Successful public health action to reduce the incidence of symptomatic vitamin D deficiency.

BACKGROUND: In response to a resurgence of symptomatic cases of vitamin D deficiency in a high-risk predominantly ethnic minority population, a programme of universal rather than targeted vitamin D supplementation was begun with a public awareness campaign about the importance of vitamin D. OBJECTIVE: To evaluate the effectiveness of this programme in reducing case numbers. METHODS: Cases of symptomatic vitamin D deficiency in children under 5 years resident in a primary care trust catchment area presenting at local hospitals were identified through laboratory records of low vitamin D levels which were cross-checked against medical records to confirm the diagnosis. Comparisons were made of the case incidence rate, level of public knowledge and vitamin supplement uptake rate at the onset of the programme in 2005 and 4 years later. RESULTS: The number of cases of symptomatic vitamin D deficiency in those under 5 years fell by 59% (case incidence rate falling from 120/100 000 to 49/100 000) despite the supplement uptake rate rising only to 17%. Public awareness of vitamin D deficiency rose to near universal levels. CONCLUSIONS: A programme of universal rather than targeted Healthy Start vitamin D supplementation for pregnant and lactating women and young children has led to a substantial decrease in cases of symptomatic vitamin D deficiency in a high-risk population. Supplementation was also started at a younger age than in the national programme. This approach has implications for the delivery of vitamin D supplementation programmes in similar populations.

Introduction: secretory activation: from the past to the future.

This issue of the Journal of Mammary Gland Biology brings a synthesis of the historical data leading to our understanding of the physiology of lactation up to about 1980 with the new technologies and understanding resulting from the molecular revolution in the late 20th century. We focus specifically on the activation of secretion at parturition, and show that the field is ripe for new investigation.