High prevalence of asymptomatic vitamin D and iron deficiency in East African immigrant children and adolescents living in a temperate climate.

OBJECTIVES: Vitamin D deficiency (VDD) is common in immigrant children with increased skin pigmentation living in higher latitudes. We assessed the pattern of and risk factors for VDD in immigrant East African children living in Melbourne (latitude 37 degrees 49' South). STUDY DESIGN: A prospective survey of 232 East African children attending a clinic in Melbourne. Data were collected by questionnaire, medical assessment and laboratory tests. RESULTS: Low 25-hydroxyvitamin D (25-OHD) levels (<50 nmol/l) occurred in 87% of children, and VDD (25-OHD <25 nmol/l) in 44%. Risk factors included age <5 years, female gender, increased time in Australia, decreased daylight exposure and winter/spring season. Anaemia (20%), vitamin A deficiency (20%) and iron deficiency (19%) were also identified. CONCLUSIONS: Asymptomatic VDD is common in East African immigrant children residing at a temperate latitude. Risk factors for VDD limit endogenous vitamin D production. Screening of immigrant children with increased skin pigmentation for VDD, anaemia, iron and vitamin A deficiency is appropriate. VDD in adolescent females identifies an increased risk of future infants with VDD.

Demographics and utilisation of health services by paediatric refugees from East Africa: implications for service planning and provision.

Little is known of difficulties in accessing health care for recently arrived paediatric refugees in Australia. We reviewed routinely collected data for all 199 East African children attending a hospital Immigrant Health Clinic for the first time over a 16 month period. Although 63% of parents reported medical consultations since arrival, 77% of this group reported outstanding, unaddressed health problems. Availability of interpreters and information on health services were the main factors hindering access to care. These data have informed future service planning at the Clinic. Ongoing data collection is key to maintaining a responsive, targeted service for a continually changing population.

Eating disorders in adolescence. An approach to diagnosis and management.

BACKGROUND: Eating disorders in adolescence are complex problems that may result in significant morbidity. The majority of eating disorders begin in adolescence, a time of critical importance for growth, pubertal development, acquisition of peak bone mass and psychosocial development. OBJECTIVE: This article presents a review of eating disorders in adolescence with particular reference to the role of the general practitioner in early recognition of disordered eating and in the ongoing management of adolescents with established eating disorders. Specific management priorities in this age group are also addressed. DISCUSSION: Eating disorders in adolescence have significant consequences for the current and future health of the affected young person and for family functioning. Early detection and early intervention are key elements in achieving good, long term outcomes. A comprehensive approach to management that addresses physical, psychosocial, family and educational concerns is necessary. The goal of weight restoration needs to be pursued aggressively in adolescents to prevent adverse effects on future growth and bone mass acquisition.