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  1. Michael Muir

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    Children living in areas of high pollution are at risk of developing vitamin D deficiency rickets and should be offered vitamin D supplements. The most important source of vitamin D is that produced in the skin after exposure to ultraviolet B (UVB) sunlight, and there is increasing concern that smog created by industrial and vehicular emissions absorbs UVB photons, thus reducing the cutaneous vitamin D synthesis. Researchers recruited a total of 57 children from Delhi, India, who lived in two areas of the city with disparate pollution levels, and hypothesised that serum total 25-hydroxycholecalciferol (25(OH)D)—a reliable measure of vitamin D status—would be lower in those from the heavily polluted area. They were right: mean 25(OH)D of children in the more polluted area was 12.4 (7) ng/ml, compared with 27.1 (7) ng/ml in children in the less polluted area. The authors also measured the amount of UVB sunlight to reach the ground in both areas and found that significantly more did so in the less polluted area. The findings swell unease about the public health effects of our increasingly polluted planet, and confirm the importance of that pollution on reducing effective UVB levels, even in traditionally sunny countries at low latitudes. The authors recommend the introduction of a vitamin D supplement programme and are currently evaluating the potential effectiveness of such a programme through a large randomised trial. (



    Severe visual impairment (VSI) or blindness in childhood carries weighty consequences, given the implications for development, and it is acknowledged that much childhood blindness in developing countries is preventable or treatable. A recent study from Delhi, India, has confirmed this, with almost half of the children suffering potentially preventable or treatable visual conditions, of which vitamin A deficiency, measles, and cataract were the leading causes. The authors also examined temporal trends in three age groups, and the results suggest that childhood onset disorders—such as vitamin A deficiency—are gradually declining as the cause of VSI or blindness, as retinal disorders increase in importance. (



    Researchers from the Netherlands have come up with a scoring rule, based on easily obtainable clinical data, which allows accurate prognosis for individual patients with heart failure. By allocating values to pre-existing independent mortality factors (including diabetes mellitus, renal dysfunction history, and lower weight or body mass index) present in each patient, predictive formulas can be created that have a good degree of accuracy. The addition of further factors, such as the use of β blockers, further improved accuracy, while including quality of life scores did not have a significant effect. The authors recommend further research to validate their method in other populations. (



    Rates of low vision and blindness in rural Indonesia are similar to other developing countries in Asia. After surveying 929 adults in a rural provincial area of Sumatra, Indonesia, researchers found the prevalence of bilateral low vision to be 5.8% and blindness 2.2%. Rates increased with age, and the main causes were, as usual, preventable: cataract and uncorrected refractive errors were the major culprits. This study is the first large population based survey conducted in Indonesia, where most of the population live rurally, and the data should prove useful in developing preventative and treatment programmes. (



    Regional differences exist in the prevalence of rheumatoid factor (RF) in Finland. RFs are antibodies used as diagnostic and prognostic markers of rheumatoid arthritis (RA), which often appear years before the onset of clinical RA. Prevalence rates were highest in the north of the country (1.43), followed by the east (1.38), south (1.08), west (0.95), and lowest in the south west at 0.42. The findings are in accordance with recent data suggesting regional differences in the prevalence of RA in Finland. (


    The incidence of Crohn’s disease (CD) increased in northern France over a 12 year period while that of ulcerative colitis (UC) decreased over the same period, in contrast with what has been reported in comparable countries. Trends in the incidence of these inflammatory bowel diseases (IBD) were studied between 1988 and 1999 and adjusted for age and sex, with incidence rates standardised for age with the European standard population. The results showed a 23% increase in the incidence of CD, with a simultaneous decrease of 17% for UC, suggesting that factors influencing IBD frequency are still at work in this area of Europe. (



    A recent study has found no evidence of increased risk of infant death with greater travel time to hospitals. Each infant death that occurred between 1950 and 1993 in one English region was analysed against data on travel time to hospital. Rather than use straight line distance to calculate the travel time, detailed information on the road network, location of built up areas, and the location of all hospitals was considered to produce a more accurate assessment of the geographical accessibility. The authors suggest that their data may be important in considering the future location of paediatric facilities, but believe that the absence of data after 1993 prevents it being used as justification for further centralisation of hospital services. (