The high prevalence of vitamin D insufficiency across Australian populations is only partly explained by season and latitude.Most (90-100%) vitamin D vitamin D Any of a group of fat-soluble alcohols important in calcium metabolism in animals to form strong bones and teeth and prevent rickets and osteoporosis. It is formed by ultraviolet radiation (sunlight) of sterols (see steroid) present in the skin. is produced endogenously en·dog·e·nous adj. 1. Produced or growing from within. 2. Originating or produced within an organism, tissue, or cell: endogenous secretions. following solar ultraviolet An invisible band of radiation at the upper end of the visible light spectrum. With wavelengths from 10 to 400 nm, ultraviolet starts at the end of visible light and ends at the beginning of X-rays. The primary source of ultraviolet light is the sun. radiation (UVR UVR Ultraviolet Radiation UVR Unidad de Valor Real (Spanish) UVR Under-Voltage Relay UVR Ultraviolet Radiometer ) of precursors within sun-exposed skin (Holick 1994). Only a few foods, such as oily fish Oily fish, oil-rich fish or pelagic fish are those fish which have oils throughout the fillet and in the belly cavity around the gut, rather than only in the liver like white fish. , contain significant amounts of vitamin D naturally (Holick 1994). Serum 25-hydroxyvitamin D [25(OH)D] is widely recognized as the best measure of vitamin D status (Holick 2004a), and reflects UVR exposure and vitamin D intake of the previous few months (Vieth 1999). In the absence of dietary fortification fortification, system of defense structures for protection from enemy attacks. Fortification developed along two general lines: permanent sites built in peacetime, and emplacements and obstacles hastily constructed in the field in time of war. , vitamin D intake in Australia is low, varying from 1.2 to 2.6 [micro]g/day (Nowson and Margerison 2002). This is much lower than the recommended dietary intake (5 [micro]g/day for those 0-50 years of age, 10 [micro]g/day for those 51-70 years, 15 [micro]g/day for those> 70 years) (Commonwealth of Australia Commonwealth of Australia: see Australia. 2006) or the estimated intake of 10-15 [micro]g/day required to obtain serum 25(OH)D levels of 50 nmol/L (Dawson-Hughes et al. 2005). Vitamin D status is often defined by serum levels of 25(OH)D as follows: vitamin D deficiency Vitamin D Deficiency Definition Vitamin D deficiency exists when the concentration of 25-hydroxy-vitamin D (25-OH-D) in the blood serum occurs at 12 ng/ml (nanograms/milliliter), or less. , 25(OH)D < 25 nmol/L; vitamin D insufficiency INSUFFICIENCY. What is not competent; not enough. , 25(OH)D of 25-50 nmol/L; and optimal status, 25(OH)D> 50 nmol/L (Nowson and Margerison 2002; Vieth et al. 2001). Recent evidence suggests that the optimal serum 25(OH)D levels may be even higher,> 80 nmol/L (Dawson-Hughes et al. 2005; Hollis 2005). A balance is required in the amount of personal UVR exposure. Excessive sun exposure has been associated with increased risk of cutaneous cutaneous /cu·ta·ne·ous/ (ku-ta´ne-us) pertaining to the skin. cu·ta·ne·ous adj. Of, relating to, or affecting the skin. Cutaneous Pertaining to the skin. malignant melanoma Malignant Melanoma Definition Malignant melanoma is a type of cancer arising from the melanocyte cells of the skin. Melanocytes are cells in the skin that produce a pigment called melanin. , nonmelanoma skin cancers nonmelanoma skin cancer 1 Basal cell carcinoma, see there 2 Squamous cell cancer, see there 3. Skin adnexal carcinoma 4. Cutaneous lymphoma , and some cataracts Cataracts Definition A cataract is a cloudiness or opacity in the normally transparent crystalline lens of the eye. This cloudiness can cause a decrease in vision and may lead to eventual blindness. (Lucas et al. 2006); however, low UVR exposure can result in vitamin D deficiency or insufficiency. It has been well established that vitamin D is essential to bone health, with low levels associated with rickets rickets or rachitis (rəkī`tĭs), bone disease caused by a deficiency of vitamin D or calcium. Essential in regulating calcium and phosphorus absorption by the body, vitamin D can be formed in the skin by ultraviolet , osteoporosis osteoporosis (ŏs'tēō'pərō`sĭs), disorder in which the normal replenishment of old bone tissue is severely disrupted, resulting in weakened bones and increased risk of fracture; osteopenia , and osteomalacia osteomalacia /os·teo·ma·la·cia/ (os?te-o-mah-la´shah) inadequate or delayed mineralization of osteoid in mature cortical and spongy bone; it is the adult equivalent of rickets and accompanies that disorder in children. (Holick 2004b). Vitamin D insufficiency causes muscle weakness and may contribute to falls in the elderly, which--when associated with osteoporosis--increases the likelihood of fractures. However, more recent evidence indicates that vitamin D insufficiency might also be associated with diseases such as colorectal cancer colorectal cancer Malignant tumour of the large intestine (colon) or rectum. Risk factors include age (after age 50), family history of colorectal cancer, chronic inflammatory bowel diseases, benign polyps, physical inactivity, and a diet high in fat. , prostate cancer prostate cancer, cancer originating in the prostate gland. Prostate cancer is the leading malignancy in men in the United States and is second only to lung cancer as a cause of cancer death in men. , multiple sclerosis (MS), type 1 diabetes type 1 diabetes n. See diabetes mellitus. , cardiovascular diseases Cardiovascular disease Disease that affects the heart and blood vessels. Mentioned in: Lipoproteins Test cardiovascular disease , and tuberculosis (Hughes et al. 2004; Hypponen et al. 2001; Luscombe et al. 2001; van der Mei et al. 2003; Zittermann 2003). The "sun smart" public health messages, aimed at reducing skin cancer, have been successful, partly because of their simplicity. However, there is increasing awareness that any simple public health message of sun avoidance may cause harm by increasing vitamin D insufficiency (Grant et al. 2005; Sinclair 2006). A more balanced approach is now being taken, and new public health messages are being developed that provide a more tailored approach concerning factors such as latitude, time of year, skin type, and age (Holick 2004b; Samanek et al. 2006; Working Group of the Australian and New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. Bone and Mineral Society, Endocrine endocrine /en·do·crine/ (en´do-krin, en´do-krin) 1. secreting internally. 2. pertaining to internal secretions; hormonal. See also under system. en·do·crine adj. Society of Australia, and Osteoporosis Australia 2005). Tools, such as the UV Index [based on a weighting of UV irradiances that produce erythema erythema (ĕr'əthē`mə), more or less diffuse redness of the skin due to concentration of an abnormally large amount of blood within the small vessels of the skin (hyperemia), as in burns. (i.e., sunburn sunburn, inflammation of the skin caused by actinic rays from the sun or artificial sources. Moderate exposure to ultraviolet radiation is followed by a red blush, but severe exposure may result in blisters, pain, and constitutional symptoms. )] are being used to identify the appropriate times of the year or day that sun protection is most important (Sinclair 2006). The World Health Organization (WHO 2007) and the Cancer Council Australia (2007) currently recommend that protective measures should be taken (e.g., use of a hat, sunscreen sunscreen /sun·screen/ (-skren) a substance applied to the skin to protect it from the effects of the sun's rays. sun·screen n. , or sunglasses sunglasses A tinted pair of glasses used to ↓ light arriving at the eye, which are labeled according to the amount of UV light blocked; nonprescription glasses are classified according to use and amount of UV radiation blocked Sunglasses ; seek shady areas) when the UV index is [greater than or equal to] 3. In addition, recommended solar UVR exposure periods to maintain vitamin D sufficiency have been calculated at different locations based on ambient UVR (assuming sufficiency is maintained by one-third of a minimal erythemal dose of sunlight for an individual with moderately fair skin who exposes 15% of the body (e.g., face, arms, hands) (Samanek et al. 2006). This information is important, but a stronger evidence base is required on the actual serum 25(OH)D status in different regions and by season, reflecting interindividual differences in sun exposure behaviors and other factors, rather than the predicted serum 25(OH)D status from ambient UVR alone. We pooled population-based samples of individuals < 60 years of age with serum measurements of 25(OH)D across a broad latitudinal range in Australia [southeast Queensland, 27[degrees]S; the Geelong region (specifically the Barwon Statistical Division), 38[degrees]S; and Tasmania, 43[degrees]S] (McGrath et al. 2001b; Pasco et al. 2001; van der Mei et al. 2007). We also included new data on a large population-based sample from Tasmania [the Tasmanian Older Adult Cohort (TasOAC) study]. In the present study, we aimed to a) examine the prevalence of vitamin D deficiency and insufficiency by season at each of the three locations; b) examine differences in the seasonal variation between the three locations in terms of the timing of the peak and the trough Trough The stage of the economy's business cycle that marks the end of a period of declining business activity and the transition to expansion. , the magnitude of the amplitude amplitude (ăm`plĭt  d'), in physics, maximum displacement from a zero value or rest position. of the seasonal variation and the
estimated mean, peak, and trough 25(OH)D values; and c) examine to what
extent actual serum 25(OH)D levels are predicted by season, latitude,
and the maximum daily duration of vitamin D synthesis in human skin, and
vitamin D effective daily dose.
Methods Participants. In this study we used data from three published studies (McGrath et al. 2001b; Pasco et al. 2001; van der Mei et al. 2007) and the TasOAC study, covering three regions and including subjects in varying age ranges. All of these studies included participants < 60 years of age and provided a good sample of young and middle-aged adults. Southeast Queensland. A case-control study case-control study, n an investigation employing an epidemiologic approach in which previously existing incidents of a medical condition are used in lieu of gathering new information from a randomized population. on psychosis psychosis (sīkō`sĭs), in psychiatry, a broad category of mental disorder encompassing the most serious emotional disturbances, often rendering the individual incapable of staying in contact with reality. was conducted in southeast Queensland from 1997 to 1999 and included 310 cases and 303 controls (McGrath et al. 2001a, 2002). All subjects provided written informed consent, and the study was approved by the Wolston Park Hospital Institutional Ethics Committee ethics committee A multidisciplinary hospital body composed of a broad spectrum of personnel–eg, physicians, nurses, social workers, priests, and others, which addresses the moral and ethical issues within the hospital. See DNR, Institutional review board. . For the present study, we selected only those subjects < 60 years of age (167 women and 211 men) for whom serum 25(OH)D levels were available. Geelong region. In the Geelong region (in southern Victoria), an age-stratified, random, population-based sample of women (n = 1,494) was recruited from Commonwealth Electoral Rolls electoral roll n → censo electoral electoral roll n (Brit) → liste électorale electoral roll n (BRIT (1993-1997), with a response rate of 77.1% (Henry et al. 2000; Pasco et al. 2000). Of the subjects of the original study, 99% were white, and none were shrouded shroud n. 1. A cloth used to wrap a body for burial; a winding sheet. 2. Something that conceals, protects, or screens: under a shroud of fog. 3. a. for religious reasons. Written informed consent was obtained from all participants, and the project was approved by the Barwon Health Human Research and Ethics Committee. For the present study, we used data only from the women < 60 years of age if they were free from exposure to drugs and diseases known to influence calcium metabolism calcium metabolism The constellation of ionic checks & balances that maintain Ca2+ homeostasis in the blood and tissues. See Calcium. (n = 561). Tasmania. In Tasmania, control participants from the Tasmanian MS case-control study (1999-2001) (van der Mei et al. 2003) and participants from the TasOAC study (2002-2004) were included. The controls from the Tasmanian MS case-control study (van der Mei et al. 2003) (n = 272; response rate 76%) were randomly drawn from the Tasmanian Electoral Roll and matched on sex and birth year to prevalent MS cases < 60 years of age. Data from 174 women and 88 men with serum 25(OH)D were available. The TasOAC study included participants 50-80 years of age randomly selected from the Tasmanian Electoral Roll (response rate 54%); all participants < 60 years of age (258 women and 211 men) were included. Written informed consent was obtained from all participants, and the projects were approved by the Human Research Ethics Research ethics involves the application of fundamental ethical principles to a variety of topics involving scientific research. These include the design and implementation of research involving human participants (human experimentation); animal experimentation; various aspects of Committee of the Royal Hobart Hospital The Royal Hobart Hospital (RHH or 'The Royal' as its often known) is the largest hospital in Tasmania, Australia. It is a public hospital managed by the Tasmanian Government. 'The Royal' is located in central Hobart. . Measurements and simulations. For the present study, the following data were available at an individual level for all of the studies: serum 25(OH)D, date of serum sample collection, date of birth, and sex. In all studies, serum 25(OH)D was measured using a radioimmunoassay kit (DiaSorin, Stillwater, MN, USA) (McGrath et al. 2001b; Pasco et al. 2001; van der Mei et al. 2007). The intraassay and interassay precisions of these assays are 6% and 15%, respectively. Of the four studies, only participants in the TasOAC study in Tasmania provided information on the amount of time spent in the sun during weekends and holidays in the past winter and summer (< 1 hr/day, 1-2 hr/day, 2-3 hr/day, 3-4 hr/day, or > 4 hr/day). For each of the three locations, we used the VitD methodology of Engelsen et al. (2005) to estimate maximum daily duration of vitamin D synthesis in human skin, vitamin D effective daily dose, and the UV index for each day in the years that the four studies were conducted. Maximum daily duration of vitamin D synthesis in human skin is the time per day in hours in which UVR exceeds the threshold required to produce vitamin D (Brustad et al. 2004; Webb et al. 1988). Vitamin D effective daily dose is the daily dose of UVR wavelengths relevant to the conversion of 7-dehydrocholesterol into previtamin D in the skin, based on the vitamin D action spectrum (MacLaughlin et al. 1982). This is important because the action spectrum to produce previtamin D is different from the action spectrum that produces erythema (sunburn). First, using the method of MacLaughlin et al. (1982), we established a biologically effective UV dose rate for photoconversion of 7-dehydrocholesterol to previtamin D in skin by integrating the measured UV surface irradiances weighted by the relative efficiencies for converting 7-dehydrocholesterol to previtamin D. Then, the biologically effective dose was integrated over a full day to estimate the vitamin D effective daily dose. The UV index (WHO 2002) gives an indication of the UV intensity at solar noon using the action spectrum to produce erythema. The daily values were calculated without rounding to nearest integer integer: see number; number theory , but the monthly mean values were rounded to the nearest integer. To estimate UV irradiances, taking ozone levels into account, we used the VitD methodology of Engelsen et al. (2005). Satellite ozone data from the Total Ozone Mapping Spectrometer The Total Ozone Mapping Spectrometer (TOMS) is a satellite instrument for measuring ozone values. Of the five TOMS instruments which were built, four entered successful orbit. (TOMS) were used for Brisbane (for southeast Queensland), Aspendale (for the Geelong region), and Hobart (for Tasmania). From 25 November 1994 to 24 July 1996, no TOMS satellite instruments were in operation. Because the Geelong study was conducted during this period, the TOMS ozone series for the Geelong region was complemented with Dobson dob·son n. See hellgrammite. [Probably from the name Dobson.] Noun 1. dobson - large brown aquatic larva of the dobsonfly; used as fishing bait hellgrammiate ozone measurements from Melbourne Airport Melbourne Airport (also known as Tullamarine Airport) (IATA: MEL, ICAO: YMML) is to the north of the city, adjacent to the suburb of Tullamarine, Victoria, Australia. . All remaining total ozone data gaps were filled using linear interpolation Linear interpolation is a method of curve fitting using linear polynomials. It is heavily employed in mathematics (particularly numerical analysis), and numerous applications including computer graphics. It is a simple form of interpolation. . We assumed a dry concrete surface at sea level and a cloudless atmosphere with a surface visibility of 25 km. All other remaining model parameters used for the simulations of UV radiation were fixed and identical to those reported by Engelsen et al. (2005). Statistical analysis. Because the sample in the Geelong region consisted of women only, most analyses were restricted to women; however, in some instances, comparisons were made with men. Tests for differences of the mean age by location or serum 25(OH)D levels by sex were performed using analysis of variance (ANOVA anova see analysis of variance. ANOVA Analysis of variance, see there ). In southeast Queensland, half the sample had a diagnosis of psychosis, but we found no difference in mean 25(OH)D between the groups with and without that diagnosis (p = 0.98) (McGrath et al. 2001b). The prevalence of vitamin D deficiency or insufficiency was calculated using commonly used cut-points ([less than or equal to] 25 nmol/L and [less than or equal to] 50 nmol/L, respectively) (Nowson and Margerison 2002; Vieth et al. 2001). We also used [less than or equal to] 60 nmol/L and [less than or equal to] 80 nmol/L as cutpoints, because there is an increasing debate whether optimal serum 25(OH)D levels might be > 50 nmol/L (Dawson-Hughes et al. 2005; Hollis 2005). We used logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. to examine whether the prevalence of vitamin D insufficiency or deficiency differed by latitude by including the actual latitude of each of the regions as a predictor. We adjusted for season by including binary (0, 1) terms for three of the four seasons (summer, autumn, winter, and spring). To model the seasonal variation of serum 25(OH)D, we fitted a sinusoidal sinusoidal /si·nus·oi·dal/ (si?nu-soi´dal) 1. located in a sinusoid or affecting the circulation in the region of a sinusoid. 2. shaped like or pertaining to a sine wave. model to the actual serum 25(OH)D levels and the month the sample was taken (t): 25(OH)D levels = [[beta].sub.0] + [[beta].sub.1] sin [2[pi]t/12] + [[beta].sub.2] cos [2[pi]t/12] [1] With the same method we modeled the seasonal variation of simulated daily duration of vitamin D synthesis and simulated vitamin D effective daily dose. We used the ANOVA F-test to determine whether the seasonal variation was significant, and we calculated the amplitude using the formula [square root of [[beta].sub.1.sup.2] + [[beta].sub.2.sup.2]]] [2] The peak and trough were found by taking the first derivative Noun 1. first derivative - the result of mathematical differentiation; the instantaneous change of one quantity relative to another; df(x)/dx derivative, derived function, differential, differential coefficient of the sinusoidal function and solving for the value of t for which the first derivative was zero. This gave the formula t = 12/2[pi] arctan ([[beta].sub.1]/[[beta].sub.2]) [3] For the test for trend of the mean serum 25(OH)D levels by location, we tested the significance of a covariate taking latitude values for each location (southeast Queensland = 27, Geelong = 38, Tasmania = 43). For the test for trend by location of the estimated mean maximum daily duration of vitamin D synthesis and vitamin D effective daily dose, we followed the same procedure but allowing variation in the seasonal patterns between the three locations. For tests for trend of the estimated amplitude for serum 25(OH)D, maximum daily duration of vitamin D synthesis, and vitamin D effective daily dose, we used meta-regression methods with precision weighting of the point estimates and adjustment of SEs using the procedure described by Greenland (1998). To compare the seasonal pattern in 25(OH)D in men and women, we added a sex interaction for each of the sine and cosine cosine: see trigonometry. See sine. COSINE - Cooperation for Open Systems Interconnection Networking in Europe. A EUREKA project. components of the sinusoidal model, and tested the improvement in fit using a partial F-test. To examine predictors of 25(OH)D, we calculated Pearson correlation coefficients Correlation Coefficient A measure that determines the degree to which two variable's movements are associated. The correlation coefficient is calculated as: or used linear regression Linear regression A statistical technique for fitting a straight line to a set of data points. . For these analyses, 25(OH)D values were transformed to reduce skewness Skewness A statistical term used to describe a situation's asymmetry in relation to a normal distribution. Notes: A positive skew describes a distribution favoring the right tail, whereas a negative skew describes a distribution favoring the left tail. using a square root transformation. A logarithmic logarithmic pertaining to logarithm. logarithmic relationship when the logs of two variables plotted against each other create a straight line. transformation produced similar results (data not shown). With linear regression, tests for interaction were conducted using the coefficient and SE of a product term. Results Table 1 shows that the sample of women in the Geelong region was younger than the samples in southeast Queensland (p = 0.02) and Tasmania (p < 0.01). Serum 25(OH)D levels were not strongly associated with age in any of the three samples (southeast Queensland, r = -0.02, p = 0.74; Geelong region, r = -0.08, p = 0.07; Tasmania, r = 0.01, p = 0.81). As expected, mean levels of serum 25(OH)D were lower in women than in men (southeast Queensland: women, 67.0 nmol/L and men 72.2 nmol/L, p = 0.06; Tasmania: women, 51.1 nmol/L and men, 55.2 nmol/L, p < 0.01).
Table 1. Age and season of blood sampling in population-based
samples of men and women < 60 years.
Southeast Queensland
Females Males
No. (%) No. (%)
Age (years)
< 20 6 (3.6) 7 (3.3)
20-29 34 (20.4) 41 (19.4)
30-39 38 (22.8) 65 (30.8)
40-49 49 (29.3) 61 (28.9)
50-59 40 (24.0) 37 (17.5)
Total 167 211
Season serum sample collected
Summer (Dec-Feb) 55 (32.9) 44 (20.9)
Autumn (Mar-May) 28 (16.8) 63 (29.9)
Winter (Jun-Aug) 27 (16.2) 24 (11.4)
Spring (Sep-Nov) 57 (34.1) 80 (37.9)
Total 167 211
Geelong region Tasmania
Females Females Males
No. (%) No. (%) No. (%)
Age (years)
< 20 0 (0) 0 (0) 0 (0)
20-29 162 (28.9) 17 3.9) 1 (0.3)
30-39 177 (31.6) 45 10.4) 21 (7.1)
40-49 144 (25.7) 67 (15.5) 34 (11.4)
50-59 78 (13.9) 303 (70.1) 242 (81.2)
Total 561 432 298
Season serum sample collected
Summer (Dec-Feb) 121 (21.6) 57 (13.2) 49 (16.4)
Autumn (Mar-May) 175 (31.2) 167 (38.7) 114 (38.3)
Winter (Jun-Aug) 136 (24.2 103 (23.8) 77 (25.8)
Spring (Sep-Nov) 129 (23.0) 105 (24.3) 58 (19.5)
Total 561 432 298
Prevalence of vitamin D insufficiency and deficiency by location and by season. Figure 1 shows the prevalence of vitamin D deficiency and insufficiency in women by season. Irrespective of irrespective of prep. Without consideration of; regardless of. irrespective of preposition despite their location across Australia, vitamin D insufficiency was common in winter and spring. For example, the prevalence of levels [less than or equal to] 50 nmol/L in winter/spring was 40.5% for southeast Queensland, 37.4% for the Geelong region, and 67.3% for Tasmania. The prevalence of deficiency (< 25 nmol/L) in women was also highest in winter and spring (7.1% in southeast Queensland, 7.9% in the Geelong region, and 13.0% in Tasmania). If we define vitamin D insufficiency as levels [less than or equal to] 60 nmol/L or [less than or equal to] 80 nmol/L, respectively, then the prevalence in winter/spring would be as follows: southeast Queensland 54.8% and 82.1%; Geelong region, 50.2% and 74.0%; and Tasmania, 83.7% and 97.0%. In this sample pooled over three locations, vitamin D insufficiency (p < 0.01, adjusted for season) and vitamin D deficiency (p = 0.05, adjusted for season) increased, on average, with increasing latitude. In the TasOAC study in Tasmania, data were also available on the amount of time participants spent in the sun during weekends and holidays in the past winter (here termed "winter sun exposure"). People who reported more winter sun exposure had higher levels of serum 25(OH)D in winter (r = 0.28, p < 0.01) and spring (r = 0.25, p = 0.02); the prevalence of vitamin D insufficiency and deficiency in winter/spring was also lower among those who had most sun exposure: Vitamin D insufficiency and deficiency were 42.9% (12/28) and 7.1% (2/28), respectively, among those who reported on average > 4 hr/day of sun, and 74.6% (50/67) and 19.4% (13/67) among those who reported on average < 1 hr/day of sun. Monthly prevalence of vitamin D insufficiency and deficiency compared with UV index. Figure 2 shows the monthly prevalence of vitamin D insufficiency and deficiency as well as the average monthly UV index, simulated for cloudless conditions. The colors of the bars represent the current sun protection recommendations based on the UV index for a cloudless day: green indicates that the UV level is low and no or minimal protection is required, whereas the other colors indicate that sun protection should be used. In southeast Queensland, there is a high prevalence of vitamin D insufficiency in July, which is midwinter mid·win·ter n. 1. The middle of the winter. 2. The period of the winter solstice, about December 22. midwinter Noun 1. the middle or depth of winter 2. ; however, UV protection is still recommended at this time of year. In Geelong, there is substantial vitamin D insufficiency and deficiency during winter and spring, and for a large part of that time sun protection is recommended. In Tasmania, vitamin D insufficiency and deficiency seems to be common for a large part of the year, including the months May-August, when generally no protection is recommended. Seasonal variation in serum 25(OH)D levels, maximum daily duration of vitamin D synthesis, and vitamin D effective daily dose. Serum 25(OH)D. At each location, there was significant seasonal variation in 25(OH)D levels among women (p < 0.01) (Figure 3A,D,G). Surprisingly, the Geelong region had the highest mean 25(OH)D levels (p < 0.01 compared with southeast Queensland; p < 0.01 compared with Tasmania) and the strongest amplitude (Table 2). Southeast Queensland had the least seasonal variation in serum 25(OH)D. As expected, Tasmania had the lowest mean 25(OH)D level. The amplitude of seasonal variation in men in southeast Queensland was similar to that of the women (mean 72.2 nmol/L, amplitude 10.6 nmol/L, peak 80.5 nmol/L in early January, trough 59.6 nmol/L in early July). In Tasmania, the amplitude was greater for men than for women (p = 0.03; mean 55.2 nmol/L, amplitude 16.2 nmol/L, peak 70.5 nmol/L in mid-February, trough 38.2 nmol/L in mid-August).
Table 2. Characteristics of the seasonal variationa in
serum 25(OH)D levels in population-based samples of women
< 60 years of age in southeast Queensland, the Geelong
region, and Tasmania.
Estimated
Mean Amplitude (b) Peak Month
(nmol/L) (nmol/L) (nmol/L) peak
Southeast Queensland 67.0 10.34 75.3 Early January
Geelong region 75.5 17.7 92.5 Early February
Tasmania 51.1 10.9 62.1 Early February
Test for trend p < 0.01 p = 0.15
Trough Month
(nmol/L) trough
Southeast Queensland 54.6 Early July
Geelong region 57.1 Early August
Tasmania 40.3 Early August
Test for trend
(a) A sinusoidal model was applied to the actual 25(OH)D
levels and the month the serum sample was taken.
(b) Half the difference between the estimated peak and trough.
Maximum daily duration of vitamin D synthesis. The predicted seasonal variation of simulated maximum daily duration of vitamin D synthesis in human skin is shown in Figure 3B, 3E, and 3H. Our analyses show that southeast Queensland had the greatest mean duration per day when UVR was such that vitamin D production could occur (Table 3). In addition, southeast Queensland had the least seasonal variation over the year (amplitude) in hours per day of vitamin D production (Table 3). Tasmania had the lowest mean duration per day when vitamin D production could occur, but the greatest seasonal variation over the year and the highest number of hours of vitamin D production in summer (peak). The time of the year of the peaks and troughs were the same for all locations (Table 3).
Table 3. Characteristics of the estimated seasonal variation
ain simulated maximum daily duration of vitamin D
synthesis in human skin and simulated vitamin D effective
daily dose in southeast Queensland, the Geelong
region, and Tasmania.
Mean Amplitude (b) Peak
Maximum daily duration of vitamin D
Synthesis (hr/day)
Southeast 9.6 1.7 11.3
Queensland
Geelong region 9.0 2.8 11.8
Tasmania 8.6 3.5 12.1
Test for trend p < 0.01 p < 0.01
Vitamin D effective daily dose (consistent
With J/[m.sup.2]/day)
Southeast 3,848 2,639 6,487
Queensland
Geelong 2,642 2,687 5,330
region
Tasmania 2,220 2,538 4,758
Test for p < p < 0.01
trend 0.01
Month peak Trough Month trough
Maximum daily duration of vitamin D synthesis
(hr/day)
Southeast Mid-January 7.9 Mid-July
Queensland
Geelong region Mid-January 6.1 Mid-July
Tasmania Mid-January 5.1 Mid-July
Test for
trend
Vitamin D effective daily dose (consistent with
J/[m.sup.2]/day)
Southeast Mid-January 1,209 Mid-July
Queensland
Geelong Mid-January -45 Mid-July
region
Tasmania Mid-January -319 Mid-July
Test for
trend
(a) A sinusoidal model was applied to the simulated maximum
daily duration of vitamin D synthesis or the simulated
vitamin D effective daily dose and the month of the year; data
were included for complete years in which each study was
completed.
(b) Half the difference between the estimated peak and trough.
Vitamin D effective daily dose. Table 3 and Figure 3C, 3F, and 3I show the seasonality in the daily dose of UVR effective for vitamin D production at each location, based on the vitamin D action spectrum for the conversion of 7-dehydrocholesterol into previtamin D. Although Tasmania had the highest peak for daily hours of vitamin D production in summer compared with the other regions, the vitamin D effective daily dose in that location was the lowest of the three regions in summer (Table 3, Figure 3C,F,I). This is consistent with the known lower intensity of UVR per hour in Tasmania. Multivariable analysis of serum 25(OH)D levels. Latitude and season. For the total sample of women, we examined the contribution of season by fitting a sinusoidal model to square root-transformed 25(OH)D levels and the month the serum sample was collected. Season explained 13.6% of the variation in 25(OH)D levels. We noted above that the effect of season was less pronounced for southeast Queensland than for Geelong and Tasmania, but a test of difference of the seasonal pattern by latitude was not significant (p = 0.21 for interaction). A higher latitude was significantly associated with lower serum 25(OH)D (p < 0.01). Although it only explained 3.9% of the variation in 25(OH)D, the clinical contribution of higher latitude seems substantial because serum 25(OH)D decreased on average by 1.0 nmol/L (95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. , 0.7-1.3 nmol/L) for every degree increase in latitude. Also, after taking season into account, latitude remained significantly associated with serum 25(OH)D (p < 0.01). This model, including latitude and season, predicted 16.5% of the variation in 25(OH)D levels. Maximum daily duration of vitamin D synthesis and vitamin D effective daily dose. We found a high correlation (r = 0.92) between simulated maximum daily duration of vitamin D synthesis in human skin and vitamin D effective daily dose. Maximum daily duration of vitamin D synthesis explained 7.0% of the variation in serum 25(OH)D levels, and vitamin D effective daily dose explained 7.8%. Shifting the data so the estimated peaks and troughs were aligned with the estimated peak and trough of serum 25(OH)D levels at each location made a substantial difference. After alignment, maximum daily duration of vitamin D synthesis explained 14.5% of the variation in serum 25(OH)D levels, and vitamin D effective daily dose explained 14.8%. The lag time between the estimated peak of maximum daily duration of vitamin D synthesis and the estimated peak in serum 25(OH)D was 26 days for southeast Queensland, 53 days for the Geelong region, and 47 days for Tasmania. For vitamin D effective dose, the lag times were 21 days for southeast Queensland, 49 days for the Geelong region, and 43 days for Tasmania. Interestingly, a model including maximum daily duration of vitamin D synthesis with season and latitude did not explain much more of the variation of serum 25(OH)D (17.1%) than a model including season and latitude alone (16.5%). In line with this, after adjustment for maximum daily duration of vitamin D synthesis and latitude, there remains a seasonal pattern (p < 0.01), but it is diminished. Similarly, after adjustment for the seasonal pattern and latitude, the association between maximum daily duration of vitamin D synthesis and serum 25(OH)D is significant (p < 0.01) but diminished. This indicates that both variables partly capture the same information. The same was true for the analyses using vitamin D effective daily dose. Discussion In three population-based samples of women < 60 years of age across Australia [southeast Queensland (27[degrees]S), Geelong region (38[degrees]S), and Tasmania (43[degrees]S)], vitamin D insufficiency was common in winter and spring. Season was a strong determinant determinant, a polynomial expression that is inherent in the entries of a square matrix. The size n of the square matrix, as determined from the number of entries in any row or column, is called the order of the determinant. of vitamin D status. Simulated maximum daily duration of vitamin D synthesis and vitamin D effective daily dose were also important predictors of serum 25(OH)D levels after aligning the seasonal patterns of those variables with seasonal pattern of serum 25(OH)D. The contribution of latitude was also evident but of lower magnitude. In some months when sun exposure protection would be recommended based on the simulated UV index, there was a high insufficiency or even deficiency. Many studies assessing vitamin D status have been conducted in groups at high-risk of vitamin D deficiency, such as the elderly, infants, or veiled women. These data cannot be generalized to the entire adult Australian population. In this study we examined population- based samples of women < 60 years of age in three locations covering a broad latitudinal range. The limitations of this study are that the three populations were recruited with their own eligibility criteria, which could have resulted in some selection bias. For example, the vitamin D insufficiency in the Geelong region was lower than expected, on the basis of its latitude. Although we cannot rule out selection bias, the sample of women in the Geelong region was recruited from the Commonwealth Electoral Roll with a high response rate, and the sample was relatively large. In addition, we could examine the effect of latitude and season on 25(OH)D, but we could not directly determine to what extent 25(OH)D levels were determined by other factors such as skin type, dietary intake, sun behavior, and sun avoidance behavior avoidance behavior, n a conscious or unconscious defense mechanism by which a person tries to escape from unpleasant situations or feelings, such as anxiety and pain. . A large percentage of the study participants considered here were Caucasian. In Geelong, 99% were of European descent, and 81% reported having a skin type that sunburned sun·burn n. Inflammation or blistering of the skin caused by overexposure to direct sunlight. tr. & intr.v. sun·burned or sun·burnt , sun·burn·ing, sun·burns To affect or be affected with sunburn. easily or moderately easily (Pasco et al. 2001). In Tasmania, all participants were Caucasian (van der Mei et al. 2003). However, even within Caucasians, skin type could have had an influence on vitamin D status (van der Mei et al. 2007). The contribution of dietary intake of vitamin D to serum 25(OH)D levels was probably small because the intake of vitamin D in Australia is generally low (Nowson and Margerison 2002). Indeed, in the Geelong region dietary intake was low (1.2 [micro]g/day), and only 7.9% regularly used vitamin D-containing supplements (Pasco et al. 2001). In Tasmania, 8.1% of participants used vitamin D-containing supplements; no association was observed between serum 25(OH)D and the use of vitamin D-containing supplements or intake of fish, milk, eggs, or meat (van der Mei et al. 2007). For the location-specific simulations of maximum daily duration of vitamin D synthesis, vitamin D effective daily dose, and UV index, changes in ambient conditions (clouds and aerosols) were not taken into account. Therefore, our simulated values can be expected to be higher than the true values. Our data confirm that season is an important predictor of serum 25(OH)D levels, as previously reported by Webb et al. (1988). Season is known to be associated with ambient ultraviolet radiation; however, it can also reflect changes in outdoor behavior and amount of clothing worn. In an in vitro in vitro /in vi·tro/ (in ve´tro) [L.] within a glass; observable in a test tube; in an artificial environment. in vi·tro adj. In an artificial environment outside a living organism. study conducted in Johannesburg, South Africa South Africa, Afrikaans Suid-Afrika, officially Republic of South Africa, republic (2005 est. pop. 44,344,000), 471,442 sq mi (1,221,037 sq km), S Africa. (latitude 26[degrees]S), Pettifor et al. (1996) observed no seasonal variation throughout the year in the formation of previtamin D3 and vitamin D3 under the influence of ambient ultraviolet radiation. However, a clear seasonal pattern in 25(OH)D levels has been shown at an individual level (Pettifor et al. 1978). This suggests that the seasonal variation at an individual level [shown in an elderly population in Johannesburg by (Pettifor et al. 1978)] is a consequence of the increased clothing worn and the decreased time spent outdoors during winter, rather than decreased vitamin D-effective UVR reaching the Earth. Although season was a strong predictor of serum 25(OH)D, latitude was not as important as might have been expected based on the knowledge that ambient ultraviolet radiation levels (and particularly UVB UVB ultraviolet B; see ultraviolet. ) generally decrease with increasing latitude (r = -0.96 for annual ambient UVR) (Gies et al. 1999). However, the effect of latitude was significant, and its contribution is likely to be clinically relevant with serum 25(OH)D levels, on average decreasing 1.0 nmol/L (95% confidence interval, 0.7-1.3 nmol/L) for every degree increase in latitude. A latitudinal gradient gradient In mathematics, a differential operator applied to a three-dimensional vector-valued function to yield a vector whose three components are the partial derivatives of the function with respect to its three variables. The symbol for gradient is ∇. in 25(OH)D levels has been found within a number of countries such as France (43-55[degrees]N) (Chapuy et al. 1997) and Argentina (26-55[degrees]S) (Oliveri et al. 2004). Interestingly, across countries in Europe, a latitudinal gradient in the opposite direction has been demonstrated among healthy elderly individuals, with a lower prevalence of vitamin D insufficiency in northern Europe compared with southern Europe Southern Europe or sometimes Mediterranean Europe is a region of the European continent. There is no clear definition of the term which can vary depending on whether geographic, cultural, linguistic or historical factors are taken into account. (Lips et al. 2001). One explanation could be that countries where a negative latitudinal gradient in 25(OH)D levels was observed might be more homogeneous in regard to ethnicity and living and dietary habits (Oliveri et al. 2004). Across countries, cultural differences in constitutional skin color, outdoor behavior, diet, and clothing would have played a role, as well as vitamin D supplementation policies (Scharla 1998). Location-specific estimates of ambient UVR important for the production of vitamin D (maximum daily duration of vitamin D synthesis and vitamin D effective daily dose) were also a strong determinant of serum 25(OH)D after aligning the seasonal patterns of those variables with the seasonal pattern of serum 25(OH)D, although they seemed to capture similar information as the seasonal variation in 25(OH)D. A lag period between the maximum UV dose and the peak 25(OH)D levels has been described previously (Lucas et al. 2005; Pasco et al. 2004). Here, using simple sinusoidal models, we observed that the lag time was approximately twice as long for Tasmania as for southeast Queensland. This variation in the number of days by which serum 25(OH)D lagged behind maximum daily duration of vitamin D synthesis and vitamin D effective daily dose may reflect behavioral factors (e.g., amount of clothing worn), the biological lag between UVR exposure and 25(OH)D synthesis, and/or other locationspecific variables (e.g., actual level of vitamin D effective daily dose). Importantly, we found a concerning high prevalence of vitamin D insufficiency in winter and spring, irrespective of the location within Australia. In winter/spring, the prevalence of insufficiency ([less than or equal to] 50 nmol/L) was 40.5% in southeast Queensland, 37.4% in the Geelong region, and 67.3% in Tasmania. Thus, even residence in a sunny climate, such as southeast Queensland (27[degrees]S), did not prevent vitamin D insufficiency. The same was found in a healthy adult population in south Florida (USA; 25[degrees]N), where 40% of the women and 38% of the men had serum 25(OH)D levels < 50 nmol/L at the end of winter (Levis et al. 2005). These authors thought that avoidance of sun exposure because of the heat and increased awareness of the risk of developing skin cancer were the underlying reasons for the high prevalence of insufficiency. In Tasmania (43[degrees]S), time in the sun was a predictor of 25(OH)D; although higher levels of sun exposure are associated with better vitamin D status, the prevalence of vitamin D insufficiency in winter/spring was still high (43%) among the subgroup sub·group n. 1. A distinct group within a group; a subdivision of a group. 2. A subordinate group. 3. Mathematics A group that is a subset of a group. tr.v. of people that were most sun seeking (time in the sun > 4 hr/day during weekends and holidays). This suggests that, in winter and spring, the combination of low ambient UVR and an increased amount of clothing worn makes it difficult to achieve an adequate vitamin D status (> 50 nmol/L) without a high dietary intake of vitamin D or vitamin D supplementation. The current vitamin D and adult bone health position statement in Australia and New Zealand indicates that in winter in the southern states Southern States U.S. Confederacy government of 11 Southern states that left the Union in 1860. [Am. Hist.: EB, III: 73] Dixie popular name for Southern states in U.S. and for song. [Am. Hist. , vitamin D levels may be maintained by approximately 2-3 hr of sunlight exposure accumulated over a week to the face, arms, and hands or equivalent surface area (Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia, Osteoporosis Australia 2005). Our data suggest that recommended exposure should be reconsidered and/or that vitamin D supplementation might be required. The question of what an "optimal" level or range of serum 25(OH)D might be remains difficult to answer, but suggestions have been made that the optimal serum 25(OH)D levels may be > 50 nmol/L (Dawson-Hughes et al. 2005; Hollis 2005). In our study samples, > 50% of participants would be vitamin D insufficient in winter if the cut-off cut-off Anesthesiology The point at which elongation of the carbon chain of the 1-alkanol family of anesthetics results in a precipitous drop in the anesthetic potential of these agents–eg, at > 12 carbons in length, there is little anesthetic activity, were 60 nmol/L, and > 70% if the cut-off were 80 nmol/l. Furthermore, even in summer, a high percentage of the population would be insufficient for vitamin D if those higher cut-off points were used. A national cohort study A cohort study is a form of longitudinal study used in medicine and social science. It is one type of study design. In medicine, it is usually undertaken to obtain evidence to try to refute the existence of a suspected association between cause and disease; failure to refute of Caucasian 45-year-old subjects in the United Kingdom has also reported a high prevalence of hypovitaminosis D in the general population, warranting action at a population, not individual level (Hypponen and Power 2007). Our data indicate that even in Australia, a location with higher ambient UVR, similar problems exist. Our study findings indicate that sun exposure protection is recommended in Australia in some months or regions where vitamin D insufficiency is high or where vitamin D deficiency exists. A full discussion of the potential solution to this problem, taking into account other health effects of UVR such as skin cancer, are beyond the scope of this article; however, policy strategies requiring consideration include a) the greater promotion of safe sun exposure while avoiding adverse UVR effects; b) adequate vitamin D supplementation; and c) vitamin D fortification of foods. With regard to the first option, our findings that maximum daily duration of vitamin D synthesis and vitamin D effective daily dose were important predictors of serum 25(OH)D indicate that the use of a vitamin D index could be a valuable additional tool (Kimlin 2004). Using a vitamin D index in addition to the UV index for recommending sun exposure to achieve and/or maintain vitamin D adequacy, within the range of exposure that avoids adverse UVR effects, might be useful because the UV index is weighted by UVB and UVA wavelengths that produce erythema (sunburn), which is different from the UVB-only action spectrum for vitamin D photoproduction. The present study also particularly emphasizes that living at low latitude that part of the earth's surface which is near the equator. See also: Latitude does not prevent vitamin D insufficiency and that behavior (amount of time outside, amount of clothing) is important. Education should be provided on these issues. In addition, in Tasmania, a state with a high level of vitamin D insufficiency, we had data available on personal sun exposure. The prevalence of vitamin D insufficiency in winter and spring was high even among those who reported high levels of sun exposure, suggesting that vitamin D levels should be monitored and that increased dietary intake of vitamin D, either through supplements or fortification, should also be considered. In conclusion, we found that vitamin D insufficiency was common in winter and spring in three locations in Australia, covering a latitude of 27[degrees]S to 43[degrees]S. Season was more important than latitude in determining serum 25(OH)D. However, both only explained less than one-fifth of the variation in 25(OH)D levels, highlighting the importance of behavioral factors. Simulated maximum daily duration of vitamin D synthesis and vitamin D effective daily dose were also important predictors of serum 25(OH)D, indicating that a location-specific indicator of vitamin D production, such as the vitamin D index, could be useful for recommendations for the achievement and maintenance of vitamin D adequacy. Current sun exposure practices and dietary intake do not seem to fully prevent vitamin D insufficiency and deficiency, and consideration should be given to modification of sun exposure advice or pursuing other means to achieve vitamin D adequacy. REFERENCES Brustad M, Alsaker E, Engelsen O, Aksnes L, Lund E. 2004. Vitamin D status of middle-aged women at 65-71[degres]N in relation to dietary intake and exposure to ultraviolet radiation. Public Health Nutr 7(2):327-335. Cancer Council Australia. 2007. Risks and Benefits of Sun Exposure. Position Statement. 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Past exposure to sun, skin phenotype phenotype (fē`nətīp'): see genetics. phenotype All the observable characteristics of an organism, such as shape, size, colour, and behaviour, that result from the interaction of its genotype (total genetic makeup) with , and risk of multiple sclerosis: case-control study. BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift 327(7410):316-320. van der Mei IAF (Internet Application Framework) A suite of software development technologies from Ross Systems, Inc., Atlanta, GA (www.rossinc.com) that is the backbone of its iRenaissance Suite. Meta-data driven, IAF comprises a . , Ponsonby AL, Dwyer T, Blizzard L, Taylor BV, Kilpatrick T, et al. 2007. Vitamin D levels in people with multiple sclerosis This is a list of people with multiple sclerosis, similar to the category "People with multiple sclerosis" but with sources and explanations. : Top - 0–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z B
Vieth R. 1999. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69(5):842-856. Vieth R, Chan PC, MacFarlane MacFarlane or Macfarlane is a surname shared by:
Webb AR, Kline L, Holick MF. 1988. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67(2):373-378. Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia, Osteoporosis Australia. 2005. Vitamin D and adult bone health in Australia and New Zealand: a position statement. Med J Aust 182(6):281-285. WHO. 2007. Sunshine and Health: How to Enjoy the Sun Safely. Geneva:World Health Organization. Available: http://www. who.int/uv/publications/solaruvflyer2006.pdf [accessed 31 May 2007]. WHO. 2002. Global Solar UV Index. A Practical Guide. Geneva:World Health Organization. Available: http://www. unep.org/PDF/Solar_Index_Guide.pdf [accessed 31 May 2007]. Zittermann A. 2003. Vitamin D in preventive medicine preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance of good health practices. Until recently preventive medicine was largely the domain of the U.S. : are we ignoring the evidence? Br J Nutr89(5):552-572. Address correspondence to I.A.F. van der Mei, Menzies Research Institute, Private Bag 23, Hobart, Tasmania, Australia 7001. Telephone: 61 3 6226 7700. Fax: 61 3 62267704. E-mail: Ingrid.vanderMei@utas.edu.au We gratefully acknowledge access to Total Ozone Mapping Spectrometer ozone data from the NASA NASA: see National Aeronautics and Space Administration. NASA in full National Aeronautics and Space Administration Independent U.S. Goddard Space Flight Center The Goddard Space Flight Center (GSFC) is a major NASA space research laboratory established on May 1, 1959 as NASA's first space flight center. GSFC employs approximately 10,000 civil servants and contractors, and is located approximately 6.5 miles northeast of Washington, D.C. and Dobson ozone data from the Australian Bureau of Metereology via the World Ozone and Ultraviolet Radiation Data Centre. The Geelong Osteoporosis Study was funded by the Victorian Health Promotion Foundation and the Geelong Region Medical Research Foundation. The Tasmanian multiple sclerosis (MS) case-control study was funded by the Australian National Health & Medical Research Council (NHMRC), the Australian Rotary Health Research Fund, and MS Australia. The Tasmanian Older Adult Cohort was also funded by the NHMRC, and measurement of vitamin D was supported by the Arthritis Foundation This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article. of Australia. G.J. is funded by a NHMRC practitioner fellowship. The authors declare they have no competing financial interests. Received 28 November 2006; accepted 17 April 2007. Ingrid A.F. van der Mei, (1) Anne-Louise Ponsonby, (1), (2) Ola Engelsen, (3) Julie A. Pasco, (4) John J. McGrath John J. McGrath was born in Limerick, Ireland, July 23 1872, died August 25 1951. He was a U.S. Representative from California, 1933-39. He was a Democrat. , (5), (6) Daryl W. Eyles, (5), (7) Leigh Blizzard, (1) Terence Dwyer, (1), (2) Robyn Lucas, (8) and Graeme Jones (1) (1)Menzies Research Institute, University of Tasmania (body, education) University of Tasmania - ftp://ftp.utas.edu.au/. , Hobart, Australia; (2)Murdoch Childrens Research Institute, Melbourne, Australia; (3)Norwegian Institute for Air Research The Norwegian Institute for Air Research (Norwegian: Norsk Institutt for luftforskning) or NILU is one of the leading specialized scientific laboratories in Europe dealing solely with problems related to air pollution. (NILU NILU Norwegian Institute for Air Research ), Troms[empty set], Norway; (4)The University of Melbourne
In 2006, Times Higher Education Supplement ranked the University of Melbourne 22nd in the world. Because of the drop in ranking, University of Melbourne is currently behind four Asian universities - Beijing University, , Department of Clinical and Biomedical Sciences Noun 1. biomedical science - the application of the principles of the natural sciences to medicine bioscience, life science - any of the branches of natural science dealing with the structure and behavior of living organisms , Barwon Health, Geelong, Australia; (5)Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia; (6)Department of Psychiatry, and (7)School of Biomedical Sciences, University of Queensland The University of Queensland (UQ) is the longest-established university in the state of Queensland, Australia, a member of Australia's Group of Eight, and the Sandstone Universities. It is also a founding member of the international Universitas 21 organisation. , St. Lucia, Australia; (8)National Centre for Epidemiology and Population Health, Australian National University Australian National University, located in Canberra and state-sponsored, founded 1946 as Australia's only completely research-oriented university. Originally limited to graduate studies, it expanded in 1960, merging with Canberra University College (est. 1929). , Canberra, Australia |
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