This study aimed to assess the attitudes, practices and knowledge of general practitioners (GPs) with regards to vitamin D. A cross-sectional survey of a random sample of GPs stratified by location of practice (rural/remote or metropolitan) and employment status (full-time or part-time) in New South Wales (NSW), Australia was conducted. Of 500 respondents, 58.1% (95% CI 53.8-62.4) reported that up to 39% of their tested patients showed vitamin D deficiency or insufficiency and a further 37.7% (95% CI 33.5-41.9) of respondents said that over 40% of their patients were vitamin D insufficient. Vitamin D supplementation and advice to receive more natural sunlight were the most common ways vitamin D insufficiency was managed (97.1%; 95% CI 95.6-98.6 and 82%, 95% CI 78.6-85.4, respectively). Some gaps in knowledge were identified. Most respondents (64%; 95% CI 59.8-68.2) believed that a person of average sun sensitivity required 10 min of direct sun exposure during summer in peak UV time and a further 21.6% (95% CI 18.0-25.2) believed that people required 30 min of direct sun. A third of respondents (33.1%; 95% CI 29.0-37.2) advised their patients to use sun protection at all times during winter. In general, the attitude items showed that respondents expressed greater concern about vitamin D deficiency than skin cancer. The results reveal some confusion in general practice regarding vitamin D, sun exposure, sun protection and skin cancer risk. Some of the advice that GPs are offering may needlessly increase their patients' risk for vitamin D insufficiency or skin cancer.The scientific literature about vitamin D contains conflicting evidence. Although some estimates suggest that vitamin D deficiency has reached 'pandemic' proportions, 1 others caution that limitations in testing and definitions of deficiency may be inflating prevalence rates.2-4 Similarly, while evidence regarding the important role of vitamin D in bone and skeletal health is strong, 3 an Institute of Medicine (IOM) review has found that evidence regarding its role in preventing cancer, improving immune function, and preventing or treating other chronic conditions including diabetes and cardiovascular disease is mixed and mostly limited to observational data.2-4 Due to some degree to this uncertainty, vitamin D continues to be an important area for investigation. Sometimes referred to as the 'sunshine vitamin,'5 the main source of vitamin D is exposure to sunlight or more specifically ultraviolet-B (UV-B) radiation. 6 Although there is debate regarding optimal vitamin D levels, 4,7,8 a serum 25-hydroxy vitamin D3 [25(OH)D] level of 50 nmol/l and above is generally recognised as sufficient. 9,10Although there is greater insufficiency of vitamin D at high latitudes, [11][12][13] it is also found in fair-skinned people living at low latitudes like Australia, where ambient UV irradiance is high and the rates of skin cancer are amongst the highest in the world.14,15 This co-occurrence of vitamin D insufficiency and skin cancer has led to the development of ...

Older Australians living in rural areas have long faced significant challenges in maintaining health. Their circumstances are shaped by the occupations, lifestyles, environments and remoteness which characterise the diversity of rural communities. Many rural regions face threats to future sustainability and greater proportions of the aged reside in these areas. The emerging changes in Australia's climate over the past decade may be considered indicative of future trends, and herald amplification of these familiar challenges for rural communities. Such climate changes are likely to exacerbate existing health risks and compromise community infrastructure in some instances. This paper discusses climate change-related health risks facing older people in rural areas, with an emphasis on the impact of heat, drought and drying on rural and remote regions. Adaptive health sector responses are identified to promote mitigation of this substantial emerging need as individuals and their communities experience the projected impact of climate change.

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Global Environmental Changes are dynamic and complex, crossing disciplines, sectors, regions, and populations and shaping the health of current and future generations. GECs present an unprecedented challenge demanding a response of equal scale and complexity involving unfettered collaboration beyond disciplines with implications for global health. At this critical point, health professions' education should have moved on from building consensus about the relevance of education for sustainable healthcare (ESH) to active implementation. In this commentary, we discuss why transdisciplinary problem-solving and interprofessional education should be considered in education for sustainable healthcare. We review types of collaborative educational practices, outline opportunities, challenges, and resources to enable implementation.