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Natalie Vicca Good Food for New Arrivals Project ASeTTS

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Presentation on theme: "Natalie Vicca Good Food for New Arrivals Project ASeTTS"— Presentation transcript:

1 Natalie Vicca Good Food for New Arrivals Project ASeTTS
Vitamin D Natalie Vicca Good Food for New Arrivals Project ASeTTS

2 ASeTTS Association for Services to Torture and Trauma Survivors
Free & Confidential service Counselling, advocacy, support, group and community activities

3 Good Food for New Arrivals
Funded by Australian Government under the Stronger Families and Communities Invest to Grow Program.

4 Services at ASeTTS Counselling & Advocacy
Community development programs and support groups Personal Support Program Volunteer program Settlement grants program Training, professional development & consultation Strength to Strength Relationship support Good Food for New Arrivals Nutrition Project Integrated service centre MDT at selected Primaries Newly Arrived Youth Support Service Sessional psychiatrist

5 Australia’s Humanitarian Programme
Nationally 13,000 accepted each year 2006 Total under 18 years = 56% Under 9 years old = 27% 200 visa is refugee visa or 204 woman at risk The SHP includes those that are sponsored to come by other family members and PPV and TPV as well as the onshore processed visas Numbers from =12144 Total under 18 years = 56% = 6735 Under 9 years old = 27% = 3262

6 Learning Objectives Be aware of sources and function of Vit D
Be aware of the effects of Vit D deficiency Recognise groups at risk of deficiency The situation in WA Identify screening/treatment strategies

7 Sources Sunlight -D3 cholecalciferol Diet -D2 ergocalciferol
Fish, Eggs, Margarine, Milk, some meats Requirements = 5-15 Micrograms/day (Nutrient Reference Values for Australia and New Zealand 2006) Where do we get the stuff and how much do we need? 19-50yrs = 5mcg 51-70yrs = 10 mcg >70yrs = 15mcg

8 Function Variety of neuromuscular and physiological functions
Maintains serum calcium and phosphorus Role in enhancing immune function

9 sunlight skin 7 -dehydrocholesterol cholecalciferol
Vitamin D3 (fish, meat) Vitamin D2 (supplements) liver The vitamin is activated through multiple organ systems When anything is wrong with these systems there may be issues with Vitamin D i.e kidney failure, bowel disease 25 dihydroxyvitamin D3 1,25-dihydroxyvitamin D3 ↑Ca absorption small intestine ↑Urinary calcium reabsorption (kidney) ↑Bone mineralisation kidney

10 Deficiency Rickets in children Osteoporosis and Osteomalacia adults
Implicated in development of Psoriasis Type 1 Diabetes Mellitus Multiple Sclerosis Gastrointestinal Cancers Difference due to pathogenesis of growing versus mature bone

11 WA Situation Migrant Health found approx 16% of children and 11% of adults have moderate to severe vitamin D deficiency Many more with mild deficiency - 40% Have been emergency presentations due to hypocalcaemic seizures 40% of all those seen have inadequate levels of vitamin D

12 Who is at risk? Those who do not get enough sunlight.
Covered for cultural reasons Dark skin needs longer exposure Elderly Breastfed babies of deficient mothers Babies not introduced to solids appropriately Who are we talking about? Insufficient sun exposure Elderly do not metabolise as efficiently

13 Sun exposure Outside of peak hours
Without sun screen for short periods only Hands, arms and face if possible Darker skins require longer exposure 7 minutes in summer for moderate to fair skin, up to 3-4 times longer for highly pigmented skins.

14 Symptoms and Signs Young Infants Restlessness Poor sleep Craniotabes
(Soft posterior skull due to reduced mineralisation) Obviously difficult to assess!!

15 Older infants Delayed sitting/crawling Delayed closure fontanelle
Bossing of skull Costochondral beading Delayed tooth development Photos courtesy of Tom D Thacher, MD

16 Children (1-4 yrs) Enlarged Epiphysial cartilages wrists/ankles
Kyphoscoliosis Delayed walking Abnormal teeth excessive caries


18 Bow leg abnormality Knock knees Photos courtesy of Tom D Thacher, MD

19 Marion Post Wolcott. Corbis

20 Older children and adolescents
Painful walking Bowlegs Knock knees Abnormal teeth Excessive caries Neuromuscular hyperactivity muscle weakness

21 Adults Weak bones Bone pain (spinal, pelvic, legs) Muscle weakness
Hypocalcaemia Compressed vertebrae Pelvic flattening Easy fracturing

22 What can be done? Screening
Blood test – vitamin D, U&E’S, PTH, Ca, LFT’s Signs or symptoms screened by GP

23 Treatment Children Adults
Managed via PMH due to sole access to supplementation Adults Managed by GP E.g. Ostelin tablets/d

24 After 2 years of treatment
Photos courtesy of Tom D Thacher, MD

25 Summary Slip Slap Slop Still stands but…. SPOT – those at risk
SCREEN - those likely to be deficient SUPPLEMENT – those with low levels

26 Questions?

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