’’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

Anthony I Reeder, Janet A Jopson and Andrew R Grey
BMC Family Practice 2012, 13:85 doi:10.1186/1471-2296-13-85; Published: 17 August 2012

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.

Provisional PDF is attached at the bottom of this page

PDF of File4 details is also attached
- - - - - - - - - - - - - - - - - - -

See also VitaminDWiki

• Excessive vitamin D testing in Australia – July 2012
• 10X increase in vitamin D tests in Australia – time for the doctors to learn about vitamin D – April 2011
• All items in category Australia and NZ 68 items
• 73 % of Australians had too little vitamin D a decade ago – Dec 2011
• Australia and NZ conservative position vitamin D position statement – June 2012
• Should NZ and Australia increase vitamin D fortification - June 2012
• Majority of those living in the ozone hole lack vitamin D Blog post March 15 2012
• New Zealand consensus: at risk should take more Vitamin D – March 2012
• Black Sudanese children 350X more likely to have rickets than white Australians – April 2012

See also web

• People in NZ need a prescription to get more than 1,000 IU of vitamin D Sept 2012