This document summarizes a study examining the use of supplemental vitamin D among infants who were breastfed for prolonged periods. The study found that among infants who were predominantly breastfed for at least 6 months, the rate of receiving supplemental vitamin D was only 15.9%. Parental decisions about vitamin D supplementation were significantly associated with whether the parent agreed their pediatrician recommended it and whether they believed breast milk contains all needed nutrition. Educational efforts are needed to increase compliance with guidelines recommending all breastfed infants receive vitamin D supplementation.
Vita D Defic Insuffic Pregnancy Johnson Am J Perinatol 2010alisonegypt
This study found that vitamin D deficiency and insufficiency are common among pregnant women in the United States, especially for African American and Hispanic women. The study measured vitamin D levels in 154 African American, 194 Hispanic, and 146 Caucasian pregnant women early in their pregnancies. It found that 97% of African American women, 81% of Hispanic women, and 67% of Caucasian women had insufficient or deficient vitamin D levels. African American women were the most likely to have deficiency, while Caucasian women were the most likely to have sufficient levels. Race was identified as the most important risk factor for deficiency or insufficiency.
Vitamin D Deficiency In Pre Birth Studiesalisonegypt
1) Lower maternal vitamin D status was associated with greater femoral metaphyseal cross-sectional area and higher femoral splaying index in fetuses at 19 weeks and 34 weeks gestation, suggesting maternal vitamin D insufficiency can influence fetal femoral development as early as 19 weeks.
2) Over 30% of mothers had vitamin D levels considered insufficient or deficient. Lower maternal vitamin D levels were related to increased femoral splaying and larger femoral cross-sectional area in fetuses.
3) The findings suggest that improving maternal vitamin D status early in pregnancy through supplementation may help support optimal fetal bone development.
1) The study examined the impact of maternal vitamin D status on fetal skeletal development through 3D ultrasound measurements in 424 pregnant women.
2) It found that suboptimal maternal vitamin D status was associated with increased femur cross-sectional area and splaying in utero, resembling signs of rickets.
3) This suggests that ensuring optimal maternal vitamin D levels during pregnancy may be important for proper fetal skeletal development.
Vita D Defic Mothers Newborns Merewood Pediatrics 2010alisonegypt
This study found high rates of vitamin D deficiency in mothers and newborns in Boston, Massachusetts. 58% of infants and 36% of mothers had vitamin D levels below 20 ng/mL. Risk factors for infant deficiency included a deficient mother, winter birth, black race, and a maternal BMI over 35. Prenatal vitamin use was protective against deficiency for both mothers and infants, however 30% of mothers still had low vitamin D levels despite taking prenatal vitamins.
This document summarizes the growing issue of vitamin D deficiency (DD) in infants and children. It discusses how DD rates have risen significantly in recent decades across diverse populations. Multiple factors are contributing to the problem, including decreased food fortification of vitamin D, more sun avoidance behaviors, increased obesity rates, and longer breastfeeding durations without adequate supplementation. The document outlines how DD can manifest radiographically as softening of the skull and indistinct facial bones in young infants, as well as subtle metaphyseal changes in the long bones that could be mistaken for abuse-related fractures without consideration of the underlying DD.
Dr. Narendra Malhotra gave the POGS oration on fetal origins of adult diseases. He has had an illustrious career as an obstetrician and gynecologist in India, holding many leadership positions and publishing extensively. His research has shown that adverse conditions in the womb and early life can program the fetus's development and permanently increase risks for diseases like diabetes, hypertension, and heart disease later in adulthood. Maternal nutrition, infections, and other environmental factors during pregnancy can influence the fetus through hormonal and epigenetic changes leading to effects on organs like the pancreas, kidneys and blood vessels that manifest as disease in later life.
a presentation by Abdulkareeem Toyyib Oladimeji at the department of physiology, faculty of basic medical sciences, univeristy of ilorin teaching hospital, Ilorin, Kwara state, Nigeria.
Vita D Perrine Cg Ea At Adherence To Vit D Recommendations Among Us Infants P...alisonegypt
This study examined adherence to vitamin D recommendations among US infants using data from the Infant Feeding Practices Study II from 2005-2007. The researchers estimated the percentage of infants meeting the 2003 and 2008 vitamin D recommendations from the American Academy of Pediatrics at various ages from 1 to 10.5 months. They found that use of oral vitamin D supplements was low, ranging from 1% to 13% regardless of whether infants were breastfed, formula-fed, or mixed-fed. Most infants did not consume adequate amounts of vitamin D according to the 2008 recommendation, suggesting pediatricians should encourage vitamin D supplementation for breastfed and partially breastfed infants.
Vita D Defic Insuffic Pregnancy Johnson Am J Perinatol 2010alisonegypt
This study found that vitamin D deficiency and insufficiency are common among pregnant women in the United States, especially for African American and Hispanic women. The study measured vitamin D levels in 154 African American, 194 Hispanic, and 146 Caucasian pregnant women early in their pregnancies. It found that 97% of African American women, 81% of Hispanic women, and 67% of Caucasian women had insufficient or deficient vitamin D levels. African American women were the most likely to have deficiency, while Caucasian women were the most likely to have sufficient levels. Race was identified as the most important risk factor for deficiency or insufficiency.
Vitamin D Deficiency In Pre Birth Studiesalisonegypt
1) Lower maternal vitamin D status was associated with greater femoral metaphyseal cross-sectional area and higher femoral splaying index in fetuses at 19 weeks and 34 weeks gestation, suggesting maternal vitamin D insufficiency can influence fetal femoral development as early as 19 weeks.
2) Over 30% of mothers had vitamin D levels considered insufficient or deficient. Lower maternal vitamin D levels were related to increased femoral splaying and larger femoral cross-sectional area in fetuses.
3) The findings suggest that improving maternal vitamin D status early in pregnancy through supplementation may help support optimal fetal bone development.
1) The study examined the impact of maternal vitamin D status on fetal skeletal development through 3D ultrasound measurements in 424 pregnant women.
2) It found that suboptimal maternal vitamin D status was associated with increased femur cross-sectional area and splaying in utero, resembling signs of rickets.
3) This suggests that ensuring optimal maternal vitamin D levels during pregnancy may be important for proper fetal skeletal development.
Vita D Defic Mothers Newborns Merewood Pediatrics 2010alisonegypt
This study found high rates of vitamin D deficiency in mothers and newborns in Boston, Massachusetts. 58% of infants and 36% of mothers had vitamin D levels below 20 ng/mL. Risk factors for infant deficiency included a deficient mother, winter birth, black race, and a maternal BMI over 35. Prenatal vitamin use was protective against deficiency for both mothers and infants, however 30% of mothers still had low vitamin D levels despite taking prenatal vitamins.
This document summarizes the growing issue of vitamin D deficiency (DD) in infants and children. It discusses how DD rates have risen significantly in recent decades across diverse populations. Multiple factors are contributing to the problem, including decreased food fortification of vitamin D, more sun avoidance behaviors, increased obesity rates, and longer breastfeeding durations without adequate supplementation. The document outlines how DD can manifest radiographically as softening of the skull and indistinct facial bones in young infants, as well as subtle metaphyseal changes in the long bones that could be mistaken for abuse-related fractures without consideration of the underlying DD.
Dr. Narendra Malhotra gave the POGS oration on fetal origins of adult diseases. He has had an illustrious career as an obstetrician and gynecologist in India, holding many leadership positions and publishing extensively. His research has shown that adverse conditions in the womb and early life can program the fetus's development and permanently increase risks for diseases like diabetes, hypertension, and heart disease later in adulthood. Maternal nutrition, infections, and other environmental factors during pregnancy can influence the fetus through hormonal and epigenetic changes leading to effects on organs like the pancreas, kidneys and blood vessels that manifest as disease in later life.
a presentation by Abdulkareeem Toyyib Oladimeji at the department of physiology, faculty of basic medical sciences, univeristy of ilorin teaching hospital, Ilorin, Kwara state, Nigeria.
Vita D Perrine Cg Ea At Adherence To Vit D Recommendations Among Us Infants P...alisonegypt
This study examined adherence to vitamin D recommendations among US infants using data from the Infant Feeding Practices Study II from 2005-2007. The researchers estimated the percentage of infants meeting the 2003 and 2008 vitamin D recommendations from the American Academy of Pediatrics at various ages from 1 to 10.5 months. They found that use of oral vitamin D supplements was low, ranging from 1% to 13% regardless of whether infants were breastfed, formula-fed, or mixed-fed. Most infants did not consume adequate amounts of vitamin D according to the 2008 recommendation, suggesting pediatricians should encourage vitamin D supplementation for breastfed and partially breastfed infants.
The document discusses the developmental origins of health and disease theory proposed by Barker, which links poor fetal and early life nutrition to increased risk of chronic diseases like heart disease and diabetes later in life. Barker observed correlations between low birth weights in the 1920s and higher heart disease rates decades later. His theory proposes that the fetus adapts to inadequate nutrition by diverting resources from organs like the heart to the brain, with health consequences appearing later. Subsequent studies found links between small fetal size and later health issues. The theory suggests these effects may be passed on to later generations through epigenetic changes and fetal programming of gene expression.
This document discusses nutrition and hyperemesis gravidarum (HG), a severe form of morning sickness. It notes that patients with HG often have poor nutritional intake which can negatively impact both mother and baby. Specific vitamin deficiencies like thiamine and vitamin K are discussed which can cause complications if not addressed. The effects of decreased caloric intake are also summarized based on research from the Dutch Famine. The importance of optimizing nutritional intake for HG patients is emphasized through various treatment options like medications, enteral/parenteral nutrition.
Collaborative on Health and the Environment Webinar, 20 March 2019.
Study : https://diethylstilbestrol.co.uk/multigenerational-neurodevelopmental-deficits/
Analysis : https://diethylstilbestrol.co.uk/transgenerational-neurodevelopmental-deficits/
DES transgenerational effects studies : https://diethylstilbestrol.co.uk/studies/transgenerational-effects/
Lecture held at the 4th Evidence-Based Neonatology conference, Nov 12 2017, in Hyderabad, India.
The lecture gives a short overview of the "fetal programming" theory, also referred to as the Developmental Origin of Health and Disease (DOHaD).
Global Health Crises Caused By The Collision Of Biological And Cultural Evolu...Global Risk Forum GRFDavos
This document discusses global health crises caused by the collision of biological and cultural evolution. It notes that the human biological genome is becoming stressed by rapid changes in cultural evolution and modern diets. Currently, limited healthcare resources focus on "crisis medicine" to treat chronic diseases like diabetes and heart disease that result from poor nutrition. However, the document proposes that preventing harmful prenatal exposures during the pregnancies of the 3 billion babies expected by 2100 could reduce risks of diseases later in life, based on the Barker Hypothesis that prenatal environments can influence later health. It advocates shifting resources from crisis to preventive medicine by educating parents on healthy diets during pregnancy and development.
This document discusses genetic considerations in the prenatal diagnosis of fetal overgrowth syndromes. It reviews several overgrowth syndromes that can be detected prenatally through ultrasound findings or molecular testing, including Pallister-Killian syndrome, Beckwith-Wiedemann syndrome, Sotos syndrome, and Simpson-Golabi-Behmel syndrome. Prenatal diagnosis of an overgrowth syndrome can help prepare for potential neonatal complications and recurrence risks. However, genetic causes are often not diagnosed prenatally due to overlapping features and limitations of prenatal testing.
The study aimed to identify genetic factors associated with pre-eclampsia by genotyping over 650 women affected by pre-eclampsia and their families at 28 SNPs in 7 candidate genes. Using transmission disequilibrium testing to distinguish maternal and fetal effects, they found that none of the genetic variants tested conferred a statistically significant risk of pre-eclampsia based on their criteria. The results emphasize the need for large, well-designed studies to reliably identify genetic risks and avoid false positives.
exome sequencing improves genetic diagnosis of fetal increased nuchal translu...Võ Tá Sơn
This study analyzed exome sequencing results from 73 fetuses with isolated increased nuchal translucency but normal chromosomal microarray analysis. Exome sequencing identified pathogenic variants in 4 cases (5.5% diagnostic rate), including 3 de novo dominant variants and 1 recessive variant. Three of the 4 cases developed structural anomalies on later ultrasound. This shows exome sequencing can detect genetic conditions in some cases with increased nuchal translucency not detected by other tests, aiding parental counseling.
SOURCES
CDC Resources and Educational Tools - Educational Tools for Clinicians
DES Lecture Presentation and DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_clinicians.html
CDC Resources and Educational Tools - Educational Tools for Nurses
DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_nurses.html
CDC Resources and Educational Tools - Clinician Information
DES References > http://www.cdc.gov/des/hcp/bibliography/index.html
MORE DES DIETHYLSTILBESTROL RESOURCES
DES cases and lawsuits:
http://diethylstilbestrol.co.uk/studies/des-lawsuits/
DES studies on cancers and screening:
https://desdaughter.com/2013/09/08/diethylstilbestrol-resources-1/
DES studies on epigenetics and transgenerational effects:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-6/
DES studies on fertility:
http://diethylstilbestrol.co.uk/studies/des-and-fertility/
DES studies on gender identity and psychological health:
https://desdaughter.com/2015/12/04/diethylstilbestrol-resources-3/
DES studies on in-utero exposure to DES and side-effects:
https://desdaughter.com/2013/12/31/diethylstilbestrol-resources-4/
DES studies on pregnancy:
http://diethylstilbestrol.co.uk/studies/des-and-pregnancy/
DES studies on the genital tract:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-7/
DES videos:
https://www.youtube.com/playlist?list=PL3D4F4A11812DAE00
Precision medicine involves using genomic testing to individualize medical care by testing multiple genes at once. Genomic counseling is the process of obtaining a family history, formulating a testing strategy, providing counseling on potential outcomes, coordinating testing, and disclosing results. Key steps include referring to a genomic counselor, who will discuss testing options and implications of various results, order the appropriate tests, track the results, and arrange follow-up care. Genomic information can guide medical management and reproductive decision making for patients and their families.
The document describes a case of a 1-month-old girl brought for follow-up after being hospitalized for acute gastroenteritis caused by rotavirus. When her mother resumed the usual cow milk formula, the girl began having increased watery stools. On examination she appears well hydrated with normal abdomen. The best management is to change to a lactose-free formula for the next few days as she likely has secondary lactose intolerance from the rotavirus infection. Repeating stool studies is unnecessary and other options like diluting formula or only oral rehydration are inappropriate.
This document summarizes a study that examined the effect of a community-based group physical activity (CBGPA) program on the risk of preeclampsia during pregnancy. The study found that among 88 women who participated in the standardized CBGPA program, the rate of preeclampsia was significantly lower (2.2%) than the overall rate at the hospital (7.8%). Pregnancies in the CBGPA group also had lower rates of preterm birth and low birthweight compared to the overall rates. The study concludes that CBGPA may help reduce the risk of complications like preeclampsia during pregnancy.
Increasing Trends in Male Reproductive Disorders, Environmental Exposures, an...DES Daughter
On this call, Dr. Skakkebaek presented his concerns about increasing trends in male reproductive disorders, including the significant global increase in incidence of germ cell tumors. He and colleagues from all over the world demonstrated that over half of all young men's semen quality does not meet the reference standard of the World Health Organization. Dr. Skakkebaek presented evidence linking testicular cancer, poor semen quality, childlessness, and rapidly decreasing fertility rates. He showed how there is little doubt that environmental factors, most likely associated with modern lifestyles, have - in a broad sense - had an adverse influence on male reproductive health. He and his group are examining a fundamental role that exposure to endocrine-disrupting chemicals may play in these trends, trends that in a few decades will result in decreasing populations in industrialized countries, and believes collaborative research is required to identify the causes of these adverse trends.
Sources: http://healthandenvironment.org/partnership_calls/18355
This document discusses genetics and genetic disorders. It begins by defining genetics and describing early discoveries in genetics research. It then discusses the prevalence of genetic birth defects worldwide and in India. Several genetic disorders are described in more detail, including Down syndrome, neural tube defects, sickle cell anemia, and thalassemia. For each disorder, the document outlines causes and inheritance patterns, symptoms, prevalence, and treatment options. Throughout, it emphasizes the public health importance of understanding genetics and genetic disorders.
Effect Of An Educational Intervention About Breastfeeding On The Knowledge,Biblioteca Virtual
This study evaluated the impact of an educational intervention on pediatric residents' knowledge, confidence, and clinical behaviors regarding breastfeeding. The residents completed pre- and post-intervention questionnaires to assess knowledge and confidence. Telephone interviews with breastfeeding mothers after clinic visits evaluated residents' clinical behaviors. The results showed that residents' knowledge scores increased significantly after the intervention. Their clinical behaviors when interacting with breastfeeding mothers also improved substantially. The educational intervention was effective in enhancing residents' support of breastfeeding patients.
Opinions And Practices Of Clinicians Associated With Continuation Of Exclusiv...Biblioteca Virtual
This study examined how clinician opinions and practices are associated with continuation of exclusive breastfeeding. The study prospectively followed 288 low-risk mother-newborn pairs who were breastfeeding at 4 weeks. Mothers completed interviews at 4 and 12 weeks, and their obstetric and pediatric clinicians completed surveys. The primary outcome was exclusive breastfeeding at 12 weeks. The study found that clinicians who recommended formula supplementation if an infant was not gaining weight or who felt their breastfeeding advice was not important were associated with early discontinuation of exclusive breastfeeding. Continued exclusive breastfeeding support from clinicians may help improve breastfeeding rates at 6 months.
Association Of Breastfeeding Intensity And Bottle Emptying Behaviors At Early...Biblioteca Virtual
This study examined the relationship between breastfeeding intensity, bottle emptying behaviors, and risk of excess weight in infants. The study found:
1) Infants who were breastfed at low (20% of milk feeds) or medium (20-80% of milk feeds) intensities in early infancy were over twice as likely to have excess weight in late infancy compared to infants breastfed at high (80% of milk feeds) intensities.
2) Infants who often emptied bottles in early infancy were 69% more likely to have excess weight in late infancy than infants who rarely emptied bottles.
3) Mothers' encouragement of bottle emptying was negatively associated with infants' risk of
Infant Feeding And Feeding Transitions During The First Year Of LifeBiblioteca Virtual
This document summarizes infant feeding patterns during the first year of life based on data from the Infant Feeding Practices Study II. Key findings include:
1) While 83% of infants were breastfed in the hospital, 42% of these infants also received formula supplementation. By 3 months, 61% of infants received formula.
2) Solid foods were introduced earlier than recommended, with 40% of infants consuming cereal and 17% consuming fruits/vegetables by 4 months of age.
3) Early introduction of solids was associated with discontinuing breastfeeding earlier and consuming more fatty/sugary foods by 12 months.
The document discusses the developmental origins of health and disease theory proposed by Barker, which links poor fetal and early life nutrition to increased risk of chronic diseases like heart disease and diabetes later in life. Barker observed correlations between low birth weights in the 1920s and higher heart disease rates decades later. His theory proposes that the fetus adapts to inadequate nutrition by diverting resources from organs like the heart to the brain, with health consequences appearing later. Subsequent studies found links between small fetal size and later health issues. The theory suggests these effects may be passed on to later generations through epigenetic changes and fetal programming of gene expression.
This document discusses nutrition and hyperemesis gravidarum (HG), a severe form of morning sickness. It notes that patients with HG often have poor nutritional intake which can negatively impact both mother and baby. Specific vitamin deficiencies like thiamine and vitamin K are discussed which can cause complications if not addressed. The effects of decreased caloric intake are also summarized based on research from the Dutch Famine. The importance of optimizing nutritional intake for HG patients is emphasized through various treatment options like medications, enteral/parenteral nutrition.
Collaborative on Health and the Environment Webinar, 20 March 2019.
Study : https://diethylstilbestrol.co.uk/multigenerational-neurodevelopmental-deficits/
Analysis : https://diethylstilbestrol.co.uk/transgenerational-neurodevelopmental-deficits/
DES transgenerational effects studies : https://diethylstilbestrol.co.uk/studies/transgenerational-effects/
Lecture held at the 4th Evidence-Based Neonatology conference, Nov 12 2017, in Hyderabad, India.
The lecture gives a short overview of the "fetal programming" theory, also referred to as the Developmental Origin of Health and Disease (DOHaD).
Global Health Crises Caused By The Collision Of Biological And Cultural Evolu...Global Risk Forum GRFDavos
This document discusses global health crises caused by the collision of biological and cultural evolution. It notes that the human biological genome is becoming stressed by rapid changes in cultural evolution and modern diets. Currently, limited healthcare resources focus on "crisis medicine" to treat chronic diseases like diabetes and heart disease that result from poor nutrition. However, the document proposes that preventing harmful prenatal exposures during the pregnancies of the 3 billion babies expected by 2100 could reduce risks of diseases later in life, based on the Barker Hypothesis that prenatal environments can influence later health. It advocates shifting resources from crisis to preventive medicine by educating parents on healthy diets during pregnancy and development.
This document discusses genetic considerations in the prenatal diagnosis of fetal overgrowth syndromes. It reviews several overgrowth syndromes that can be detected prenatally through ultrasound findings or molecular testing, including Pallister-Killian syndrome, Beckwith-Wiedemann syndrome, Sotos syndrome, and Simpson-Golabi-Behmel syndrome. Prenatal diagnosis of an overgrowth syndrome can help prepare for potential neonatal complications and recurrence risks. However, genetic causes are often not diagnosed prenatally due to overlapping features and limitations of prenatal testing.
The study aimed to identify genetic factors associated with pre-eclampsia by genotyping over 650 women affected by pre-eclampsia and their families at 28 SNPs in 7 candidate genes. Using transmission disequilibrium testing to distinguish maternal and fetal effects, they found that none of the genetic variants tested conferred a statistically significant risk of pre-eclampsia based on their criteria. The results emphasize the need for large, well-designed studies to reliably identify genetic risks and avoid false positives.
exome sequencing improves genetic diagnosis of fetal increased nuchal translu...Võ Tá Sơn
This study analyzed exome sequencing results from 73 fetuses with isolated increased nuchal translucency but normal chromosomal microarray analysis. Exome sequencing identified pathogenic variants in 4 cases (5.5% diagnostic rate), including 3 de novo dominant variants and 1 recessive variant. Three of the 4 cases developed structural anomalies on later ultrasound. This shows exome sequencing can detect genetic conditions in some cases with increased nuchal translucency not detected by other tests, aiding parental counseling.
SOURCES
CDC Resources and Educational Tools - Educational Tools for Clinicians
DES Lecture Presentation and DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_clinicians.html
CDC Resources and Educational Tools - Educational Tools for Nurses
DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_nurses.html
CDC Resources and Educational Tools - Clinician Information
DES References > http://www.cdc.gov/des/hcp/bibliography/index.html
MORE DES DIETHYLSTILBESTROL RESOURCES
DES cases and lawsuits:
http://diethylstilbestrol.co.uk/studies/des-lawsuits/
DES studies on cancers and screening:
https://desdaughter.com/2013/09/08/diethylstilbestrol-resources-1/
DES studies on epigenetics and transgenerational effects:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-6/
DES studies on fertility:
http://diethylstilbestrol.co.uk/studies/des-and-fertility/
DES studies on gender identity and psychological health:
https://desdaughter.com/2015/12/04/diethylstilbestrol-resources-3/
DES studies on in-utero exposure to DES and side-effects:
https://desdaughter.com/2013/12/31/diethylstilbestrol-resources-4/
DES studies on pregnancy:
http://diethylstilbestrol.co.uk/studies/des-and-pregnancy/
DES studies on the genital tract:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-7/
DES videos:
https://www.youtube.com/playlist?list=PL3D4F4A11812DAE00
Precision medicine involves using genomic testing to individualize medical care by testing multiple genes at once. Genomic counseling is the process of obtaining a family history, formulating a testing strategy, providing counseling on potential outcomes, coordinating testing, and disclosing results. Key steps include referring to a genomic counselor, who will discuss testing options and implications of various results, order the appropriate tests, track the results, and arrange follow-up care. Genomic information can guide medical management and reproductive decision making for patients and their families.
The document describes a case of a 1-month-old girl brought for follow-up after being hospitalized for acute gastroenteritis caused by rotavirus. When her mother resumed the usual cow milk formula, the girl began having increased watery stools. On examination she appears well hydrated with normal abdomen. The best management is to change to a lactose-free formula for the next few days as she likely has secondary lactose intolerance from the rotavirus infection. Repeating stool studies is unnecessary and other options like diluting formula or only oral rehydration are inappropriate.
This document summarizes a study that examined the effect of a community-based group physical activity (CBGPA) program on the risk of preeclampsia during pregnancy. The study found that among 88 women who participated in the standardized CBGPA program, the rate of preeclampsia was significantly lower (2.2%) than the overall rate at the hospital (7.8%). Pregnancies in the CBGPA group also had lower rates of preterm birth and low birthweight compared to the overall rates. The study concludes that CBGPA may help reduce the risk of complications like preeclampsia during pregnancy.
Increasing Trends in Male Reproductive Disorders, Environmental Exposures, an...DES Daughter
On this call, Dr. Skakkebaek presented his concerns about increasing trends in male reproductive disorders, including the significant global increase in incidence of germ cell tumors. He and colleagues from all over the world demonstrated that over half of all young men's semen quality does not meet the reference standard of the World Health Organization. Dr. Skakkebaek presented evidence linking testicular cancer, poor semen quality, childlessness, and rapidly decreasing fertility rates. He showed how there is little doubt that environmental factors, most likely associated with modern lifestyles, have - in a broad sense - had an adverse influence on male reproductive health. He and his group are examining a fundamental role that exposure to endocrine-disrupting chemicals may play in these trends, trends that in a few decades will result in decreasing populations in industrialized countries, and believes collaborative research is required to identify the causes of these adverse trends.
Sources: http://healthandenvironment.org/partnership_calls/18355
This document discusses genetics and genetic disorders. It begins by defining genetics and describing early discoveries in genetics research. It then discusses the prevalence of genetic birth defects worldwide and in India. Several genetic disorders are described in more detail, including Down syndrome, neural tube defects, sickle cell anemia, and thalassemia. For each disorder, the document outlines causes and inheritance patterns, symptoms, prevalence, and treatment options. Throughout, it emphasizes the public health importance of understanding genetics and genetic disorders.
Effect Of An Educational Intervention About Breastfeeding On The Knowledge,Biblioteca Virtual
This study evaluated the impact of an educational intervention on pediatric residents' knowledge, confidence, and clinical behaviors regarding breastfeeding. The residents completed pre- and post-intervention questionnaires to assess knowledge and confidence. Telephone interviews with breastfeeding mothers after clinic visits evaluated residents' clinical behaviors. The results showed that residents' knowledge scores increased significantly after the intervention. Their clinical behaviors when interacting with breastfeeding mothers also improved substantially. The educational intervention was effective in enhancing residents' support of breastfeeding patients.
Opinions And Practices Of Clinicians Associated With Continuation Of Exclusiv...Biblioteca Virtual
This study examined how clinician opinions and practices are associated with continuation of exclusive breastfeeding. The study prospectively followed 288 low-risk mother-newborn pairs who were breastfeeding at 4 weeks. Mothers completed interviews at 4 and 12 weeks, and their obstetric and pediatric clinicians completed surveys. The primary outcome was exclusive breastfeeding at 12 weeks. The study found that clinicians who recommended formula supplementation if an infant was not gaining weight or who felt their breastfeeding advice was not important were associated with early discontinuation of exclusive breastfeeding. Continued exclusive breastfeeding support from clinicians may help improve breastfeeding rates at 6 months.
Association Of Breastfeeding Intensity And Bottle Emptying Behaviors At Early...Biblioteca Virtual
This study examined the relationship between breastfeeding intensity, bottle emptying behaviors, and risk of excess weight in infants. The study found:
1) Infants who were breastfed at low (20% of milk feeds) or medium (20-80% of milk feeds) intensities in early infancy were over twice as likely to have excess weight in late infancy compared to infants breastfed at high (80% of milk feeds) intensities.
2) Infants who often emptied bottles in early infancy were 69% more likely to have excess weight in late infancy than infants who rarely emptied bottles.
3) Mothers' encouragement of bottle emptying was negatively associated with infants' risk of
Infant Feeding And Feeding Transitions During The First Year Of LifeBiblioteca Virtual
This document summarizes infant feeding patterns during the first year of life based on data from the Infant Feeding Practices Study II. Key findings include:
1) While 83% of infants were breastfed in the hospital, 42% of these infants also received formula supplementation. By 3 months, 61% of infants received formula.
2) Solid foods were introduced earlier than recommended, with 40% of infants consuming cereal and 17% consuming fruits/vegetables by 4 months of age.
3) Early introduction of solids was associated with discontinuing breastfeeding earlier and consuming more fatty/sugary foods by 12 months.
This study assessed how mothers learn about proper handling of infant formula and whether they follow safe practices. The study found that most mothers did not receive instruction from health professionals on formula preparation or storage. Many mothers did not fully read or understand package label instructions. While most believed following safety directions was important, many mothers engaged in unsafe practices like not always washing hands before preparing formula or heating bottles in microwaves. No consistent maternal traits predicted unsafe practices. More education is needed to promote proper formula handling and reduce risks of illness.
Characteristics Of Breastfeeding Practices Among Us MothersBiblioteca Virtual
1) More than half of breastfeeding mothers exclusively breastfed (breast milk only) until 4 months of age, after which exclusive breastfeeding declined sharply. Formula supplementation peaked at 42% at 1 month and declined to 15% at 1 year.
2) Around 6% of mothers reported exclusively pumping breast milk rather than directly breastfeeding.
3) Maternal reports showed considerable variation in behaviors related to common breastfeeding advice on frequency, duration, and intervals of feedings over the infant's first year.
There are two main feeding methods for preterm infants in the NICU - practitioner-driven feeding (PDF) and infant-driven feeding (IDF). Recent research shows IDF decreases time to full oral feeds and earlier hospital discharge. IDF relies on infant feeding cues rather than scheduled intervals. While physicians and nurses initially resisted IDF due to biases, education increased confidence in the method. IDF is now widely adopted as it improves outcomes for infants and lowers hospital costs without compromising safety. Further research is still needed on high-risk infants and implementing IDF protocols.
A pediatrician provides safety tips for common summer activities like swimming, sun exposure, fires, and biking. Parents are advised to closely supervise young swimmers and apply sunscreen before going outdoors. Burns from barbecues and fireworks can be avoided by keeping children away from all fire sources. Wearing a helmet is critical for biking and skating safety. A pre-sports physical exam can help determine if a child is physically ready for athletics and identify any health issues.
This document from the American Academy of Pediatrics outlines their policy statement on breastfeeding and the use of human milk. The key points are:
1) Extensive research has demonstrated significant health benefits for infants and mothers from breastfeeding, including reduced risk of infectious diseases, sudden infant death syndrome, diabetes, obesity, and improved cognitive development.
2) The policy statement provides recommendations for pediatricians and healthcare professionals to promote, protect, and support breastfeeding through individual practice, hospitals, medical schools, and communities.
3) Certain infectious diseases like HIV may preclude breastfeeding in some situations, but exclusive breastfeeding for the first 6 months does not increase HIV transmission risk according to some studies in developing countries.
This study analyzed survey responses from 1,323 mothers who stopped breastfeeding their infants before 12 months to identify the primary reasons for stopping breastfeeding at different infant ages. The researchers conducted factor analysis to group mothers' reasons into seven constructs: lactation issues, psychosocial factors, nutritional concerns, lifestyle interference, medical issues, pumping difficulties, and self-weaning. Across all ages, mothers most frequently cited their infant not being satisfied by breast milk alone as a key reason for stopping. Younger, unmarried, and lower-income mothers tended to stop earlier. Reasons for stopping varied by infant age, from lactation issues in early months to self-weaning in later months.
This document discusses vitamin D supplementation for breastfed infants. It begins by presenting a case of an infant with seizures from vitamin D deficiency. It then reviews the clinical presentations of acute versus chronic vitamin D deficiency. Risk factors for deficiency include limited sunlight exposure and fat malabsorption. The American Academy of Pediatrics recommends all infants receive a daily vitamin D supplement of 400IU. While breastmilk contains little vitamin D, breastfeeding is still recommended with supplementation. Oral liquid vitamin D drops are available for infants without other vitamins. However, many breastfed infants still do not receive supplements.
This randomized controlled trial evaluated the effects of high-dose docosahexaenoic acid (DHA) supplementation on neurodevelopmental outcomes in preterm infants. The study found that:
1) Overall, high-DHA supplementation did not significantly improve Bayley Mental Development Index (MDI) scores at 18 months corrected age compared to standard DHA supplementation.
2) However, girls who received high-DHA supplementation had significantly higher MDI scores than girls who received standard supplementation.
3) Infants born weighing less than 1250g who received high-DHA supplementation tended to have higher MDI scores, but the difference was not statistically significant after adjustment for confounders.
Lamotrigine In Breast Milk And Nursing Infants Determination Of ExposureBiblioteca Virtual
This study characterized lamotrigine concentrations in breast milk and nursing infant plasma in 30 women taking lamotrigine who were breastfeeding their infants. The mean ratio of lamotrigine in breast milk compared to maternal plasma was 41.3%. There was a non-significant trend for higher concentrations in breast milk 4 hours after the maternal dose. Infant plasma concentrations were 18.3% of maternal plasma concentrations. The theoretical infant dose was 0.51 mg/kg per day and the relative infant dose was 9.2%. Mild thrombocytosis was seen in 7 of 8 infants tested but no adverse effects were reported in breastfed infants. The study provides valuable data on lamotrigine exposure during breastfeeding.
Vita d defic mothers newborns merewood pediatrics 2010Alison Stevens
This study found high rates of vitamin D deficiency in newborns and their mothers in Boston, Massachusetts. The median vitamin D level was below the sufficient level in 58% of infants and 36% of mothers. Risk factors for infant deficiency included having a deficient mother, winter birth, black race, and a maternal BMI over 35. Prenatal vitamin use was protective against deficiency for both infants and mothers, however over 30% of mothers still had insufficient levels despite prenatal vitamin use. The results suggest prenatal vitamins may not provide enough vitamin D to ensure sufficiency.
2 physiology and benefits of bf, risk of artificial feeding230113Varsha Shah
Here are the answers to the true/false and multiple choice questions:
1. True
2. True
3. False
4. True
5. False
6. e. Tonsillitis
7. e. Infertility
8. c. Higher cost to feed a lactating mother
9. f. No free sponsorship from pharma, samples of formula and less earnings for hospital
10. d. Mother can do house works, can take care of sibling and save money
11. c. Causes high incidence of jaundice
12. e. All of the above
13. a. Exclusive breast feeding till 6 month
Professor Forsyth studied the health outcomes of 543 children from lower and higher socioeconomic groups. He found that (1) in the lower socioeconomic group, breastfed children had similar or significantly better health outcomes than formula-fed children, even compared to formula-fed children in the higher socioeconomic group. Subsequent studies discussed in the document found that (2) exclusive breastfeeding for at least 15 weeks reduced respiratory illness and that (3) one month of exclusive breastfeeding conferred protection against allergies and respiratory issues into childhood and adolescence. Overall, the document reviews extensive evidence that breastfeeding leads to improved health outcomes related to infectious disease, cognitive development, cardiovascular risk factors, obesity, and diabetes among others.
The Effects Of Early Pacifier Use On Breastfeeding DurationBiblioteca Virtual
This study examined the effects of pacifier use on breastfeeding duration in a cohort of 265 breastfeeding mother-infant dyads in the United States. The researchers found that:
1) Pacifier introduction by 6 weeks was associated with a 53% increased risk of shortened duration of full breastfeeding and a 61% increased risk of shortened overall breastfeeding duration.
2) Mothers who introduced pacifiers tended to breastfeed less frequently, with statistically significant differences at 2 and 12 weeks.
3) At 12 weeks, mothers using pacifiers were more likely to report breastfeeding being inconvenient and having insufficient milk supply.
4) Pacifier use begun before 2 weeks or 6 weeks was not significantly associated
Why Do Women Stop Breastfeeding Findings From The Pregnancy RiskBiblioteca Virtual
This study examined breastfeeding behaviors using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) from 2000-2001. The authors found that 32% of women did not initiate breastfeeding, 4% stopped within the first week, 13% stopped within the first month, and 51% continued for over 4 weeks. Younger women and those with limited socioeconomic resources were more likely to stop breastfeeding early. Common reasons for stopping included sore nipples, perceived inadequate milk supply, and difficulties with breastfeeding. Women's predelivery intentions impacted their likelihood of initiating and continuing breastfeeding.
Recent Advances in of BREAST FEEDING : Dr Sharda Jain Lifecare Centre
This document discusses the importance of breastfeeding and providing human milk to newborns within the first hour after birth, known as the "Golden Hour." It recommends exclusively breastfeeding or providing pasteurized donor human milk during this critical period, as formula feeds are not recommended. Initiating feeding within the Golden Hour provides significant health benefits and can reduce neonatal mortality rates. Challenges to early feeding include caesarean deliveries and ensuring babies receive an adequate volume of milk. New products like NeoLact 70 Prime aim to provide short term human milk-based nutrition for all newborns during the Golden Hour to promote gut health and a smooth transition to breastfeeding.
Similar to Vita D Supple Breatfed Infants Pediatrics 2010 (20)
Vinchon M Sdh In Infants Can It Occur Spontaneously Childs Nerv Sys 2010[1]alisonegypt
This study examines cases of subdural hematoma (SDH) in infants that were considered to have occurred spontaneously rather than from nonaccidental trauma. The study identified 16 cases of spontaneous SDH in infants (SSDHI) from a prospective database that met criteria for lack of trauma history or suspicious findings. Most SSDHI cases involved males and had predisposing factors like macrocephaly, arachnoidomegaly, or obstetric complications. The study aims to better characterize SSDHI and identify risk factors to differentiate it from cases of traumatic SDH caused by nonaccidental injury.
This document discusses trial tactics and techniques based on the advice of experienced litigators. It recommends gaining experience through taking on as many trials as possible in one's early career, even if they are minor cases. While advocacy skills can be learned, experience trying many cases, preferably dozens per year, is the best teacher. Different advocates have different styles as well, so one should not slavishly copy others but develop their own approach. Overall, industry, hard work, and experience are more important than innate talent for most advocates to achieve success.
1) Recent reports in England have outlined issues with forensic science evidence and its presentation in courts, including concerns about biases towards prosecution experts.
2) There is a large funding gap between the prosecution and publicly funded defense, undermining the principle of a fair trial.
3) English courts have been reluctant to assess the reliability and validity of novel scientific techniques, allowing potentially unreliable evidence that has contributed to past miscarriages of justice.
The Next Innocence Project Law Reivew On Sbsalisonegypt
The article discusses shaken baby syndrome (SBS) convictions and new scientific research casting doubt on the forensic significance of the diagnostic triad used to convict hundreds of caregivers. It presents the case of Audrey Edmunds, who was convicted of murder and sentenced to 18 years in prison based solely on expert testimony that an infant suffered from SBS, despite no evidence the caregiver shook the baby. New research has undermined the triad as proof of shaking and removed shaking from the syndrome. However, the criminal justice system has been slow to incorporate this, and triad-based convictions continue regularly. The author argues this constitutes a criminal justice crisis requiring resolution.
This document summarizes the changing role of expert witnesses in court. It discusses how expert witnesses are traditionally expected to say whatever can reasonably support the client's position, rather than provide objective assistance. Courts have taken a more aggressive role in screening out "junk" testimony. One reform is the "gatekeeper" role of judges to exclude dubious expertise, based on criteria like testing and peer review. However, studies show judges rarely discuss these criteria and more often exclude evidence based on relevance or witness qualifications. There is a clash between the legal system's need for settled conclusions and experts' view that some issues have no settled answer. Through screening and cross-examination, the legal process does not always succeed at exposing problematic expert testimony that could lead
Strengthening Forensic Science A Way Station On The Way To Justicealisonegypt
1) The document discusses the need to strengthen forensic science through ongoing validation research to determine which practices are scientifically valid and the limits of their validity.
2) It proposes a series of "validation investigations" be conducted by a respected body like the National Academy of Sciences to determine if certain forensic techniques and theories have already been scientifically validated or not.
3) The validation investigations would examine all prior studies to determine if a technique has been validated, has not been validated, or has been found invalid. This would provide clarity on forensic practices and could reveal issues requiring re-examination of past convictions.
The document discusses the scientific and legal history of shaken baby syndrome. It describes the medical theory behind shaken baby syndrome - that violently shaking an infant can cause subdural hematomas and retinal hemorrhages leading to death. It notes the debate between experts who support the theory and those who are critical of it. The author argues that this is a genuine battle between qualified experts on both sides, and that expert testimony from both sides should be admitted in court under the Daubert and Kumho standards for expert testimony."
This document discusses shaken baby syndrome (SBS) cases and challenges the prevailing assumptions around SBS. It summarizes that shaking alone cannot cause the injuries typically associated with SBS, and that many other causes could result in retinal hemorrhages and subdural hematomas. It provides tips for challenging SBS claims using Daubert motions and expert witnesses in biomechanics, radiology, neurology and pathology that can argue alternative causes. Contact information is given for several medical experts who may be willing to review cases or testify that the injuries were not necessarily caused by shaking.
This case involves a negligence claim brought by L.C. and L.S. against the Ministry of Children and Families regarding their investigation into injuries sustained by L.C.'s infant son, D.C. D.C. was found to have a serious skull fracture and was initially removed from L.C.'s care. The Ministry conducted an investigation but L.C. maintained her innocence. The key issues are whether the Ministry owed a duty of care to L.C. and L.S., whether the Ministry breached the standard of care in its investigation, and whether any breach caused damages.
The Canadian Paediatric Surveillance Program is a national surveillance system that identifies cases of rare diseases in children through the participation of over 2300 pediatricians. A recent study using this program identified over 100 cases of vitamin D deficiency rickets in Canadian children. National surveillance systems are important for collecting epidemiological data on uncommon conditions to answer research questions and guide public health policy. The Canadian Paediatric Surveillance Program provides valuable data and stimulates collaborative research that can improve children's health.
Nutritional rickets, once thought to be conquered, has reemerged as a public health issue in the United States. Recent case reports have highlighted dark-skinned breastfed infants, especially those in northern latitudes without vitamin D supplementation, as being most vulnerable. This article reviews a seminal 1917 study by Alfred Hess on using cod liver oil to prevent rickets in a black community in New York. The study found that cod liver oil effectively prevented and treated rickets in African American infants. Hess's success led to the development of the first rickets clinic and was an important step in overcoming the early 20th century rickets epidemic through vitamin D supplementation.
This document summarizes a court case from the Supreme Court of British Columbia regarding two parents, Muhammad and Muzzammil Rahman, appealing a lower court's decision granting continuing custody of their four children to the Director of Child, Family and Community Service. The case involves the death of the parents' two-year-old niece while in their care. While the mother was initially charged and acquitted of manslaughter, the Director has had custody of the Rahmans' four children since 2005. The Rahmans are appealing to have custody of their four children returned to them.
Multiple Fractures From Metabolic Bone Diseasealisonegypt
This document discusses multiple potential causes of fractures in infants that can be mistakenly attributed to child abuse, including metabolic bone diseases, prematurity, and nutritional deficiencies. It notes that fractures from metabolic causes often involve no pain, no soft tissue damage, and no dislocations, unlike traumatic fractures. It emphasizes the need for differential diagnosis to rule out conditions like rickets, scurvy, osteopenia of prematurity, and immobilization-related bone loss before accusing parents of abuse. Failure to consider other causes can lead to misdiagnosis of abuse when fractures actually have metabolic origins.
Mscr 2 Newer Clinical Signs Of Early Ricketsalisonegypt
This document summarizes a 1924 medical article on newer clinical signs of early rickets. It discusses:
1) Craniotabes, or softening of the cranial bones, was found in 60% of infants examined in the first 4 months, most commonly on the occiput and parietals. Associated findings included palpable parietal bosses and flattened areas on the back or sides of the head.
2) Common abnormal chest shapes in the first 4 months were square, triangular, and oval, rather than the normal circular shape. Specific characteristics of each shape are described.
3) Costomalacia, or softening of the cartilage portion of ribs near the sternum, was a
This document summarizes the issues surrounding shaken baby syndrome convictions. It introduces the medical symptoms associated with SBS (brain hemorrhaging, retinal hemorrhaging, brain swelling), and discusses how SBS convictions are often based solely on medical testimony of these symptoms. It also discusses how the science around SBS is changing, with some experts arguing there can be other causes of the symptoms besides shaking. The document examines the role of medical experts in SBS trials and how their standards of "reasonable medical certainty" may not be compatible with legal standards of "beyond a reasonable doubt." It concludes innocent people may be convicted of crimes related to SBS due to uncertainties in the medical understanding and problems with medical expert testimony.
The document is a program for the 2nd National Conference on Metabolic Bone Disorders taking place on February 15-16, 2011 in London. The conference will bring together experts in fields related to metabolic bone disorders to discuss causes, diagnosis, treatment, and management of conditions like osteoporosis, fractures, and other disorders. Over the two days, there will be keynote speeches and sessions on topics such as pathogenesis of osteoporosis, use of biomarkers, identification and treatment of fractures, management of primary and secondary osteoporosis, and other disorders including Paget's disease and osteomalacia.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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3. Because the vitamin D content in hu- supplement, their breastfed infants. TABLE 1 Statements Regarding Vitamin D
Supplementation and Rickets on the
man milk may be relatively low, breast- We were particularly interested in the Practitioner Vitamin D Survey and
fed infants are at risk for rickets un- role that their child’s pediatrician had Parental Survey of Infant Feeding
less they are exposed to adequate in influencing this choice. Before the Practitioner vitamin D survey
amounts of sunshine to produce en- project, we postulated that approxi- In order to practice high quality medicine it is
important to follow AAP practice guidelines.
dogenous vitamin D or receive it from mately one third of infants who were A major limitation of the AAP recommendation
other sources.1–4 For more than a de- breastfed for at least 6 months would that all breastfed infants receive
cade, supplemental vitamin D has been receive supplemental vitamin D and supplemental vitamin D is that the
recommendation is not evidence-based.
recommended for certain infants who that a parent’s decision regarding sup- Routinely recommending vitamin D for
are breastfed to prevent rickets.5 In plementation would be highly influ- breastfed babies may result in some
2003, the American Academy of Pediat- enced by the recommendation of their mothers electing to formula feed instead.
Some of my breastfed patients will likely
rics (AAP) recommended that all child’s pediatrician.
develop rickets if they don’t receive
breastfed infants receive at least 200 supplemental vitamin D.
IU/day of supplemental vitamin D; METHODS Parental survey of infant feeding
I think that giving vitamins to babies and young
in 2008, the recommendation was A prospective observational study was children is important for their overall
changed to at least 400 IU/day.2,6 conducted by the Puget Sound Pediat- health.
Estimates of physician adherence to ric Research Network (PSPRN), a re- Vitamins may be needed to prevent rickets or
other bone diseases in some babies.
the AAP recommendations regarding gional practice-based network of pri- It is inconvenient to give vitamins to young
vitamin D supplementation vary. A mary care pediatric practices in the babies.
1999 survey of North Carolina pediatri- Seattle, Washington, area. For this When my baby was less than 6 months old,
he/she didn’t need any extra vitamins
cians found that 44.6% recommended project, 44 PSPRN practitioners from 7 because the breast milk or formula that
the supplement for all breastfed in- private practice offices and 1 inner- he/she took had everything my baby needed.
fants, and 38.6% recommended it for city pediatric clinic participated. The If babies are out in the sunlight and fresh air
they don’t need extra vitamins.
some infants.7 These results are simi- study consisted of 2 surveys, including
My child’s doctor recommended that I give my
lar to a study of Las Vegas, Nevada, a practitioner vitamin D survey and an baby vitamins.
pediatricians in which 48% recom- infant-feeding survey completed by
mended vitamin D for breastfed in- parents. Survey data were collected
fants.8 Recently, it was reported that between July 2006 and June 2008. responses to statements by pedia-
89% of responding pediatricians in the Before collecting data on infants, the tricians who indicated that they rec-
US military recommended supplemen- practitioner vitamin D survey was dis- ommended vitamin D for all breastfed
tation for all, or some, infants fed hu- tributed to 44 PSPRN pediatricians. The infants were compared with the re-
man milk.9 More important, however, pediatricians were asked about their sponses of those who had some other
there have been few data on whether current recommendation regarding vi- practice regarding supplementation.
these recommendations influence pa- tamin D supplementation for breastfed Likert-scale responses were trans-
rental behavior and how many breast- infants. Possible responses included formed to an ordinal scale for the anal-
fed infants actually receive supple- recommend vitamin D for all breastfed ysis. Regression analysis was used to
mental vitamin D. In a study on the patients; recommend for “high-risk” chil- assess differences; generalized esti-
prevalence of hypovitaminosis D in dren; discuss pros and cons of supple- mating equation techniques were used
young children in the Boston, Massa- mentation with parents; and do not rou- to account for the clustering of pedia-
chusetts, area, Gordon et al10 reported tinely discuss vitamin D with parents. tricians in different practices.11
that only 2% of breastfed infants re- Pediatricians were asked to indicate The infant-feeding survey was distrib-
ceived supplemental vitamin D. their level of agreement with 4 state- uted to parents of children 6 to 24
We conducted a study to determine the ments regarding supplemental vitamin months old at the time of an office visit
rate of supplemental vitamin D usage D by using a 6-point Likert scale, with to a PSPRN practice. This survey was
among a group of infants from the Se- possible responses to each statement anonymous; no identifying health in-
attle, Washington, area who were pre- ranging from “completely agree” to formation was collected. Surveys were
dominantly breastfed for at least the “completely disagree.” The statements available in both English and Spanish
first 6 months of life. We were inter- on vitamin D usage are shown in Table 1. and were distributed by a research as-
ested in identifying the reasons par- For the analysis of data in the prac- sistant who visited practices on a reg-
ents choose to supplement, or to not titioner vitamin D surveys, the ularly scheduled basis. Surveys were
106 TAYLOR et al
Downloaded from www.pediatrics.org. Provided by Stanford Univ Med Ctr on February 5, 2010
4. ARTICLES
also distributed to parents by office mula daily during the first 6 months of garding supplementation and use of
staff in participating practices during life and “never” or “almost never” re- vitamin D in study patients was as-
multiple data-collection periods that ceived 16 oz of formula in 1 day. Be- sessed. Parental agreement with
ranged from 1 to 3 months. cause commercial formula contains statements regarding vitamin D use
For the infant-feeding survey, parents 400 IU/L,12 the infants who were de- was dichotomized; responses of “com-
of age-eligible children provided the fined as being predominantly breast- pletely agree” or “agree” were com-
current age of their child and were fed received 100 IU of vitamin D from pared with all other responses for
asked the initial type of feeding for him formula on a routine basis and never each item. Similarly, the response to
or her (breast milk or infant formula). or almost never received 200 IU daily. the item in the infant-feeding survey in
On the basis of the recommendation which parents were asked how im-
Parents of those infants who were ini-
for 200 IU of supplemental vitamin D portant their child’s pediatrician’s
tially breastfed were asked how long
daily that was in place when the study recommendation was regarding sup-
their child received human milk, how
data were collected,2 none of these plemental vitamin D was dichotomized
much formula their child received on a
predominantly breastfed, unsupple- by comparing responses of “very im-
routine basis, and how often the child
portant” or “important” to other
received 16 oz of formula in a single mented study children received 50%
responses.
day (possible responses included of the recommended vitamin D dose
“never or almost never,” “a few days from infant formula on a daily basis Each individual characteristic or belief
each week,” “almost every day,” or and virtually never received all of the was compared with the use of vitamin
“every day,”). Parents were asked recommended dose from this source. D in predominantly breastfed study pa-
whether their child routinely received The rate of supplemental vitamin D use tients. Those characteristics and be-
in the children who were predomi- liefs statistically associated with vita-
a multivitamin (all containing vitamin
min D use in univariate analyses,
D) during the first 6 months of life. The nantly breastfed for at least 6 months
defined as an odds ratio (OR) with a
parent was also asked to provide the was calculated. The rate of breast-
95% CI that did not include 1.0, were
name of his or her child’s pediatrician feeding, prolonged breastfeeding,
included in a multivariate model to
during the child’s first 6 months of life and vitamin D use was also com-
identify factors independently associ-
and to indicate how important this puted for children from different ra-
ated with vitamin D use in breastfed
physician’s recommendation was re- cial and ethnic groups; 95% confi-
children.
garding the decision of whether to give dence intervals (CIs) around point
his or her infant vitamins; responses estimates were calculated. Finally, during the study period, there
were categorized with a 5-point Likert was increasing publicity regarding vi-
Characteristics and parental beliefs tamin D deficiency in children and
scale that ranged from “very impor- associated with supplemental vitamin adults.13,14 To protect the anonymity of
tant” to “very unimportant.” Parents D use in children who were predomi- study children and their parents, we
were also asked to provide the race nantly breastfed for at least 6 months did not collect data on the date that
and ethnicity of their child. were assessed with the use of logistic infant surveys were completed (these
Six statements regarding vitamin D regression. Generalized estimating dates corresponded to dates of physi-
supplementation were listed on the equation techniques were used in cian visits, which is considered to be
survey. As with the practitioner survey, these analyses to account for the clus- identifiable health information).15 How-
parents indicated their level of agree- tering of patients in different prac- ever, information on the surveys was
ment with each statement by using a tices.11 Characteristics assessed in- entered into databases as they were
6-point Likert scale. The statements on cluded race, ethnicity, and age. Data on collected. To assess the effects of sec-
the infant-feeding survey are listed in the infant-feeding surveys regarding ular trends in vitamin D use during the
Fig 1. the child’s pediatrician during the first study period (2006 –2008), we catego-
Much of the analysis of data in the 6 months of life were linked to re- rized study patients into tertiles on the
infant-feeding surveys was focused on sponses on the practitioner vitamin D basis of the chronological order of
those children who were predomi- surveys. On the basis of this linkage, when their data were entered into the
nantly breastfed for at least the first 6 the association between having a pedi- study databases.
months of life. Children were consid- atrician who recommended vitamin D The study was approved by the Seattle
ered to be predominantly breastfed if for all breastfed infants versus having Children’s Hospital’s institutional re-
they routinely received 8 oz of for- a provider who had another policy re- view board.
PEDIATRICS Volume 125, Number 1, January 2010 107
Downloaded from www.pediatrics.org. Provided by Stanford Univ Med Ctr on February 5, 2010
5. RESULTS 2433 completed surveys
-69 surveys on children <6 mo or >25 mo old
A total of 44 PSPRN pediatricians com-
2364 surveys on eligible children (97.2%)
pleted the practitioner vitamin D sur-
vey. At the time that the survey was
completed, 16 pediatricians (36.4%) in-
dicated that they routinely recom- 1945 initially breastfed (82.6%) 411 formula fed (17.4%) 8 missing
mended supplemental vitamin D for all
of their breastfed patients. Fourteen
respondents (31.8%) recommended 1456 infants breastfed for ≥6 mo (75%)
supplemental vitamin D for breastfed 4 missing
infants who were at high risk for de-
veloping rickets. Six pediatricians
- 287 infants who took ≥8 oz/d formula on
(13.6%) responded that they discussed routine basis and/or 16 oz formula a few
the pros and cons of supplementation d/wk or more (20.1%)
-29 with missing data
with parents of breastfed infants, and
8 (18.2%) indicated that they did not
routinely discuss vitamin D supple-
1140 infants predominately
mentation with parents. breastfed for ≥6 mo
(58.6% of those initially breastfed)
Physicians who did not recommend vi-
tamin D for all breastfed infants had FIGURE 1
Survey completion and breastfeeding practices in study children.
significantly higher levels of agree-
ment with the statement, “A major lim-
itation of the AAP recommendation TABLE 2 Rate of Initial Breastfeeding Among Study Infants of Different Racial and/or Ethnic Groups
and Rates of Being Predominately Breastfed for at Least 6 Months
that all breastfed infants receive sup-
Race/Ethnicity No.a % Initially % Predominantly
plemental vitamin D is that the recom-
Breastfed Breastfed for 6 mo
mendation is not evidence based,”
Black 120 62.5 24.2
than pediatricians who recommended American Indian/Alaskan Native 42 88.1 52.4
vitamin D for all breastfed infants (39 Asian/Pacific Islander 427 81.5 44.8
total responses; P .011). Those prac- White 1695 85.1 52.4
Hispanic ethnicityb 232 73.7 41.0
titioners who were not universally rec- a Data on children whose parents indicated that they were of multiple races are included in more than 1 race category.
ommending vitamin D also had higher b Includes children from all racial groups.
levels of agreement than those who
universally recommended supplemen-
tation for breastfed children with the breastfeeding practices of their chil- As shown in Fig 1, surveys were com-
statement indicating that recommend- dren are summarized in Fig 1. Among pleted by parents of 1140 children who
ing supplementation might lead some the 2364 eligible children whose par- were predominantly breastfed for at
mothers to choose to not breastfeed ents completed surveys, 1945 (82.6% least the first 6 months of life. The rest
their infants (P .042). There were no [95% CI: 81.0%– 84.1%]) were mainly of the analysis was focused on these
significant differences in levels of fed with human milk during their first 1140 study infants and toddlers. Over-
agreement for the statement regard- month of life. The race and ethnicity of all, 181 of 1139 of these children
ing the importance of following AAP eligible children are shown in Table 2 (15.9% [95% CI: 13.8%–18.1%]) were
guidelines and the statement regard- along with the rates of initial breast- routinely given supplemental vitamin D
ing the possibility of rickets in breast- feeding and the proportion who were during the first 6 months of life. Infor-
fed children who were not supple- predominantly fed human milk for at mation on vitamin D use for 1 child was
mented between those pediatricians least 6 months. The mean age of the missing. Use of supplemental vitamin
who routinely recommended vitamin D infants and toddlers at the time their D in predominantly breastfed infants
and those who had another policy re- parents completed the survey was 12.1 varied according to race, with val-
garding supplementation. months (SD: 4.8 months); 25% were ues ranging from 14.2% (95% CI:
Data on completion of the infant- aged 8 months or younger, and 25% 11.9%–16.6%) among white children to
feeding survey by parents and on were aged 16 months or older. 27.1% (95% CI: 20.9%–34.0%) among
108 TAYLOR et al
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6. ARTICLES
TABLE 3 Univariate Association Between Vitamin D Use and Patient Characteristics, Parental tamin D supplementation and that vita-
Beliefs, and Policy of the Child’s Pediatrician Among Study Children Who Were
Predominantly Breastfed for at Least the First 6 Months of Life mins are important for a child’s over-
Variable ORa 95% CI No.b all health were the only variables that
White 0.63 0.44–0.90 1089 were positively and significantly asso-
Nonwhite race and/or Hispanic ethnicityc 1.67 1.22–2.27 1089 ciated with the use of vitamin D. Con-
Black 1.12 0.49–2.62 1089 versely, parental agreement that sup-
Asian/Pacific Islander 2.02 1.43–2.87 1089
Hispanic ethnicity 0.93 0.56–1.54 1084 plementation is unnecessary because
Child’s age 1.00 0.97–1.03 1139 breast milk has all needed nutrition
Parent agrees: vitamins important for overall health 5.22 3.45–7.90 1101 and that giving vitamins is inconve-
Parent agrees: vitamins needed to prevent rickets/other diseases 2.77 1.93–3.98 1020
Practitioner survey: child’s doctor recommends vitamin D for all 3.88 2.23–6.73 926 nient were both significantly associ-
breastfed infants ated with not using vitamin D. Addi-
Parent agrees: child’s doctor recommended vitamin D 19.52 10.61–35.93 1083 tional models that included all racial
Parent agrees: vitamins unnecessary, breast milk has all needed nutrition 0.07 0.04–0.13 1109
Parent agrees: giving vitamins inconvenient 0.59 0.42–0.84 1087
variable terms and/or data on the
Parent agrees: vitamins not needed if infant is out in sunlight 0.29 0.17–0.49 1074 child’s pediatrician’s recommendation
Child’s doctor’s recommendation regarding vitamin D important in 2.88 1.65–5.03 1037 regarding supplementation were ana-
parent’s decision about vitamin D supplementation
a
lyzed. The results of every analysis
OR was calculated by using logistic regression after accounting for clustering of children into different practices.
b No. indicates number of valid responses to each item. were similar. Parental agreement that
c Of the study children, 335 of 1090 (30.7%) were nonwhite race and/or Hispanic ethnicity; information on vitamin D
vitamin D was recommended by the
supplementation was collected for 1089 of these children.
child’s physician (adjusted ORs rang-
ing from 7.76 to 8.93 in different analy-
Asian/Pacific Islander children. A total tritional rickets are nonwhite and/or ses) and agreement that vitamins are
of 29 black patients were predomi- Hispanic,16 only 1 race variable (non- good for overall infant health (ad-
nantly breastfed for at least 6 months; white race and/or Hispanic ethnicity, justed ORs: 1.98 –2.23) were signifi-
6 of these children (20.7%) received or non-Hispanic white race) was in- cantly associated with providing sup-
supplemental vitamin D. The rate of vi- cluded in the model. In addition, be- plementation; agreement that breast
tamin D usage among Hispanic chil- cause 213 predominantly breastfed milk had all needed nutrition (adjusted
dren who were breastfed for at least 6 study children had an initial primary ORs: 0.10 – 0.12) and agreement that
months without significant formula care provider who was not a member giving vitamins is inconvenient (ad-
supplementation was 15.8% (95% CI: of PSPRN and did not complete the justed ORs: 0.45– 0 .46) were statisti-
9.1%–24.7%). practitioner survey, data on the child’s cally associated with not giving vita-
The univariate association between vi- pediatrician’s vitamin D recommenda- min D.
tamin D use in predominantly breast- tion policy were not included in the When asked to identify their child’s
fed children and several variables, in- larger model. The results of the multi- main doctor during the first 6 months
cluding race, ethnicity, age, parental variate analysis are shown in Table 4. of life, parents of 927 patients listed a
beliefs, and the policy of the child’s pe- Of the variables assessed in the full PSPRN pediatrician who had com-
diatrician regarding supplementation, model, parental agreement that the pleted the practitioner vitamin D sur-
are summarized in Table 3. In the child’s pediatrician recommended vi- vey (81.3% of those infants who were
unadjusted analyses, most of the vari-
ables assessed were statistically asso-
ciated with supplementation. To iden- TABLE 4 Multivariate Analysis to Identify Patient Characteristics, Parent Beliefs, and Provider
tify characteristics and beliefs that Policies Associated With Vitamin D Supplementation in Predominantly Breastfed Infants
were independently associated with vi- Variable ORa 95% CI
tamin D use in breastfed infants, an Nonwhite race and/or Hispanic ethnicity 1.29 0.81–2.06
analysis including those variables sig- Parent agrees: vitamins important for overall health 1.98 1.17–3.34
Parent agrees: vitamins needed to prevent rickets/other diseases 1.37 0.81–2.31
nificantly associated with supplemen- Parent agrees: child’s doctor recommended vitamin D 7.76 4.11–14.64
tation in univariate comparisons was Parent agrees: vitamins unnecessary, breast milk has all needed nutrition 0.12 0.07–0.23
conducted. Because of both the over- Parent agrees: giving vitamins inconvenient 0.45 0.26–0.76
Parent agrees: vitamins not needed if infant is out in sunlight 0.94 0.42–2.10
lap between several racial and ethnic Child’s doctor’s recommendation regarding vitamin D important in 1.83 0.77–4.39
groups and evidence that 90% of decision about vitamin D supplementation
children in the United States with nu- a OR calculated using logistic regression after accounting for clustering of children into different practices.
PEDIATRICS Volume 125, Number 1, January 2010 109
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7. predominantly breastfed). Among this secular trend, there were no sig- tific and lay press, has likely increased
these 927 study children, 218 (23.5%) nificant changes in the results; 4 vari- interest in providing vitamin D to
were seen by a health care provider ables (agreeing that the child’s doc- breastfed infants. In our study, we
who indicated that he or she routinely tor recommended supplementation, found that vitamin D use increased sig-
recommended supplemental vitamin D agreeing that vitamins are important nificantly during the final third of our
for all breastfed infants. Parents of for overall infant health, agreeing that study period (roughly covering the pe-
children whose provider universally breast milk has all needed nutrition, riod of late 2007 to mid-2008) when
recommended vitamin D for breastfed and agreeing that giving vitamins is in- there was publicity about vitamin D.13,14
infants were significantly more likely convenient) remained significantly as- However, even during this most recent
to agree that the provider recom- sociated with vitamin D use. period, fewer than one quarter of the
mended this supplement than those of responding parents of predominantly
children whose pediatrician had an- DISCUSSION breastfed infants reported giving vita-
other policy (64.7% and 22.7%, respec- Our results indicate that only a minor- min D to their children. The same fac-
tively; OR: 3.10 [95% CI: 1.95– 4.91]). ity of study children who were predom- tors (their child’s doctor’s recommen-
Parents of nonwhite and/or Hispanic inantly breastfed for 6 months re- dation and a belief that breast milk has
children were also more likely to agree ceived supplemental vitamin D. This all needed nutrition) remained signifi-
that their child’s provider recom- rate of usage is explained, to a large cantly associated with a parent’s deci-
mended vitamin D than those of white degree, by 2 conflicting influences. sion regarding supplementation.
non-Hispanic children (44.6% and Parents who reported that their child’s
27.8%, respectively; OR: 1.75 [95% CI: As expected, we found a high rate of
pediatrician recommended vitamin D
1.37–2.27]). Overall, 33.3% of respond- breastfeeding in this population of in-
were 8 times more likely to provide
ing parents indicated that their child’s fants seen in primary care pediatric
the supplementation than parents
provider recommended vitamin D practices in the Seattle area. In 2002, it
whose child’s pediatrician did not
supplementation. Among these par- was estimated that 71% of US children
make this recommendation. However,
ents, 44.6% gave the supplement to had ever been breastfed and that
only one third of the parents of breast-
their child versus 2.8% of those 63.2% were breastfed at 1 month of
fed infants indicated that the pediatri-
whose child’s provider did not rec- age. The Pacific region of the country
cian recommended vitamin D. In addi-
ommend vitamin D (OR: 19.52 [95% CI had the highest reported rates of
tion, and perhaps the most striking
10.61–35.93]). breastfeeding, with 76.4% of infants
finding of this study, fewer than half
from this region reportedly being
Among the responding parents of chil- (44.6%) of the parents who responded
dren who were predominantly breast- that vitamin D was recommended by breastfed at 1 month of age.18 We found
fed for at least 6 months, 743 of 1110 their child’s pediatrician actually ad- that 82.6% of the children in our study
(67.0%) agreed with the statement ministered the supplementation. This were mainly breastfed during the first
that vitamin D supplementation is not counterintuitive result is partially ex- month of life. We also found that
required because breast milk has all plained by our finding that 67% of the breastfeeding among black infants
needed nutrition. Only 3.0% of children parents believed that supplementation was more common in our population
of these parents received supplemen- is unnecessary because breast milk than nationally. However, breastfeed-
tal vitamin D. has all needed nutrition. Parents who ing rates in Hispanic infants in our
had this belief were 9 times less study were comparable to US rates for
There was an increase in the use of
likely to give supplemental vitamin D Hispanic infants.18 Perhaps more sur-
vitamin D in predominantly breastfed
than those who did not agree with this prising was the finding that 1140 of the
infants during the 2-year study period.
During the first third of the period, statement. 2364 infants in the study (48.2%) were
10.8% of these children received sup- Initially, vitamin D supplementation breastfed with little or no formula sup-
plemental vitamin D; 12.7% received was recommended for breastfed in- plementation for at least 6 months.
the supplement during the middle fants as a method to prevent rickets.2 This is substantially higher than the
third and 24.0% during the last third of However, there is emerging evidence 35.1% of infants nationally who are
the study period (OR: 1.60 [95% CI: that vitamin D may play an important breastfed for at least 6 months.18
1.10 –2.32] for comparison between role in mitigating other disease pro- It is possible that the high rate of
the final and first third of the study pe- cesses in children.1,17 Information breastfeeding in study children was
riod). However, after controlling for about this evidence, both in the scien- linked to the reticence of the respond-
110 TAYLOR et al
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8. ARTICLES
ing pediatricians to recommend vita- man and Svec reported among 128 fants among participating pediatri-
min D in at least 2 ways. Pediatricians military pediatricians.9 cians. Our results suggest that vitamin
who did not universally recommend A potential limitation of this study is D use is strongly linked to physician
supplementation had a belief that rec- that parents of children up to 2 years recommendations. Efforts to increase
ommending vitamin D might cause old were asked to report whether vita- physician acceptance of vitamin D rec-
some parents to not breastfeed their mins were given during the first 6 ommendations should lead to more
infant. Perhaps these practitioners months of life and the reasons for this use in infants and increase compli-
were wary of any intervention that choice. It is possible that some parents ance with AAP guidelines.6 However,
would alter the high prevalence of did not recollect correctly. To some ex- the results of our study also suggest
breastfeeding. Conversely, pediatri- tent, our finding that significantly that there is a strong belief by parents
cians may have been hesitant to bring more parents of study children whose that breast milk has all needed nu-
up supplementation to parents who pediatricians universally recommend trition. To a large degree, this belief
have strong beliefs about the nutri- vitamin D indicated that the practitio- supersedes physician recommenda-
tional advantages of human milk. We ner recommended supplementation tion. Thus, to substantially increase vi-
found that 68.2% of responding pedi- than those whose child’s pediatrician tamin D use in predominantly breast-
atricians recommended vitamin D did not tend to validate the accuracy of fed infants, public health educational
supplementation for some or all parental reporting on the surveys. campaigns should also directly target
breastfed infants. Although this is parents.
higher than rates found in surveys of CONCLUSIONS
providers conducted before the AAP At the time that we began this study in ACKNOWLEDGMENT
recommendation in 2003,7,8 it is 2006, there was significant resistance This study was funded by a grant from
lower than the 89% rate of recom- to the AAP recommendation for sup- the Agency for Healthcare Research
mending supplementation that Sher- plemental vitamin D for breastfed in- and Quality.
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9. Use of Supplemental Vitamin D Among Infants Breastfed for Prolonged Periods
James A. Taylor, Leah J. Geyer and Kenneth W. Feldman
Pediatrics 2010;125;105-111; originally published online Nov 30, 2009;
DOI: 10.1542/peds.2009-1195
Updated Information including high-resolution figures, can be found at:
& Services http://www.pediatrics.org/cgi/content/full/125/1/105
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