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Neale RE, Beedle V, Ebeling PR, Elliott T, Francis D, Girgis CM, Gordon L, Janda M, Jones G, Lucas RM, Mason RS, Monnington PK, Morahan J, Paxton G, Sinclair C, Shumack S, Smith J, Webb AR, Whiteman DC. Balancing the risks and benefits of sun exposure: A revised position statement for Australian adults. Aust N Z J Public Health 2024; 48:100117. [PMID: 38350754 DOI: 10.1016/j.anzjph.2023.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To describe the development of a new position statement regarding balancing the risks and benefits of sun exposure for Australian adults. METHODS We conducted a Sun Exposure Summit in March 2021, with presentations from invited experts and a workshop including representation from academic, clinical, policy, and patient stakeholder organisations. The group considered advice about balancing the risks and benefits of sun exposure for Australian adults and developed a revised consensus position statement. RESULTS The balance of risks and benefits of sun exposure is not the same for everybody. For people at very high risk of skin cancer, the risks of exposure likely outweigh the benefits; sun protection is essential. Conversely, people with deeply pigmented skin are at low risk of skin cancer but at high risk of vitamin D deficiency; routine sun protection is not recommended. For those at intermediate risk of skin cancer, sun protection remains a priority, but individuals may obtain sufficient sun exposure to maintain adequate vitamin D status. CONCLUSIONS The new position statement provides sun exposure advice that explicitly recognises the differing needs of Australia's diverse population. IMPLICATIONS FOR PUBLIC HEALTH Mass communication campaigns should retain the focus on skin cancer prevention. The new position statement will support the delivery of personalised advice.
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Affiliation(s)
- Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | | | - Peter R Ebeling
- Monash University, Melbourne, Australia; Healthy Bones Australia, Australia
| | - Thomas Elliott
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Christian M Girgis
- University of Sydney, Sydney, Australia; Australa and New Zealand Bone and Mineral Society, Australia
| | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | | | - Graeme Jones
- Australa and New Zealand Bone and Mineral Society, Australia; University of Tasmania, Hobart, Australia
| | | | - Rebecca S Mason
- University of Sydney, Sydney, Australia; Healthy Bones Australia, Australia
| | | | | | | | | | | | - Jane Smith
- Royal Australian College of General Practitioners, Australia
| | - Ann R Webb
- University of Manchester, Manchester, United Kingdom
| | - David C Whiteman
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
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Sanford BS, Aliano JL, Omary CS, McDonnell SL, Kimball SM, Grant WB. Exposure to a Vitamin D Best Practices Toolkit, Model, and E-Tools Increases Knowledge, Confidence, and the Translation of Research to Public Health and Practice. Nutrients 2023; 15:nu15112446. [PMID: 37299409 DOI: 10.3390/nu15112446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
Preventable vitamin D deficiency (VDD) is a global health concern. The prevention, early detection, and treatment of vitamin D deficiency aligning with serum 25-hydroxyvitamin D concentration recommendations of 40-60 ng/mL (100-150 nmol/L), provided by an international panel of 48 vitamin D researchers, would result in significant health benefits and cost savings to individuals and society. However, research shows that healthcare professionals lack knowledge and confidence in best practices with respect to vitamin D. A vitamin D toolkit was developed that included a model for decision-making support, e-tools, and accompanying resources and was implemented using an online, asynchronous learning management system. This pre-test, post-test, and follow-up survey study design aimed to increase nurses' and dietitians' levels of knowledge and confidence regarding vitamin D, aid in their translation of evidence into spheres of practice and influence, and help them identify translation barriers. The completion of the toolkit increased the participants' (n = 119) knowledge from 31% to 65% (p < 0.001) and their confidence from 2.0 to 3.3 (p < 0.001) on a scale of 1-5. Respondents reported using the model (100%) as a framework to successfully guide the translation of vitamin D knowledge into their sphere of influence or practice (94%) and identifying translation barriers. The toolkit should be included in interdisciplinary continuing education, research/quality improvement initiatives, healthcare policy, and institutions of higher learning to increase the movement of research into practice.
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Affiliation(s)
- Beth S Sanford
- School of Nursing, Rasmussen University, 4012 19th Avenue South, Fargo, ND 58103, USA
| | - Jennifer L Aliano
- GrassrootsHealth Nutrient Research Institute, Encinitas, CA 92024, USA
| | - Courtney S Omary
- School of Nursing, Rasmussen University, 4012 19th Avenue South, Fargo, ND 58103, USA
| | | | | | - William B Grant
- Sunlight, Nutrition, and Health Research Center, San Francisco, CA 94164-1603, USA
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Tran V, Janda M, Lucas RM, McLeod DSA, Thompson BS, Waterhouse M, Whiteman DC, Neale RE. Vitamin D and Sun Exposure: A Community Survey in Australia. Curr Oncol 2023; 30:2465-2481. [PMID: 36826149 PMCID: PMC9955356 DOI: 10.3390/curroncol30020188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Sun exposure carries both harms and benefits. Exposing the skin to the sun is the main modifiable cause of skin cancers, which exert a considerable health and economic burden in Australia. The most well-established benefit of exposure to ultraviolet (UV) radiation is vitamin D production. Australia has the highest incidence of skin cancer in the world but, despite the high ambient UV radiation, approximately one quarter of the population is estimated to be vitamin D deficient. Balancing the risks and benefits is challenging and requires effective communication. We sought to provide a snapshot of public knowledge and attitudes regarding sun exposure and vitamin D and to examine the associations between these factors and sun protective behaviors. In 2020 we administered an online survey; 4824 participants with self-reported fair or medium skin color were included in this analysis. Only 25% and 34% of participants were able to identify the amount of time outdoors needed to maintain adequate vitamin D status in summer and winter, respectively and 25% were concerned that sunscreen use inhibits vitamin D synthesis. This lack of knowledge was associated with suboptimal sun protection practices. Public education is warranted to prevent over-exposure, while supporting natural vitamin D production.
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Affiliation(s)
- Vu Tran
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
- The University of Queensland, Brisbane, QLD 4006, Australia
| | - Monika Janda
- The University of Queensland, Brisbane, QLD 4006, Australia
| | - Robyn M. Lucas
- The Australian National University, Canberra, ACT 2601, Australia
| | - Donald S. A. McLeod
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
| | - Bridie S. Thompson
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Mary Waterhouse
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - David C. Whiteman
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
- The University of Queensland, Brisbane, QLD 4006, Australia
| | - Rachel E. Neale
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
- The University of Queensland, Brisbane, QLD 4006, Australia
- Correspondence:
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Liyanage G, Jayathunga S, Amarasekara T. Vitamin D knowledge and sun exposure practices among Sri Lankan healthcare undergraduates. PLoS One 2022; 17:e0279480. [PMID: 36574411 PMCID: PMC9794041 DOI: 10.1371/journal.pone.0279480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Although overexposure to ultraviolet radiation may lead to skin cancer, inadequate exposure results in vitamin D deficiency (VDD). We explored vitamin D-related knowledge and sun exposure practices among Sri Lankan healthcare undergraduates. METHODS The sampling frame consisted of medical and allied health undergraduates in a single centre. A newly developed, pre-piloted, self-administered questionnaire collected data on vitamin D knowledge, sun avoidance behaviour and outdoor time. Univariate and multivariate logistic regression analysis examined the factors related to outdoor time. RESULTS A total of 482 were included in the analysis. The mean (SD) vitamin D knowledge score (0-100% scale) was 31.3% (18%). Only 17.8% scored ≥50% for knowledge. At least one sun avoidance measure was used by 59.3% of the undergraduates. A lower knowledge score was observed with a higher number of sun-avoidance behaviour (mean difference 0.84, p = 0.03). The majority (66%) spent outdoors <30 minutes per day between 9 am-3 pm. The odds of having low outdoor time were 1.6 higher for the female sex (OR:1.61, 95%CI:1.039, 2.492, p<0.001) and studying in the final year (OR:1.63, 95%CI:1.020, 2.602, p = 0.04). Medical students had a higher likelihood of low outdoor time (OR:0.55, 95%CI: 0.361, 0.835, p = 0.005). CONCLUSIONS The healthcare undergraduates had low vitamin D knowledge and outdoor time while having increased sun avoidance. Gender, course of study, and academic year appeared to affect outdoor time. Support and guidance should improve knowledge and sun exposure habits that suit academic work and lifestyle in this population. Also, universities can actively promote positive sun exposure by organizing outdoor events.
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Affiliation(s)
- Guwani Liyanage
- Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- * E-mail:
| | - Sanjana Jayathunga
- Department of Nursing, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Thamara Amarasekara
- Department of Nursing, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Knowledge and Practice of Pediatricians Regarding Hypovitaminosis D-A Survey across 33 European Countries. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121831. [PMID: 36553275 PMCID: PMC9776671 DOI: 10.3390/children9121831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Hypovitaminosis D has been recognized as a worldwide pandemic, but there are disagreements regarding its diagnosis and treatment. This study aimed to evaluate the knowledge and practice of European pediatricians concerning vitamin D (VD) and hypovitaminosis D and their adherence to relevant guidelines. A cross-sectional study was conducted through an anonymous survey via SurveyMonkey on 304 European pediatricians. Most of the participants were general pediatricians, followed by endocrinologists and neonatologists. ESPGHAN's and the national guidelines were the most frequently used. VD testing was mostly performed in patients with skeletal, chronic kidney, and autoimmune diseases. Participants predominantly answered the questions regarding the definition of hypovitaminosis D and VD supplementation correctly, especially in children younger than 12 months. They showed the least knowledge regarding the cut off-point for the initiation of the therapy and therapeutic doses used to treat confirmed hypovitaminosis D. Participants' conflicting answers could be related to the differences between the guidelines. We consider that experts in this field should create uniform guidelines, and that those guidelines should also be promoted by national or local pediatric associations.
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Martin-Gorgojo A, Gilaberte Y, Nagore E. Vitamin D and Skin Cancer: An Epidemiological, Patient-Centered Update and Review. Nutrients 2021; 13:4292. [PMID: 34959844 PMCID: PMC8709188 DOI: 10.3390/nu13124292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The current vitamin D deficiency epidemic is accompanied by an increase in endemic skin cancer. There are still multiple controversies. This review aims to give practical recommendations regarding vitamin D among people at risk or with a personal history of skin cancer. METHODS Narrative review including human research articles published between 2011 and 2021, elaborated bearing in mind an epidemiological, patient-centered approach. RESULTS Ultraviolet (UV) exposure (neither artificial nor natural) is not the ideal source to synthesize vitamin D. There is conflicting epidemiological evidence regarding vitamin D, non-melanoma skin cancer (NMSC), and cutaneous melanoma (CMM), confounded by the effect of sun exposure and other factors. CONCLUSIONS Current evidence is controversial, and there are no widely applicable strategies. We propose three practical recommendations. Firstly, sun protection recommendations should be kept among people at risk or with a personal history of skin cancer. Secondly, vitamin D should preferably be sourced through diet. In patients with melanoma or at risk of cutaneous cancer, serum vitamin D checks are warranted to detect and avoid its insufficiency.
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Affiliation(s)
| | - Yolanda Gilaberte
- Dermatology Department, Hospital Universitario Miguel Servet, IIS Aragon, 50009 Zaragoza, Spain;
| | - Eduardo Nagore
- Dermatology Department, Universidad Catolica de Valencia, 46001 Valencia, Spain;
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Knowledge, attitude and practice of health care workers on measuring adult vitamin D level, diagnosis of deficiency, and management of consequent health conditions in three ecologies of Ethiopia: a cross-sectional study. BMC Nutr 2020; 6:77. [PMID: 33342438 PMCID: PMC7751119 DOI: 10.1186/s40795-020-00404-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/01/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Vitamin D is essential for health and its shortage exacerbates overall mortality. Health care workers (HCWs) need to educate on its uses and sources although studies indicate their low level of practice. The main aim of this study is therefore to assess the knowledge, attitude and practice of measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs in Ethiopia. METHODS This study was conducted in three ecologies covering lowland, midland and highland districts. A total of 405 health care workers with different levels were interviewed. Tablets were used for data collection to archiving in a cloud server. Data were exported to Stata version 14 software for cleaning and analysis. Rates were computed and the Chi-square test was used to compare differences between the two groups. Binary logistic regression was used to measure the strength, direction and significance of the association between different covariates and the practice of HCWs. RESULT The level of knowledge, positive attitude and good practice in measuring adult vitamin D status, diagnosis of deficiency and managing health consequences among HCWs was 210 (51.8%), 261(63.5%) and 195(47.4%) respectively. The odds of good practice in the provision of adult vitamin D service were AOR = 6.87: 95% CI (3.57, 13.21) and AOR = 2.20: 95% CI (1.23, 3.92) times higher among HCWs in Addis Ababa and highlands compared with those working in lowlands. Good practice among clinicians was AOR = 4.26: 95% CI (1.48, 12.25) times higher compared with those working in leadership positions. The likelihood was AOR = 1.96: 95% CI (1.19, 3.23) times higher among those with good knowledge compared with those with poor knowledge. Besides, good practice in adult vitamin D service provision was AOR = 2.30: 95% CI (1.40, 3.78) times higher among those with positive attitude compared with those who had negative attitude. CONCLUSIONS A little over half of HCWs have good knowledge and close to two-thirds of them have positive attitude while less than half of them have good practice on adult vitamin D deficiency. Besides, HCWs' residential ecology, clinical position, knowledge and attitude is associated with good practice on adult vitamin D. It is essential to provide rigorous and continuous training for HCWs focusing on their deployment ecology.
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Orekoya O, Rhodes LE, Osman JE, Webb AR, Farrar MD. A qualitative study of knowledge, behaviour and attitudes regarding vitamin D acquisition among patients with photosensitivity disorders. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:378-383. [PMID: 32274870 DOI: 10.1111/phpp.12561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/02/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cutaneous exposure to sunlight is a major source of vitamin D. Individuals with photosensitivity disorders have symptoms provoked by sunlight and may not achieve the brief sunlight exposures that convey vitamin D acquisition. OBJECTIVE To explore knowledge, behaviour and attitudes towards vitamin D and its acquisition in patients with photosensitivity. METHODS Patients (n = 19) diagnosed with solar urticaria, erythropoietic protoporphyria or polymorphic light eruption at a specialist photoinvestigation centre participated in semi-structured focus groups to discuss vitamin D knowledge, acquisition behaviours and attitudes towards vitamin D acquisition through sunlight and diet. Discussions were analysed by thematic analysis using MAXQDA11. RESULTS Knowledge of vitamin D was variable. There was good awareness that sunlight exposure is an important source but knowledge of dietary sources was poor. Patients had little concern for their own vitamin D status prior to attending the photoinvestigation centre. Most patients avoided sunlight exposure, were unable to achieve the guidance on sun exposure for healthy individuals and were aware this could affect their vitamin D status. Use of oral vitamin D supplements was common, and all were willing to consider supplements if required. Patients recommended improving education of clinicians to increase patient awareness of vitamin D, CONCLUSIONS: More targeted guidance is required on acquisition of vitamin D for patients with photosensitivity, supported by increased patient and clinician education.
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Affiliation(s)
- Oluwafikunayo Orekoya
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, Centre for Dermatology Research, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre and Salford Royal NHS Foundation Trust, Manchester, UK
| | - Lesley E Rhodes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, Centre for Dermatology Research, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre and Salford Royal NHS Foundation Trust, Manchester, UK
| | - Joanne E Osman
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, Centre for Dermatology Research, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre and Salford Royal NHS Foundation Trust, Manchester, UK
| | - Ann R Webb
- Faculty of Science and Engineering, School of Earth and Environmental Sciences, University of Manchester, Manchester, UK
| | - Mark D Farrar
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology Medicine and Health, Centre for Dermatology Research, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre and Salford Royal NHS Foundation Trust, Manchester, UK
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Kamiński M, Molenda M, Banaś A, Uruska A, Zozulińska-Ziółkiewicz D. Determinants of Vitamin D Supplementation among Individuals with Type 1 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030715. [PMID: 31979092 PMCID: PMC7036832 DOI: 10.3390/ijerph17030715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 11/23/2022]
Abstract
Half of the individuals with type 1 diabetes (T1DM) may present Vitamin D (VD) deficiency. There is little known about factors determining a decision on VD supplementation. The study aimed to determine the factors affecting vitamin D supplementation in people with T1DM. A cross-sectional survey study using the authors’ questionnaire paper and its digital version was performed. The questions involved data on the basic characteristics of the respondent, medical history, VD supplementation status, influence of the social environment, self-education, and the most important personal motivator for VD supplement use. Multivariate logistic regression analysis was performed. We collected a total of n = 184 papers and n = 550 digital complete surveys. From 734 total respondents, 62.0% declared VD supplementation. The main personal rationale for VD supplementation were recommendation of medical specialist 172 (37.8%) and self-education 135 (29.7%). The main reasons for non-supplementation of VD were lack of knowledge about VD 159 (57.0%) and lack of motivation 77 (27.6%). VD supplementation was independently associated with a family doctor (odds ratio (OR), 95% confidence interval (CI): 4.67, 2.32–9.40) or medical specialist recommendation (16.20, 9.57–27.43), and self-education (5.97, 3.90–9.13). Most Polish individuals with T1DM use VD supplements, and the decision is related to physicians’ recommendations and self-education.
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An investigation of the vitamin D Knowledge, Attitudes and Practice of UK practising doctors and nurses: the D-KAP study. Proc Nutr Soc 2020. [DOI: 10.1017/s0029665119001411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Gonzalez-Chica D, Stocks N. Changes to the frequency and appropriateness of vitamin D testing after the introduction of new Medicare criteria for rebates in Australian general practice: evidence from 1.5 million patients in the NPS MedicineInsight database. BMJ Open 2019; 9:e024797. [PMID: 30852539 PMCID: PMC6429877 DOI: 10.1136/bmjopen-2018-024797] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess changes in the frequency of vitamin D testing and detection of moderate/severe vitamin D deficiency (<30 nmol/L) among adults after the introduction of new Medicare Benefits Schedule (MBS) rebate criteria (November 2014), and their relationship to sociodemographic and clinical characteristics. DESIGN Dynamic (open) cohort study SETTING: Primary care PARTICIPANTS: About 1.5 million 'active' patients aged 18+ years visiting a general practitioner and included in the National Prescribing Service MedicineInsight database. OUTCOME MEASURES The frequency of vitamin D testing (per 1000 consultations) and moderate/severe vitamin D deficiency (%) recorded between October 2013 and March 2016, stratified by the release of the new MBS criteria for rebate. RESULTS More patients were female (57.7%) and 30.2% were aged 60+ years. Vitamin D testing decreased 47% (from 40.3 to 21.4 tests per 1000 consultations) after the new MBS criteria, while the proportion of tests with no indication for being performed increased from 71.3% to 76.5%. The proportion of patients identified as moderate/severe vitamin D deficient among those tested increased from 5.4% to 6.5%. Practices located in high socioeconomic areas continued to have the highest rates of testing, but moderate/severe vitamin D deficiency detection remained 90% more frequent in practices from low socioeconomic areas after the rebate change. Furthermore, the frequency of individuals being tested was reduced independent of the patients' sociodemographic or clinical condition, and the gap in the prevalence of vitamin D deficiency detection between those meeting or not meeting the criteria for being tested remained the same. Moderate/severe vitamin D deficiency detection decreased slightly among patients with hyperparathyroidism or chronic renal failure. CONCLUSIONS Although the new criteria for rebate almost halved the frequency of vitamin D testing, it also lessened the frequency of testing among those at higher risk of deficiency, with only a small improvement in vitamin D deficiency detection.
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Affiliation(s)
- David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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Rockwell M, Kraak V, Hulver M, Epling J. Clinical Management of Low Vitamin D: A Scoping Review of Physicians' Practices. Nutrients 2018; 10:nu10040493. [PMID: 29659534 PMCID: PMC5946278 DOI: 10.3390/nu10040493] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/07/2018] [Accepted: 04/12/2018] [Indexed: 12/13/2022] Open
Abstract
The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies do not recommend population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. To assess patterns of physicians’ management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and the gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Thirteen studies published between 2006 and 2015 across seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining a light on physicians’ practices in the face of uncertainty. Future research is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.
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Affiliation(s)
- Michelle Rockwell
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute & State University, Blacksburg, VA 24061, USA.
| | - Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute & State University, Blacksburg, VA 24061, USA.
| | - Matthew Hulver
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute & State University, Blacksburg, VA 24061, USA.
| | - John Epling
- Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA 24016, USA.
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Psychometric Properties of a Developed Questionnaire to Assess Knowledge, Attitude and Practice Regarding Vitamin D (D-KAP-38). Nutrients 2017; 9:nu9050471. [PMID: 28481302 PMCID: PMC5452201 DOI: 10.3390/nu9050471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/22/2017] [Accepted: 04/23/2017] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to develop a valid and reliable questionnaire to assess vitamin D-related knowledge, attitude and practices in Tehranian adults, who may be at increased risk of vitamin D deficiency. This study was conducted on 572 individuals, aged ≥20 years from public health care centers in Tehran, Iran. Based on results of a literature review and in-depth interviews, the 38-item vitamin D-related KAP questionnaire (D-KAP-38) with four subscales was developed: (1) general knowledge; (2) nutritional knowledge; (3) attitudes; (4) behaviors. Validity of the D-KAP-38 questionnaire was assessed, utilizing face, content, and construct validity methods. Internal consistency was calculated to assess reliability of the current developed questionnaire. A total of 572 (54.1% female) adults, aged 30.2 ± 7.9 years, participated in the study. All items were perceived as relevant and comprehendible by participants. Content validity was confirmed by a panel of experts. The internal consistency, as measured by Cronbach's alpha coefficients, exceeded the minimum reliability standard of 0.60 for four subscales. Exploratory factor analysis suggested a four-factor construct and the results of the confirmatory factor analysis indicated acceptable fit indices for the proposed model. No ceiling effects were observed except for general knowledge (1.2%). Floor effects detected were 0%, 1.1%, 2.4%, and 8.7% for practice, attitude, general knowledge, and nutrition knowledge, respectively. General knowledge had the highest score (79.59 ± 14.52) and nutrition knowledge had the lowest (42.58 ± 20.40), among the four sub-scales. Results confirm the initial validity and reliability of D-KAP-38 questionnaire. Further investigations in different populations are recommended.
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14
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What Do People Know and Believe about Vitamin D? Nutrients 2016; 8:nu8110718. [PMID: 27845705 PMCID: PMC5133104 DOI: 10.3390/nu8110718] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 10/26/2016] [Accepted: 11/08/2016] [Indexed: 12/18/2022] Open
Abstract
People have been exposed to a lot of information regarding vitamin D, with evidence suggesting that vitamin D may be involved in numerous health conditions, subsequently creating concerns about vitamin D insufficiency. As a result, what do people really know or believe about this topic? In this cross-sectional study, we assessed vitamin D-related knowledge and beliefs in 59,273 French adults (NutriNet-Santé cohort) using a specific questionnaire. Answers to this questionnaire were weighted according to the French sociodemographic distribution and compared across individual characteristics, using χ2-tests. Physicians and media were identified as key information providers. Participants did not always accurately cite vitamin D sources (e.g., 72% only for sun exposure, fatty fish: 61%) or established health effects (e.g., bone health: 62%–78%). Conversely, they mentioned incorrect sources and health effects for which there is no consensus yet (e.g., skin cancer). These findings were modulated by age/generational and socioeconomic factors. A strong inconsistency was also observed between participants’ true vitamin D status (plasma 25-hydroxyvitamin D concentration) and their opinion about it. This study, the first in Europe with such a large sample, stresses the need for simple and up-to-date supports of communication for the public and healthcare professionals regarding sources and health effects of vitamin D.
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Dix CF, Robinson A, Bauer JD, Wright ORL. Vitamin D: Australian dietitian's knowledge and practices. Nutr Diet 2016; 74:396-407. [PMID: 28901695 DOI: 10.1111/1747-0080.12291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/22/2016] [Accepted: 04/09/2016] [Indexed: 11/28/2022]
Abstract
AIM To survey dietitians on their knowledge and practices regarding vitamin D (VitD) intake, sources, supplementation and effect on disease state. METHODS An online survey was disseminated to members of the Dietitian Association Australia via the weekly online state newsletter during April 2015. Response rate was 3%, with 134 respondents completing the survey. The survey included questions about knowledge and current practices. Descriptive statistics were used to analyse the results. RESULTS Dietitians have good knowledge regarding dietary sources of VitD and roles in the body, but there is confusion around supplement doses for treatment and prevention of deficiency and sun exposure guidelines. CONCLUSIONS Dietitians are well positioned to provide patients with advice on VitD supplementation and sun exposure practices, but not all are confident to provide this care. There is a need for clear and well-disseminated guidelines for VitD management by dietitians.
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Affiliation(s)
- Clare F Dix
- Centre for Dietetics Research, School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Alex Robinson
- Centre for Dietetics Research, School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Judith D Bauer
- Centre for Dietetics Research, School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Olivia R L Wright
- Centre for Dietetics Research, School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
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Heffernan KJ, Chang S, Maclean ST, Callegari ET, Garland SM, Reavley NJ, Varigos GA, Wark JD. Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion. JMIR Mhealth Uhealth 2016; 4:e14. [PMID: 26860623 PMCID: PMC4764787 DOI: 10.2196/mhealth.4423] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 09/30/2015] [Accepted: 10/18/2015] [Indexed: 12/19/2022] Open
Abstract
Background The now ubiquitous catchphrase, “There’s an app for that,” rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of “do no harm.” There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. Objective This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. Methods For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. Results By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). Conclusions This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety.
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Affiliation(s)
- Kayla Joanne Heffernan
- Department of Computing and Information Systems, Melbourne School of Engineering, The University of Melbourne, Parkville, Australia
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Tapley A, Magin P, Morgan S, Henderson K, Scott J, Thomson A, Spike N, McArthur L, van Driel M, McElduff P, Bonevski B. Test ordering in an evidence free zone: Rates and associations of Australian general practice trainees' vitamin D test ordering. J Eval Clin Pract 2015; 21:1151-6. [PMID: 26011573 DOI: 10.1111/jep.12322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Indiscriminate health screening is increasingly seen as being problematic. In particular, vitamin D testing rates are increasing rapidly despite recommendations against population screening. The purpose of this study was to determine the level of vitamin D testing among family practice/general practitioner (GP) trainees and to establish associations of this testing. METHODS Cross-sectional analysis of data from the ReCEnT (Registrars Clinical Encounters in Training) cohort study. The setting was GP practices in four Australian states. Data from 60 consecutive consultations per trainee were recorded each 6-month training term (up to four terms). RESULTS Vitamin D tests were ordered in 726 (1.0%) of encounters (n = 69 412). Vitamin D test ordering was significantly associated with patients being older, female and non-English speaking. Trainees were more likely to test if they worked in a completely bulk-billing practice (i.e. a practice without any patient payment), if more problems were dealt with, more pathology tests were ordered in the consultation and if a lipid profile was ordered. They were less likely to test if they sought in-consultation advice or information. The most common reasons for testing were 'check-up' and 'health maintenance'. CONCLUSIONS In this first report of associations of vitamin D testing in the GP setting, we found that non-targeted vitamin D testing (testing inconsistent with current guidelines) is widespread in GP trainees' practice. Adoption of more rational testing approaches is needed.
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Affiliation(s)
- Amanda Tapley
- General Practice Training Valley to Coast, Mayfield, NSW, Australia
| | - Parker Magin
- General Practice Training Valley to Coast, Mayfield, NSW, Australia.,Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia
| | - Simon Morgan
- General Practice Training Valley to Coast, Mayfield, NSW, Australia
| | - Kim Henderson
- General Practice Training Valley to Coast, Mayfield, NSW, Australia
| | - John Scott
- General Practice Training Valley to Coast, Mayfield, NSW, Australia
| | - Allison Thomson
- Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia
| | - Neil Spike
- Victorian Metropolitan Alliance General Practice Training, Hawthorn, Vic., Australia.,Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - Lawrie McArthur
- Adelaide to Outback General Practice Training, North Adelaide, SA, Australia
| | - Mieke van Driel
- Discipline of General Practice, School of Medicine, University of Brisbane, Brisbane, QLD, Australia
| | - Patrick McElduff
- John Hunter Hospital Campus, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Billie Bonevski
- McAuley Centre, Calvary Mater, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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18
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An internet based approach to improve general practitioners' knowledge and practices: the development and pilot testing of the "ABC's of vitamin D" program. Int J Med Inform 2015; 84:413-22. [PMID: 25795505 DOI: 10.1016/j.ijmedinf.2015.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Online continuing medical education (CME) offers a number of advantages for physicians including flexibility with regards to location and timing of use. In order to effect physician practices and improve patient outcomes, it is important that the development of online CME is theory and evidence-based. OBJECTIVES This paper aims to describe the development of an online CME program for practising general practitioners (GPs) on vitamin D and sun health called "The ABC's of Vitamin D for GPs" using elements of design principles for physician-education web sites as a framework. The paper will also report the program's usability and acceptability pilot test results. METHODS The ABC's of Vitamin D program was developed following nine principles: needs assessment; evidence-based content development; multimodal program and modularisation; clinical cases; tailoring and interactivity; audit and feedback; credibility of the web site host; patient education materials; ease of use and navigation. Among the 20 GPs invited, acceptability and useability was tested with 12 GPs (60%) who agreed to participate and were interviewed following use of the program. The study was conducted between 2011 and 2013. RESULTS An online CME program consisting of eight modules was constructed. Of the 12 participating GPs, most (n=11) reported that the program was clear and easy to understand, logical, easy to navigate, and took a reasonable amount of time (estimated between 1 and 3h) to complete. Eleven of 12 participants said they would use the program as an accredited CME activity and all participants indicated that the program was 'very or somewhat' likely to lead to changes in the advice patients are given. CONCLUSION This study found that a theory and evidence based approach for the development of an online CME program for GPs was acceptable to users. Further research is needed to examine whether the online CME program is effective at changing GP practices and improving patient outcomes.
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Hartley M, Hoare S, Lithander FE, Neale RE, Hart PH, Gorman S, Gies P, Sherriff J, Swaminathan A, Beilin LJ, Mori TA, King L, Black LJ, Marshall K, Xiang F, Wyatt C, King K, Slevin T, Pandeya N, Lucas RM. Comparing the effects of sun exposure and vitamin D supplementation on vitamin D insufficiency, and immune and cardio-metabolic function: the Sun Exposure and Vitamin D Supplementation (SEDS) Study. BMC Public Health 2015; 15:115. [PMID: 25884724 PMCID: PMC4391331 DOI: 10.1186/s12889-015-1461-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 01/23/2015] [Indexed: 12/22/2022] Open
Abstract
Background Adults living in the sunny Australian climate are at high risk of skin cancer, but vitamin D deficiency (defined here as a serum 25-hydroxyvitamin D (25(OH)D) concentration of less than 50 nmol/L) is also common. Vitamin D deficiency may be a risk factor for a range of diseases. However, the optimal strategies to achieve and maintain vitamin D adequacy (sun exposure, vitamin D supplementation or both), and whether sun exposure itself has benefits over and above initiating synthesis of vitamin D, remain unclear. The Sun Exposure and Vitamin D Supplementation (SEDS) Study aims to compare the effectiveness of sun exposure and vitamin D supplementation for the management of vitamin D insufficiency, and to test whether these management strategies differentially affect markers of immune and cardio-metabolic function. Methods/Design The SEDS Study is a multi-centre, randomised controlled trial of two different daily doses of vitamin D supplementation, and placebo, in conjunction with guidance on two different patterns of sun exposure. Participants recruited from across Australia are aged 18–64 years and have a recent vitamin D test result showing a serum 25(OH)D level of 40–60 nmol/L. Discussion This paper discusses the rationale behind the study design, and considers the challenges but necessity of data collection within a non-institutionalised adult population, in order to address the study aims. We also discuss the challenges of participant recruitment and retention, ongoing engagement of referring medical practitioners and address issues of compliance and participant retention. Trial registration Australia New Zealand Clinical Trials Registry: ACTRN12613000290796 Registered 14 March 2013.
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Affiliation(s)
- Mica Hartley
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, 2600, Australia.
| | - Samuel Hoare
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, 2600, Australia. .,Department of Health and Human Services, Hobart, Tasmania, Australia.
| | - Fiona E Lithander
- University of Canberra, Canberra, Australian Capital Territory, Australia.
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | - Prue H Hart
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| | - Shelley Gorman
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| | - Peter Gies
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia.
| | - Jill Sherriff
- Curtin University, Perth, Western Australia, Australia.
| | - Ashwin Swaminathan
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
| | - Lawrence J Beilin
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia.
| | - Trevor A Mori
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia.
| | - Laura King
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, 2600, Australia.
| | - Lucinda J Black
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| | - Kushani Marshall
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, 2600, Australia.
| | - Fan Xiang
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, 2600, Australia.
| | - Candy Wyatt
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, 2600, Australia. .,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| | - Kerryn King
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia.
| | - Terry Slevin
- Cancer Council of Western Australia, Perth, Western Australia, Australia.
| | | | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, 2600, Australia. .,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
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20
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Wei M, Yu R, Deutsch SC. Insignificant medium-term vitamin D status change after 25-hydroxyvitamin D testing in a large managed care population. PLoS One 2014; 9:e105571. [PMID: 25136806 PMCID: PMC4138213 DOI: 10.1371/journal.pone.0105571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/24/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives To examine the clinical utility of 25-hydroxyvitamin D (25(OH)D) testing in achieving medium-term vitamin D (VD) sufficiency in a managed care population. Methods Retrospective study of a continuously-enrolled patient population in a 3-year period between 2011 and 2013. Primary outcome was VD status at ∼1 year after 25(OH)D testing. Patient demographics, comorbidities, medications, and 25(OH)D test results were gathered from relevant databases and multivariate logistic regression analysis used to study the risk factors of persistent VD deficiency or insufficiency. Results Of 22,784 patients, 7533 (females 69.3%) did 14,563 25(OH)D tests, with an estimated cost of $582,520. Of the 7533 patients, 1126 had another 25(OH)D test at 300–400 days after the first one. Based on the two test results, 234 patients (20.8%) maintained sufficient 25(OH)D levels; 132 (11.7%) turned from VD-sufficient into VD-insufficient or -deficient; 538 (47.8%) remained VD-insufficient or -deficient, and only 222 (19.7%) improved to be VD-sufficient. Overall, only 8.0% more patients were VD-sufficient at ∼1 year after 25(OH)D testing. Only younger age and higher BMI were independent risk factors for persistent low 25(OH)D levels and high-dose VD use was not associated with achieving VD sufficiency. Conclusions 25(OH)D testing only benefits a small portion of patients thus lacks clinical utility in achieving VD sufficiency in the medium term but incurs a significant cost. A practical strategy to treat VD deficiency or insufficiency is needed; without it, 25(OH)D testing adds little value to most patients’ health and should be used with discretion.
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Affiliation(s)
- Meng Wei
- Cedars-Sinai Medical Care Foundation, Beverly Hills, California, United States of America
| | - Run Yu
- Division of Endocrinology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- * E-mail:
| | - Stephen C. Deutsch
- Cedars-Sinai Medical Care Foundation, Beverly Hills, California, United States of America
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Scully M, Makin J, Maloney S, Wakefield M. Changes in coverage of sun protection in the news: threats and opportunities from emerging issues. HEALTH EDUCATION RESEARCH 2014; 29:378-387. [PMID: 24650946 DOI: 10.1093/her/cyu013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study aimed to determine whether there have been shifts in news coverage of sun protection issues over a 12-year period in the context of an evolving skin cancer prevention agenda. A content analysis was performed on all relevant articles (N = 552) published in the two metropolitan daily newspapers in Melbourne, Australia, from 2001 to 2012. Coding variables included theme, article type, prominence, spokesperson and topic slant. Articles were collapsed into three 4-year blocks and a series of chi-square analyses conducted to examine changes over time in coverage of topical issues (i.e. vitamin D and sunbeds) and established sun protection themes [i.e. health effects of ultraviolet (UV) exposure, education/prevention, attitudes/behaviour]. Coverage of vitamin D and sunbed issues increased over time and became more positive for sun protection objectives. The proportion of articles reporting on established sun protection themes remained steady over time (range: 36-38%) and there were no changes observed in the way these topics were presented in the news media. These results highlight that potentially competing sun protection issues that emerge over time need not pose a threat to existing skin cancer prevention programmes but instead can provide opportunities to further spread programme messages while increasing credibility.
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Affiliation(s)
- Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jennifer Makin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Sarah Maloney
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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The ABC of vitamin D: a qualitative study of the knowledge and attitudes regarding vitamin D deficiency amongst selected population groups. Nutrients 2013; 5:915-27. [PMID: 23503169 PMCID: PMC3705326 DOI: 10.3390/nu5030915] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/25/2013] [Accepted: 03/08/2013] [Indexed: 11/17/2022] Open
Abstract
Objective: In Australia, vitamin D supply in food is limited, and sun exposure is the main source of vitamin D. However skin cancer risk is high, and the need to gain some sun exposure for adequate vitamin D is challenging public health messages to use protection in the sun. The complex vitamin D public health message may be confusing the public and, in particular, those at highest risk for vitamin D deficiency. This study explored vitamin D and sun exposure attitudes, knowledge and practices of some groups considered at risk of vitamin D deficiency and those delivering healthy sun exposure messages to children. Method: 52 adults participated in six focus groups. Results: Results corroborated with previous research showing low levels of vitamin D knowledge. Individual and environmental barriers to receiving adequate sun exposure were also identified. Conclusions and Implications: The message advocating balanced sun exposure to produce adequate vitamin D needs to be made clearer and be more effectively communicated. Findings provide insights to aid development of appropriate public health messages for safe sun exposure and vitamin D, especially for vulnerable groups.
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REINHOLD UWE, DIRSCHKA THOMAS, HARTGENS KLAUS, KIRCHESCH HERBERT, OSTENDORF ROLF, PETERING HOLGER, PRIEUR HANSPETER, KRÄHN-SENFTLEBEN GERTRAUD, MALAISSE WILLYJ. Vitamin D supply: from sun or pill? - Attitudes and recommendation on vitamin D and impact on sun protection practices among German general practitioners evaluated by the network of dermato-oncologists, Onkoderm e.V. Oncol Lett 2012; 4:1392-1396. [PMID: 23226810 PMCID: PMC3506811 DOI: 10.3892/ol.2012.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/03/2012] [Indexed: 11/06/2022] Open
Abstract
Recommendations concerning the intake of vitamin D and/or sunlight exposure in the handling of patients with vitamin D deficiency remain a matter of debate. The present study of the German network of dermato-oncologists (Onkoderm e.V.) refers to an inquiry conducted among general practitioners on this and related issues. Based on 448 answers provided to 10 distinct questions, the consulted physicians recommended vitamin D intake (94% replies) and/or exposure to sunlight (63% replies) in their patients with vitamin D deficiency. An average of approximately 26 min daily unprotected exposure to sunlight at midday in spring and summer was recommended. Nevertheless, 91% of the physicians considered the use of creams protecting against sunlight to be judicious. However, only 54% of physicians considered it worthwhile practice to protect oneself intensively against UV radiation. This study indicates evidence of a reduction in sun protection practices. Yet, approximately 25% of the patients were considered to present vitamin D deficiency and, hence, recommendations to prevent or correct the latter situation should not be ignored. Nevertheless, we consider that there is a need to focus messages regarding sun exposure and for continued sun protection practices. These messages should specifically focus on the vitamin D issue to ensure that the incidence of skin cancer does not increase.
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Affiliation(s)
- UWE REINHOLD
- Department of Dermatology and Dermatological Oncology, Medical Center Bonn Friedensplatz, Bonn
| | | | | | | | | | | | | | | | - WILLY J. MALAISSE
- Laboratory of Experimental Hormonology, Brussels Free University, Brussels,
Belgium
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Tran B, Armstrong BK, Carlin JB, Ebeling PR, English DR, Kimlin MG, Rahman B, van der Pols JC, Venn A, Gebski V, Whiteman DC, Webb PM, Neale RE. Recruitment and results of a pilot trial of vitamin D supplementation in the general population of Australia. J Clin Endocrinol Metab 2012; 97:4473-80. [PMID: 23066119 DOI: 10.1210/jc.2012-2682] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT The benefits of high serum levels of 25-hydroxyvitamin D [25(OH)D] are unclear. Trials are needed to establish an appropriate evidence base. OBJECTIVE We plan to conduct a large-scale trial of vitamin D supplementation for the reduction of cancer incidence and overall mortality and report here the methods and results of a pilot trial established to inform its design. DESIGN Pilot D-Health was a randomized trial carried out in a general community setting with 12 months intervention and follow-up. PARTICIPANTS Participants were 60- to 84-yr-old residents of one of the four eastern Australian states who did not have any vitamin D-related disorders and who were not taking more than 400 IU supplementary vitamin D per day. A total of 644 participants were randomized, and 615 completed the study (two persons withdrew because of nonserious adverse events). INTERVENTIONS The interventions were monthly doses of placebo or 30,000 or 60,000 IU vitamin D(3). MAIN OUTCOMES The main outcomes were the recruitment rate and changes in serum 25(OH)D. RESULTS Ten percent of those approached were recruited. At baseline, the mean 25(OH)D was 42 nmol/liter in all three study arms. The mean change in 25(OH)D in the placebo group was 0.12 nmol/liter, compared with changes of 22 and 36 nmol/liter in the 30,000- and 60,000-IU groups, respectively. CONCLUSIONS The D-Health pilot has shown that a large trial is feasible in Australia and that a dose of 2000 IU/d will be needed to ensure that a large proportion of the population reaches the target serum 25(OH)D level.
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Affiliation(s)
- Bich Tran
- Population Health Division, Queensland Institute of Medical Research, Brisbane, Queensland 4006, Australia
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Reeder AI, Jopson JA, Gray AR. "Prescribing sunshine": a national, cross-sectional survey of 1,089 New Zealand general practitioners regarding their sun exposure and vitamin D perceptions, and advice provided to patients. BMC FAMILY PRACTICE 2012; 13:85. [PMID: 22901028 PMCID: PMC3460728 DOI: 10.1186/1471-2296-13-85] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022]
Abstract
Background The health effects of ultraviolet radiation vary according to wavelength, timing and pattern of exposure, personal characteristics and practices. Negative effects include skin cancers, eye diseases and immune suppression; positive effects primarily relate to endogenous vitamin D production which protects against bone disease. Drafting comprehensive guidelines regarding appropriate sun protective behaviours and vitamin D sufficiency is challenging. Advice given by general practitioners is potentially influential because they are widely respected. Methods A survey instrument was developed, pre-tested and provided to practising GP’s, either by on-line link or mailed, reply paid hard-copy. Odds ratios, differences in means, or ratios of geometric means from regression models are reported for potential predictor variables with 95% confidence intervals. Results Data (demographic, training, practicing, information accessing, confidence in vitamin D knowledge) suitable for analysis were obtained from 1,089 GPs (32% participation). Many (43%) were ‘not at all confident’ about their vitamin D knowledge. Recent information led 29% to recommend less sun protection during winter months and 10% less all year. Confidence was positively associated with non-‘Western’ medical training, information sources read and practising in a metropolitan centre with a medical school. Reading the Melanoma Clinical Practice Guidelines was associated with lower estimates of the amount of summer sun exposure required to obtain adequate vitamin D. Increasing years in practice was negatively associated with provision of recommended advice about summer and winter sun protection. Greater concern about vitamin D than skin cancer was expressed by females and those in practice longer. Conclusions Concern about the potentially negative impact of skin cancer prevention on vitamin D status may undermine appropriate sun protective recommendations. Reading some educational resources was associated with confidence about vitamin D knowledge and a perception that significantly less summer sun exposure was required for those with high sun sensitivity to achieve adequate vitamin D, suggesting a potentially positive impact of such resources. Education could be targeted towards groups least likely to promote existing recommendations. Authoritative guidelines about vitamin D and sun protection would be a valued resource among GPs. Study findings are potentially valuable to help guide public policy and target interventions.
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Affiliation(s)
- Anthony Ivor Reeder
- Cancer Society Social & Behavioural Research Unit, Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin 9058, New Zealand.
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Jayaratne N, Russell A, van der Pols JC. Sun protection and vitamin D status in an Australian subtropical community. Prev Med 2012; 55:146-50. [PMID: 22634425 DOI: 10.1016/j.ypmed.2012.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/14/2012] [Accepted: 05/16/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Claims have been made that sun protection may negatively affect vitamin D status, but very few data are available about whether this applies to people in uncontrolled settings. METHOD In 1996 we measured 25(OH)-vitamin D concentrations in 1113 adults in Nambour, a subtropical community, who reported their concurrent sun protection behaviours in a skin cancer prevention trial. Estimates were adjusted for time outdoors, vitamin D intake and other factors known to affect vitamin D status. RESULTS Persons who tended to stay in the shade had lower vitamin D levels than those who never stayed in the shade (62.5 vs. 68.8 nmol/L respectively, p=0.01), and this association remained in persons who spent less than 50% (p=0.02) but not in those who spent more than 50% of their time outdoors. Wearing a hat, long sleeves, sunglasses and use of sunscreen or umbrella were not associated with vitamin D status after adjustments, including after stratification by time outdoors. CONCLUSION Sun protection behaviour to reduce the risk of skin cancer can be maintained without affecting vitamin D serum status, although consistently seeking shade when spending less than 50% of daytime outdoors is associated with lower vitamin D levels.
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Affiliation(s)
- Naomi Jayaratne
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Brisbane, Australia
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Abstract
The incidence of vitamin D deficiency is rising worldwide, yet in the vast majority of patients, the condition remains undiagnosed and untreated. Current evidence overwhelmingly indicates that supplemental doses greater than 800 IU/day have beneficial effects on the musculoskeletal system, improving skeletal homeostasis, thus leading to fewer falls and fractures. Evidence is also accumulating on the beneficial effects of vitamin D on extraskeletal systems, such as improving immune health, autoimmune disorders, cancer, neuromodulation, diabetes, and metabolic syndrome. The cause-effect relationship of vitamin D deficiency with increasing incidences of nonskeletal disorders is being investigated. Published reports support the definition of sufficiency, serum levels of 25-hydroxyvitamin D [25(OH)D] greater than 30 ng/mL (75 nmol/L). To achieve this, most people need vitamin D supplementation ranging from 600 to 2000 IU/day; consumption up to of 5000 international units (IU) per day of vitamin D is reported as safe. Although light-skinned individuals need 1000 IU/day of vitamin D, elderly and dark-skinned individuals are likely to need approximately 2000 IU/day to maintain serum 25(OH)D levels greater than 30 ng/mL. Other vulnerable patients, such as the obese, those who have undergone bariatric surgery, and those with gastrointestinal malabsorption syndromes, may require higher doses of vitamin D to maintain normal serum levels and be healthy.
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Affiliation(s)
- Sunil J Wimalawansa
- Physiology & Integrative Biology, Endocrinology, Metabolism & Nutrition, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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