admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

It is now generally accepted that vitamin D deficiency is a worldwide health problem that affects not only musculoskeletal health but also a wide range of acute and chronic diseases. However, there remains cynicism about the lack of randomized controlled trials to support the association studies regarding the nonskeletal health benefits of vitamin D. This review was obtained by searching English-language studies published up to April 1, 2013, in PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials (search terms: vitamin D and supplementation) and focuses on recent challenges regarding the definition of vitamin D deficiency and how to achieve optimal serum 25-hydroxyvitamin D concentrations from dietary sources, supplements, and sun exposure. The effect of vitamin D on fetal programming epigenetics and gene regulation could potentially explain why vitamin D has been reported to have such wide-ranging health benefits throughout life. There is potentially a great upside to increasing the vitamin D status of children and adults worldwide for improving musculoskeletal health and reducing the risk of chronic illnesses, including some cancers, autoimmune diseases, infectious diseases, type 2 diabetes mellitus, neurocognitive disorders, and mortality.

/pdf/vitamin-d-for-health-a-global-perspective-36p410gca6.pdf

Vitamin D for Health: A Global Perspective

Relevance to nursing care The evidence available regarding vitamin D on mortality has been inconclusive. Vitamin D can be obtained from sun exposure on skin, dietary intake, or supplementation as vitamin D3 or D2. Proper balance of vitamin D and calcium levels are important for healthy bones. Past studies have indicated that vitamin D supplementation prevents osteoporosis, osteomalacia, and fractures. Contradictory studies suggest that vitamin D may prevent cancer, cardiovascular disease, and affect mortality; and observational research has indicated a relationship of low vitamin D levels and risk of mortality. Evidence related to vitamin D is important for nurses working with patients with and without vitamin D insufficiency. The value of vitamin D needs clarification, and health information about risk factors, common problems with deficiency, as well as the benefits and proper use of vitamin D supplementation are needed by patients and caregivers. The purpose of this systematic review was to assess the beneficial and harmful effects of vitamin D supplementation on the prevention of mortality in healthy adults and in adults with a stable form of disease.

Vitamin D supplementation for prevention of mortality in adults

Alzheimer's disease and osteoporosis.

Seasonal vitamin D changes and the impact on health risk assessment.

Background:Epidemiological data support a potential relationship between vitamin D deficiency and an increased risk of developing multiple sclerosis (MS). In vitro studies have expanded the potential role of vitamin D and its receptor beyond calcium modulation, regulation, and maintenance of bone mi

Vitamin D and multiple sclerosis.

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Vitamin D and multiple sclerosis.