There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.

Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

I and i

Once foods in the United States were fortified with vitamin D, rickets appeared to have been conquered, and many considered major health problems from vitamin D deficiency resolved. But vitamin D deficiency is common. This review considers the role of vitamin D in skeletal and nonskeletal health and suggests strategies for the prevention and treatment of vitamin D deficiency.

Vitamin D Deficiency

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Objective: The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. Participants: The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration. Consensus Process: Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes. Conclusions: Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recomme...

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Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline

OBJECTIVE\nThe objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency.\n\n\nPARTICIPANTS\nThe Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration.\n\n\nCONSENSUS PROCESS\nConsensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes.\n\n\nCONCLUSIONS\nConsidering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.

Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline (Journal of Clinical Endocrinology and Metabolism (2011) 96, (1911-1930))

Objective: Sun exposure is considered the single most important source of vitamin D. Vitamin D deficiency has been suggested to play a role in the etiology of psychotic disorders. The aim of the present study was to evaluate the association between sun exposure and psychotic experiences in a general population sample of Swedish women. Methods: The study population included participants from The Swedish Women's Lifestyle and Health cohort study. The 20-item Community Assessment of Psychic Experiences (CAPE) was administered between ages 30 and 50 to establish psychotic experiences. Sun exposure as measured by 1) sunbathing holidays and 2) history of sunburn was measured between ages 10 to 39. The association between sun exposure and psychotic experiences was evaluated by quantile regression models. Results: 34 297 women were included in the analysis. Women who reported no sunbathing holidays and two or more weeks of sunbathing holidays scored higher on the CAPE scale than women exposed to one week of sunbathing holidays across the entire distribution, when adjusting for age and education. Similarly, compared with women who reported a history of one sunburn, the women with none or two or more sunburns showed higher scores on the CAPE scale. Conclusion: The findings of this study suggest that in a population based cohort of middle aged women, both low and high sun exposure is associated with increased level of positive psychotic experiences.

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Sun Exposure and Psychotic Experiences

Aims The study aim was to re-examine current work practices and evaluate time trends in the cardiovascular management of people with diabetes consulted by primary healthcare nurses in New Zealand. Methods Primary healthcare nurses in the Auckland region were surveyed in 2006-2008 and 2016, with about one-third of practice, home care and specialist nurses randomly selected to participate. Nurses completed a self-administered questionnaire about demographic and workplace details, and a telephone interview about clinical care provided for people with diabetes during nursing consultations. Information was collected on a representative sample of people with diabetes consulted on one randomly selected work-day in the previous week. Results Of all people with diabetes consulted by nurses, practice nurses consulted significantly more in 2016 (83%) compared with 60% in 2006-2008, whereas specialist nurse consultations decreased from 23% to 8% (P = 0.01). In 2016, in people with diabetes, BMI was higher, and total cholesterol lower, yet the proportions of those receiving lifestyle advice (dietary and activity) remained unchanged from 2006-2008 levels. Smoking prevalence in people with diabetes was unchanged between the two surveys, although more people were asked if they wished to stop in 2016 compared with 2006-2008 (98% vs. 73%). In 2016, hours of nurses' diabetes education were associated with increased routine assessments of risk factors in people with diabetes and checking laboratory results. Conclusions Practice nurses are undertaking an increasing proportion of diabetes consultations. Although BMI in people with diabetes is increasing, the proportion of nurses offering lifestyle advice remains unchanged. Increasing diabetes education could strengthen the management of people with diabetes by community nurses.

Trends in cardiovascular management of people with diabetes by primary healthcare nurses in Auckland, New Zealand

The trends in incidence of tuberculosis in the three Auckland health districts were examined comparing the rates among Maoris, Pacific Islanders and Europeans. There was a continued falling incidence during the period 1974 to 1983, particularly in Maoris and Pacific Islanders. The age-specific rates were studied and related to case finding activities and BCG vaccination. Neonatal BCG vaccination offered to Maoris and Pacific Islanders was not shown to have any impact on incidence rates. Most childhood cases of tuberculosis were discovered by active public health screening activities, while the majority of adult cases were detected by routinely available general practitioner and hospital medical services.

Robert Scragg

Papers

Sun Exposure and Psychotic Experiences

Trends in cardiovascular management of people with diabetes by primary healthcare nurses in Auckland, New Zealand

Trends in tuberculosis incidence in the Auckland region, 1974-1983.

General practice changes in South Auckland from 1990 to 1999: a threat to continuity of care?

Preventing diabetes--time is running out.