Comorbidity and health-related quality of life in Somali women living in Sweden.

Objective: To explore the relationship between low serum vitamin D levels and comorbidity in Somali women, immigrants to Sweden. Design and setting: Cohort study in a Primary Health Care Center and a University Hospital. Subjects: Somali women skin type V, n = 114, aged 18-56 years, from latitude 0-10○ N, living in Sweden, latitude 57○ N > 2 years were compared with women from a population sample, skin type II-III, n = 69, aged 38-56 years, the WHO MONICA study, Gothenburg, Sweden. Main outcome measures: Serum (S)-25(OH)D, S-parathyroid hormone (PTH), comorbidity and Health-Related Quality of Life (HRQoL) using the Short Form-36 (SF-36) and part of the EQ-5D questionnaires. All calculations were corrected for age. Results: Vitamin D deficiency (S-25(OH)D < 25 nmol/l) was found in 73% of the Somali women and in 1% of the controls (p < .0001). S-PTH was elevated (>6.9 pmol/l) in 26% and 9%, respectively (p < .004). Somali women used less medication, 16% vs. 55%, p < .0001) but more allergy medication, 11% vs. 7% (p = .006), had fewer fractures, 2% vs. 28% (p < .0001) and lower HRQoL in 7 out of 9 scales (p < .05-.001), than native controls. There were no differences in the prevalence of diabetes mellitus, hypothyroidism, positive thyroid peroxidase antibodies, vitamin B12 deficiency, celiac disease or hypertension. Conclusions: Vitamin D deficiency was common in Somali women living in Sweden, 73%, but comorbidity was low. Both mental, and especially physical HRQoL scores were lower in the Somali women. The effects of long-lasting deficiency are unknown. Key points The aim was to explore the relationship between vitamin D deficiency (S-25(OH)D < 25 nmol/l) and comorbidity in immigrants. Vitamin D deficiency was common in Somali women living in Sweden, 73%, but comorbidity of hypothyroidism, diabetes mellitus, hypertension, fractures and use of medications was low. Both mental, and especially physical, Health-Related Quality of Life were lower in the Somali women than in native Swedish women. The effects of long-lasting deficiency are unknown.

[Time to limit the use of antibiotics in rosacea!] / Dags att minska användningen av antibiotika vid rosacea - Isotretinoin bör övervägas vid frekventa recidiv ­ lokalbehandling fortfarande förstahandsterapi.

Rosacea is a chronic inflammatory disease with facial erythema and papulopustules. It is common in middle-aged/elderly persons and often affects self-perception and social well-being. It is generally classified into four subtypes. Improved understanding of pathophysiology has resulted in novel treatment approaches, but routine management in health care usually follows old trails. Most patients are managed in primary care. Greater attention to the reduced skin barrier, avoidance of exacerbating factors, better topicals and encouragement to topical maintenance treatment should reduce the use of oral tetracyclines. Low-dose isotretinoin is reserved for treatment-resistant patients, but relapses are frequent unlike its use in acne. In order to reduce antibiotic use, we propose that patients should be referred to a dermatologist for optimization of therapy including consideration of isotretinoin following tetracycline treatment of a maximum of 4-6 months.

Vitamin D treatment in Somali women living in Sweden - Two randomized, placebo-controlled studies.

OBJECTIVE: There is limited information about the prevalence of vitamin D deficiency and the effects of treatment on immigrants. The effects of oral vitamin D intake and UVB treatment on vitamin D status in healthy Somali women living in Sweden were analysed. DESIGN: Two studies were carried out; a randomized, double-blind, placebo-controlled study, with oral drops of 800 IU and 1600 IU cholecalciferol and similar amounts of placebo given daily during 12 weeks and a single-blind, placebo-controlled study, using UVB (4·3-8·7 J/cm(2) ) or Woods lamp (placebo) on the upper body, or the face and hands. PATIENTS: One-hundred fourteen Somali women, mean age 34 years, latitude 0-10°N, living in Sweden >2 years, latitude 57°N, participated. MEASUREMENTS: Serum 25-hydroxyvitamin D (S-25(OH)D) was monitored before, every 6 weeks and at 3 months after treatment. RESULTS: The majority of the women (n = 83, 73%) were vitamin D-deficient, S-25(OH)D < 25 nmol/l at start. There was a dose-dependent increase in S-25(OH)D levels (P = 0·001, stratified Jonckheere-Terpstra test) with a mean increase after twelve weeks in women treated with 800 IU/day and women treated with 1600 IU/day of 18 nmol/l (95% CI: 6-29, median = 17) and 29 nmol/l (95% CI: 17-42, median = 34), respectively. S-25(OH)D decreased during follow-up but remained above baseline levels. The placebo group remained unchanged throughout the study. UVB treatment increased S-25(OH)D dose-dependently after 6 weeks (P = 0·03, Jonckheere-Terpstra test). CONCLUSIONS: Vitamin D deficiency was common in immigrants living at higher latitudes. Vitamin D treatment increased S-25(OH)D levels dose-dependently during 3 months. The effect was maintained for another 3 months. At least 1600 IU/day is recommended. The dropout rate was high.