubes. Holyrood, 2016. https://www.holyrood.com/articles/
comment/folic-acid-bread-barn-gates-and-neural-tubes (18 June
2018, date last accessed).
53 Campbell A, Gething V. Folic Acid in Flour: Joint Letter to the UK
Health Secretary. Edinburgh & Cardiff: Scottish and Welsh
Governments, 2017. https://news.gov.scot/news/folic-acid-in-
flour-1 (18 June 2018, date last accessed).
54 Rooker J. Bread and Flour Regulations (Folic Acid) Bill [HL] 2016-17 .
UK Parliament, 2017. https://services.parliament.uk/bills/2016-
17/breadandflourregulationsfolicacid.html (18 June 2018, date last
accessed).
55 UK House of Commons. Fortified Flour. London: Hansard, 2018.
https://hansard.parliament.uk/commons/2018-05-16/debates/
FDB21E24-2577-4541-A3B5-F06DC69A3B20/FortifiedFlour (18
June 2018, date last accessed).
56 Children in Scotland (Sher J, Collier S). Fetal Alcohol Harm e-Learning
Resource. Edinburgh: NHS Education Scotland (The Knowledge
Network), 2012. http://uat.knowledge.scot.nhs.uk/home/learning-
and-cpd/learning-spaces/fasd.aspx (18 June 2018, date last accessed).
57 Scottish Government. Supporting Children’s Learning: Statutory Guidance
on the Education (Additional Support for Learning) Act 2004 (as amended)
—Code of Practice (3rd edn). Edinburgh: Scottish Government, 2017.
http://www.gov.scot/Resource/0052/00529411.pdf (18 June 2018,
date last accessed).
58 Sher J. Missed Periods: Scotland’s Opportunities for Better Pregnancies,
Healthier Parents and Thriving Babies the First Time… and Every Time.
Glasgow: NHS Greater Glasgow and Clyde (Public Health), 2016.
http://www.nhsggc.org.uk/media/237840/missed-periods-j-sher-may-
2016.pdf (18 June 2018, date last accessed).
59 Hunter MS. Would you like to become pregnant in the next year?:
The One Key Question initiative in the United States. Int J Birth
Parent Educ 2017;4(4):19–22.
60 Davies S, Hanson M, Godfrey K. Chapter 5: Preconception Health.
The 51%: Women—Annual Report of the Chief Medical Officer
2014. London: UK Government, 2015.
61 Verbiest S. advancing preconception health in the United States:
strategies for change. Ups J Med Sci 2016;121(4):222–6.
62 Sher J. Making preconception health, education and care real. Int J
Birth Parent Educ 2017;4(4):4–8.
FAILURES IN REPRODUCTIVE HEALTH POLICY 7
Downloaded from https://academic.oup.com/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdy131/5076112
by guest
on 30 August 2018