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Rocholl M, Weinert P, Bielfeldt S, Laing S, Wilhelm KP, Ulrich C, John SM. New methods for assessing secondary performance attributes of sunscreens suitable for professional outdoor work. J Occup Med Toxicol 2021; 16:25. [PMID: 34225747 PMCID: PMC8256554 DOI: 10.1186/s12995-021-00314-2] [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: 03/29/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Outdoor workers (OW) are highly exposed to solar ultraviolet radiation (UVR) and thus at increased risk for developing skin cancer. An essential part of an overall strategy to reduce workplace UVR-exposure to OW's skin is the usage of sunscreens. However, compliance with regular sunscreen usage seems to be low, as products are usually designed for recreational sun exposure and thus do not meet the requirements of physically active OW. To date, no standardized test procedures assess the suitability of sunscreens for professional use. The aim of this pilot study was to develop standardized methods of testing secondary performance attributes (PA) to represent real-life working conditions of outdoor work. METHODS Ten sunscreen products, carefully selected after a detailed market survey of all relevant producers available on the German market, were evaluated regarding their suitability for professional outdoor work on 24 healthy volunteers in a newly designed test procedure. In addition to three standardized efficacy characteristics, i.e., sun protection factor, water-resistance, and UVA protection, we evaluated each PA involving parameters typically associated with outdoor workplaces. RESULTS We developed standardized methods for objectifying the suitability of sunscreen products for professional outdoor work. The test procedures used are well feasible and appropriate for testing the PA because they represent practical working conditions in detail - although the degree of discriminability of single test methods varied. The claimed sun protection factor (SPF) of the products was confirmed; bio-stability of the SPF after physical activity was achieved in most cases. While most products hardly irritate the eyes and are quickly absorbed, the evaluation of the subjective skin feeling and non-slip grip is inconsistent. CONCLUSIONS In this pilot study, for the first time secondary PA are defined and examined. Although further objectification of the PA assessment as well as the establishment of minimum standards should be sought, the new methods could already complement the so far mandatory labels and in this way provide a significant impetus for the current scientific and political focus on the improvement of occupational health in highly UVR-exposed OW.
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Affiliation(s)
- Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany. .,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.
| | - Patricia Weinert
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Stephan Bielfeldt
- proDERM Institute of Applied Dermatological Research GmbH, Kiebitzweg 2, 22869, Schenefeld, Hamburg, Germany
| | - Sabrina Laing
- proDERM Institute of Applied Dermatological Research GmbH, Kiebitzweg 2, 22869, Schenefeld, Hamburg, Germany
| | - Klaus Peter Wilhelm
- proDERM Institute of Applied Dermatological Research GmbH, Kiebitzweg 2, 22869, Schenefeld, Hamburg, Germany
| | - Claas Ulrich
- Department of Dermatology and Allergy, Skin Cancer Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
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2
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Saka B, Akakpo SA, Teclessou JN, Gnossike P, Adam S, Mahamadou G, Kassang P, Elegbede Y, Mouhari-Toure A, Darre T, Kombate K, Pitché P. Skin cancers in people with albinism in Togo in 2019: results of two rounds of national mobile skin care clinics. BMC Cancer 2021; 21:26. [PMID: 33402100 PMCID: PMC7786986 DOI: 10.1186/s12885-020-07747-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background In people with albinism (PWA), the deficiency of melanin increase the risk of skin cancers. The aim of this study was to determine the prevalence of skin cancers and characteristics of these detected skin cancers (histological types, localization) in PWA in 10 cities in Togo in 2019. Methods This is a cross-sectional study of medical records of PWA systematically examined during two mobile skin care clinics in 2019, as part of a programme for the prevention and management of skin cancers in these subjects. Results During the study period, 280 (95.2%) of the 294 PWA consulted, had developed skin lesions. Of the 280 PWA, the pathological reports from the medical records of 33 patients (11.8%; (95%CI = [8.2–16.2]) had concluded to non-melanoma skin cancers. The mean age of these 33 patients was 38.6 ± 15.2 years and the sex-ratio was 1. Their occupations were mainly resellers (21.2%), traders (15.2%) and farmers (12.2%). In the 33 patients, 54 cases of non-melanoma skin cancers were identified, with some patients having more than one tumor, and some of them having more than one (histologically confirmed) diagnosis. These 54 non-melanoma skin cancers were divided into 21 cases of invasive squamous cell carcinomas, 2 cases of Bowen’s disease and 31 cases of basal cell carcinomas. These non-melanoma skin cancers mainly occurred in the head and neck (33 cases; 61.1%), the upper limbs (15 cases; 27, 8%) and the trunk (4 cases; 7.4%). Conclusion The results of this study show a high prevalence of skin cancers among PWAs in Togo in 2019, only non-melanoma skin cancers. In addition, they illustrate the role of ultraviolet rays with regard to the localization of skin cancers and the occupations of patients. Popularization and compliance with photo protection measures, systematic and regular examination of the skin of these PWAs will allow early detection and treatment of these skin cancers.
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Affiliation(s)
- Bayaki Saka
- Dermatology and STIs Department, Service de dermatolgie et IST, CHU Sylvanus Olympio, Université de Lomé, BP. 30785, Lomé, Togo.
| | - Sefako Abla Akakpo
- Dermatology and STIs Department, Service de dermatolgie et IST, CHU Sylvanus Olympio, Université de Lomé, BP. 30785, Lomé, Togo
| | | | | | - Saliou Adam
- Service de Chirurgie Maxillo-faciale et Plastique, CHU Sylvanus Olympio, Université de Lomé, Lomé, Togo
| | - Garba Mahamadou
- Dermatology and STIs Department, Service de dermatolgie et IST, CHU Sylvanus Olympio, Université de Lomé, BP. 30785, Lomé, Togo
| | - Panawé Kassang
- Dermatology and STIs Department, Service de dermatolgie et IST, CHU Sylvanus Olympio, Université de Lomé, BP. 30785, Lomé, Togo
| | - Yvette Elegbede
- Service de dermatolgie et IST, Centre Hospitalier Régional de Tomdè, Kara, Togo
| | | | - Tchin Darre
- Laboratoire d'anatomie et cytotologie pathologique, CHU Sylvanus Olympio, Université de Lomé, Lomé, Togo
| | - Koussake Kombate
- Service de dermatolgie et IST, CHU Campus Université de Lomé, Lomé, Togo
| | - Palokinam Pitché
- Dermatology and STIs Department, Service de dermatolgie et IST, CHU Sylvanus Olympio, Université de Lomé, BP. 30785, Lomé, Togo
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3
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Keratinocyte skin cancer risks for working school teachers: Scenarios and implications of the timing of scheduled duty periods in Queensland, Australia. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 213:112046. [PMID: 33074139 DOI: 10.1016/j.jphotobiol.2020.112046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/20/2020] [Accepted: 09/29/2020] [Indexed: 01/01/2023]
Abstract
Relative keratinocyte skin cancer risks attributable to lifetime occupational and casual sunlight exposures of working school teachers are assessed across the state of Queensland for 1578 schools. Relative risk modeling utilizing annual ultraviolet exposure assessments of teachers working in different geographic locations and exposed during periods of measured daily playground duty times for each school were made for local administrative education districts by considering traditional school opening and closing hours, and playground lunchtime schedules. State-wide, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) relative risk estimates varied by 24% for BCC and 45% for SCC. The highest relative risk was calculated for the state's north (sunshine) coast education district which showed that risk could increase by as much as 32% for BCC and 64% for SCC due to differences in teacher duty schedules. These results highlight the importance of playground duty scheduling as a significant risk factor contributing to the overall burden of preventable keratinocyte skin cancers in Queensland.
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4
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Banza MI, Tshiamala IB, Kapessa ND. [A case study of bilateral cystic basal cell carcinoma in an albino]. Pan Afr Med J 2019; 34:43. [PMID: 31762910 PMCID: PMC6859012 DOI: 10.11604/pamj.2019.34.43.19457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/25/2019] [Indexed: 11/15/2022] Open
Abstract
Basal cell carcinoma is the most common skin cancer. It occurs in young adults older than 50 years and it is often caused by chronic exposure to solar rays, which explains why it often affects the face. In patient who are not treated immediately, the tumour develops slowly, with locoregional extension, but it rarely metastasizes. We here report a very rare case of bilateral cystic basal cell carcinoma in an albino young adult aged 36 years. The patient had terebrant left brachial ulcero-budding infiltrating mass with bone erosion (pathological fracture of the humerus) evolving over the last 7 years as well as ulcero-budding secondarily infected mass in the cervicodorsal junction evolving over the last 6 months. During his 1 month stay in our hospital, he underwent transfusion of 6 units of isogroup isoRh 450cc and boric acid dressings were applied as a complement to antibiotic therapy and iron therapy. Given the poor general health of the patient (cachexia, chronic anemia, development of the cancerous lesions), amputation of the left upper member and cervicodorsal mass excision were controindicated. Multidisciplinary team opted for second line treatment, including chemotherapy and/or radiotherapy. Given the lack technical equipment, the patient was transferred out to Lusaka.
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Affiliation(s)
- Manix Ilunga Banza
- Département de Chirurgie, Faculté de Médecine, Université de Lubumbashi, Cliniques Universitaires de Lubumbashi, Katanga, Lubumbashi, République Démocratique du Congo
| | - Israël Badypwyla Tshiamala
- Département de Chirurgie, Faculté de Médecine, Université de Lubumbashi, Cliniques Universitaires de Lubumbashi, Katanga, Lubumbashi, République Démocratique du Congo
| | - Nathalie Dinganga Kapessa
- Département de Chirurgie, Faculté de Médecine, Université de Lubumbashi, Cliniques Universitaires de Lubumbashi, Katanga, Lubumbashi, République Démocratique du Congo
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5
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Occupational UV Exposure and Sun-Protective Behaviour in German Outdoor Workers. J Occup Environ Med 2018; 60:961-967. [DOI: 10.1097/jom.0000000000001397] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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6
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Kricker A, Weber M, Sitas F, Banks E, Rahman B, Goumas C, Kabir A, Hodgkinson VS, van Kemenade CH, Waterboer T, Armstrong BK. Early Life UV and Risk of Basal and Squamous Cell Carcinoma in New South Wales, Australia. Photochem Photobiol 2017; 93:1483-1491. [PMID: 28710897 DOI: 10.1111/php.12807] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
Abstract
Sun exposure is the main cause of squamous (SCC) and basal cell carcinoma (BCC) although pattern and amount differ by cancer type, and sun sensitivity is the major host risk factor. Our study investigated risk factors and residential ambient UV in a population-based sample of Australian 45 and Up Study participants: 916 BCC cases, 433 SCC cases, 1224 controls. Unconditional logistic regression models adjusting for key covariates demonstrated 60% increased BCC risk and two-fold increased SCC risk with sun sensitivity, and three- and four-fold increased risk, respectively, with solar keratoses. BCC but not SCC risk increased with higher early-life residential UV in all participants (odds ratio (OR) = 1.54; 95% CI 1.22-1.96 for intermediate; OR = 1.31; 95% CI 1.03-1.68 for high UV at birthplace) and similarly in Australian-born participants (P-values < 0.05). Risk of SCC but not BCC increased with long-term cumulative sun exposure assessed by self-reported outdoor work (OR 1.74, 95% CI 1.21-2.49). In conclusion, sun sensitivity is important for both cancers, early-life UV but not cumulative UV appears to increase BCC risk, the former an apparently novel finding, and SCC risk appears only to be related to long-term cumulative sun exposure.
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Affiliation(s)
- Anne Kricker
- Sydney Medical School, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Marianne Weber
- Sydney Medical School, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
| | - Freddy Sitas
- Sydney Medical School, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Sax Institute, Sydney, NSW, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Chris Goumas
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Ahsanul Kabir
- Department of Environment and Geography, Faculty of Science, Formerly Geographic Information Systems, Macquarie University, Sydney, NSW, Australia
| | - Verity S Hodgkinson
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
| | | | - Tim Waterboer
- Molecular Diagnostics of Oncogenic Infections Division, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bruce K Armstrong
- Sydney Medical School, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,School of Population Health, University of Western Australia, Perth, WA, Australia
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7
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Trakatelli M, Barkitzi K, Apap C, Majewski S, De Vries E. Skin cancer risk in outdoor workers: a European multicenter case-control study. J Eur Acad Dermatol Venereol 2016; 30 Suppl 3:5-11. [PMID: 26995016 DOI: 10.1111/jdv.13603] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exposure to ultraviolet radiation (UVR) is the most important external risk factor for skin cancer. Outdoor workers, who are exposed to high ambient UVR levels are at increased risk. OBJECTIVE To compare outdoor with indoor workers in terms of: (i) skin cancer risk factors, and (ii) risk of developing skin cancer. METHODS Using descriptive methods and a large multicenter European case-control study, we compared risk factor patterns between outdoor (N = 1416) and indoor workers (N = 1863). Risk of developing basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma and actinic keratosis (AK) were analysed by type of work using multivariate logistic regression models, for three categories of work: indoor; farming/construction; other outdoor work. RESULTS Although skin phototype was equally distributed by type of work, significantly less outdoor than indoor workers used sunscreen in their own country (44.3% vs. 60.2%), but had more outdoor hobbies (66.2% vs. 58.2%). Outdoor workers had lower educational levels, and felt less confident in understanding medical information and filling medical forms (all P < 0.001). Outdoor workers had more signs of photodamage (78.1% vs. 65.5%) and among the skin cancer patients, 37.7% of outdoor workers vs. 28.6% of indoor workers had ≥2 skin cancers diagnosed during their lifetime. Multivariate logistic regression models showed significantly increased risk of outdoor vs. indoor work for AK (ORother outdoor = 1.55, ORfarming/construction = 2.58), SCC (ORother outdoor = 1.32, ORfarming/construction = 2.77) and BCC (ORother outdoor = 1.53, ORfarming/construction = 1.83). No significant associations were found for melanoma. The risk of all types of skin cancer and AK was significantly increased for workers with ≥5 years of outdoor work. CONCLUSIONS Outdoor workers had more risk behaviour with similar constitutional skin cancer risk factors: more UV exposure (both occupational and leisure) and less sunscreen use and lower health literacy. This results in higher exposure, more photodamage and an increased risk of developing AK, BCC and SCC.
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Affiliation(s)
- M Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Dermatology, St. Pierre Hospital, Brussels, Belgium
| | - K Barkitzi
- Artistotle University of Thessaloniki, Thessaloniki, Greece
| | - C Apap
- Department of Dermatology, Sir Paul Boffa Hospital, Floriana, Malta
| | - S Majewski
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - E De Vries
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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8
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Solar ultraviolet and the occupational radiant exposure of Queensland school teachers: A comparative study between teaching classifications and behavior patterns. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2016; 158:105-12. [DOI: 10.1016/j.jphotobiol.2016.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/22/2016] [Indexed: 01/28/2023]
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9
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Peters CE, Koehoorn MW, Demers PA, Nicol AM, Kalia S. Outdoor Workers' Use of Sun Protection at Work and Leisure. Saf Health Work 2016; 7:208-12. [PMID: 27630789 PMCID: PMC5011087 DOI: 10.1016/j.shaw.2016.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/18/2016] [Accepted: 01/27/2016] [Indexed: 11/19/2022] Open
Abstract
Background Outdoor workers are at risk of high ultraviolet radiation exposure, and may have difficulty using sun protection. The objectives were to determine the prevalence of sun protection behaviors in a sample of outdoor construction workers, and to assess which factors predict better sun protection practices. Methods Participants were recruited via construction unions. Workers answered a questionnaire on demographics, skin cancer risk, sun protection behaviors, and job. Sun protection behavior scores (from questions on sunscreen use, sleeved shirt, hat, shade seeking, sunglasses) were calculated by converting Likert-scale answers to scores from 0 to 4, and taking the mean (separately for work and leisure). Determinants of sun protection behavior scores were examined for work and leisure using generalized linear models. Results Seventy-seven workers had complete questionnaire data (participation 98%). Sun protection behaviors used most often were hats (79% often/always) and sleeved shirts (82% often/always); least prevalent were shade-seeking (8% often/always) and sunscreen (29% often/always). For both work and leisure scores, the strongest predictor was skin type, with fairer-skinned individuals having higher sun protection behavior scores. Workers had higher scores at work than on weekends. Workplaces that required hats and sleeved shirts for safety purposes had higher protection behavior scores. Conclusion This high-participation rate cohort helps characterize sun protection behaviors among outdoor workers. Workers practiced better sun protection at work than on weekends, suggesting that workplace policies supportive of sun protection could be useful for skin cancer prevention in the construction industry.
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Affiliation(s)
- Cheryl E Peters
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mieke W Koehoorn
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anne-Marie Nicol
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sunil Kalia
- Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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10
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Nday DK, Ngombe LK, Fundi JN, Kitenge TK, Numbi L. [Basal cell carcinoma in a Congolese (DRC) albinos: about one observation]. Pan Afr Med J 2015; 20:274. [PMID: 26161197 PMCID: PMC4483366 DOI: 10.11604/pamj.2015.20.274.6356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/26/2015] [Indexed: 11/11/2022] Open
Abstract
Les auteurs rapportent un cas d'un carcinome basocellulaire non décris dans la littérature de notre pays chez un adulte jeune congolais âgé de 25 ans, de sexe masculin présentant une récidive probable de la tumeur. Cette observation permet de décrire le carcinome basocellulaire chez un sujet noir albinos, et de souligner les particularités thérapeutiques.
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Affiliation(s)
- David Kakez Nday
- Zone de Santé de Dilolo, Hôpital General de Dilolo, Dilolo, République Démocratique du Congo
| | - Léon Kabamba Ngombe
- Université de Kamina, Faculté de Médecine, Département de Santé Publique, Unité de Toxicologie, République Démocratique du Congo ; Université de Lubumbashi, Faculté de Médecine, Département de Santé Publique, Unité de Toxicologie, Lubumbashi, République Démocratique du Congo
| | - Jimmy Ngoie Fundi
- Zone de Santé de Kolwezi, Hôpital General de Kolwezi, Kolwezi, République Démocratique du Congo
| | - Tony Kayembe Kitenge
- Université de Lubumbashi, Faculté de Médecine, Département de Santé Publique, Unité de Toxicologie, Lubumbashi, République Démocratique du Congo
| | - Luboya Numbi
- Université de Kamina, Faculté de Médecine, Département de Santé Publique, Unité de Toxicologie, République Démocratique du Congo ; Université de Lubumbashi, Faculté de Médecine, Département de Santé Publique, Unité de Toxicologie, Lubumbashi, République Démocratique du Congo ; Université de Lubumbashi, Faculté de Médecine, Département de Pédiatrie, République Démocratique du Congo
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11
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Nahar VK. Skin cancer prevention among school children: a brief review. Cent Eur J Public Health 2014; 21:227-32. [PMID: 24592730 DOI: 10.21101/cejph.a3864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In many countries the incidence of melanoma has been doubling in every 10 years. Since 1930, the rate of melanoma has increased over 1,800% and researchers are expecting this trend to continue and increase for the next 10 to 20 years. Primary prevention and early detection of skin cancer in childhood is important to reduce the risk of developing skin cancer later in life. Primary prevention programmes are more beneficial and effective in children, not only due to the particular importance of sunlight exposure during this period, but because this is when individuals are more open to changes and adopt new attitudes and behaviour. The purpose of this manuscript is to review the results of intervention studies designed to modify sun exposure behaviour among children in the United States of America, Australia and Europe. An additional purpose is to summarize the recommendations obtained from the reviewed studies. The strongest recommendation to emerge from this review is that the skin cancer primary prevention programme should be carried out over several school years, not just one time, to produce changes in the sun safety behaviour. Moreover, it recommends that parents should be targeted to educate their children about sun protective skills and promote skin cancer prevention behaviour.
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Affiliation(s)
- Vinayak K Nahar
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Oxford, MS, USA.
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12
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Walton AE, Janda M, Youl PH, Baade P, Aitken JF, Whiteman DC, Gordon LG, Neale RE. Uptake of skin self-examination and clinical examination behavior by outdoor workers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2014; 69:214-222. [PMID: 24499249 DOI: 10.1080/19338244.2013.771247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study investigated the association between outdoor work and response to a behavioral skin cancer early detection intervention among men 50 years or older. Overall, 495 men currently working in outdoor, mixed, or indoor occupations were randomized to a video-based intervention or control group. At 7 months post intervention, indoor workers reported the lowest proportion of whole-body skin self-examination (wbSSE; 20%). However, at 13 months mixed workers engaged more commonly in wbSSE (36%) compared with indoor (31%) and outdoor (32%) workers. In adjusted analysis, the uptake of early detection behaviors during the trial did not differ between men working in different settings. Outdoor workers compared with men in indoor or mixed work settings were similar in their response to an intervention encouraging uptake of secondary skin cancer prevention behaviors during this intervention trial.
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Affiliation(s)
- Ashley E Walton
- a Institute of Health and Biomedical Innovation, School of Public Health , Queensland University of Technology , Brisbane , Queensland , Australia
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13
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Nahar VK, Ford MA, Hallam JS, Bass MA, Vice MA. Sociodemographic and Psychological Correlates of Sun Protection Behaviors among Outdoor Workers: A Review. J Skin Cancer 2013; 2013:453174. [PMID: 24251040 PMCID: PMC3819754 DOI: 10.1155/2013/453174] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 08/29/2013] [Accepted: 09/01/2013] [Indexed: 11/17/2022] Open
Abstract
Outdoor workers are at a higher risk for developing skin cancer due to their increased sun exposure. The primary objective of this review was to synthesize the current research literature that addresses sociodemographic and psychological factors related to sun protection behaviors in outdoor workers. Two additional purposes were to provide an overview of sun exposure and describe sun protection behaviors of outdoor workers. To identify the studies for this review, a methodical search was performed in the PubMed, PsycInfo, MEDLINE, and ERIC databases. Fifteen studies met the review criteria. Despite regular and prolonged sun exposure, many outdoor workers fail to engage in sufficient sun protection behaviors. Correlates of outdoor workers' sun protection behaviors include being female, older age, being white, personal skin cancer history, time (hours/years) spent at work, sun safety training, perceived prioritization of sun protection, concern about sun exposure, workplace support, families' expectations, and familial information giving. However, limited attention is given to designing theoretically grounded studies to identify factors to inform future research. There is a need to conduct research based on solid theoretical foundations that explains the relationships among the factors in this domain.
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Affiliation(s)
- Vinayak K. Nahar
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, 215 Turner Center, P.O. Box 1848, University, MS 38677, USA
| | - M. Allison Ford
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, 215 Turner Center, P.O. Box 1848, University, MS 38677, USA
| | - Jeffrey S. Hallam
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, 750 Hilltop Drive, Kent, OH 44242, USA
| | - Martha A. Bass
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, 215 Turner Center, P.O. Box 1848, University, MS 38677, USA
| | - Michael A. Vice
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, 215 Turner Center, P.O. Box 1848, University, MS 38677, USA
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Skin Cancer Knowledge, Beliefs, Self-Efficacy, and Preventative Behaviors among North Mississippi Landscapers. Dermatol Res Pract 2013; 2013:496913. [PMID: 24223037 PMCID: PMC3816039 DOI: 10.1155/2013/496913] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/25/2013] [Indexed: 11/17/2022] Open
Abstract
There are slightly over one million workers in the landscape service industry in the US. These workers have potential for high levels of solar ultraviolet radiation exposure, increasing their risk of skin cancer. A cross-sectional sample of 109 landscapers completed a self-administered questionnaire based on Health Belief Model (HBM). The participants correctly answered 67.1% of the knowledge questions, 69.7% believed they were more likely than the average person to get skin cancer, and 87.2% perceived skin cancer as a severe disease. Participants believed that the use of wide-brimmed hats, long sleeved shirts/long pants, and sunscreen was beneficial but reported low usage of these and other sun protective strategies. The primary barriers to using sun protection were “I forget to wear it” and “it is too hot to wear.” Of the HBM variables, perceived benefits outweighing perceived barrier (r = .285, P = .003) and self-efficacy (r = .538, P = .001) were correlated with sun protection behaviors. The reasons for absence of the relationship between perceived skin cancer threat and sun protection behaviors could be lack of skin cancer knowledge and low rate of personal skin cancer history.
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Reeder AI, Gray A, Mccool JP. Occupational Sun Protection: Workplace Culture, Equipment Provision and Outdoor Workers' Characteristics. J Occup Health 2013; 55:84-97. [DOI: 10.1539/joh.12-0182-oa] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anthony I. Reeder
- Cancer Society of New Zealand Social and Behavioral Research Unit, Department of Preventive and Social MedicineDunedin School of Medicine, University of OtagoNew Zealand
| | - Andrew Gray
- Department of Preventive and Social MedicineUniversity of OtagoNew Zealand
| | - Judith P. Mccool
- Department of Social and Community HealthSchool of Population Health, University of AucklandNew Zealand
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Reinau D, Weiss M, Meier C, Diepgen T, Surber C. Outdoor workers’ sun-related knowledge, attitudes and protective behaviours: a systematic review of cross-sectional and interventional studies. Br J Dermatol 2013; 168:928-40. [DOI: 10.1111/bjd.12160] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Duffy SA, Ronis DL, Waltje AH, Choi SH. Protocol of a randomized controlled trial of sun protection interventions for operating engineers. BMC Public Health 2013; 13:273. [PMID: 23530608 PMCID: PMC3616939 DOI: 10.1186/1471-2458-13-273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin cancer are increasing and some types of skin cancer are among the most lethal cancers yet are easily preventable. However, sun protection interventions are rarely implemented among outdoor workers. Our prior work shows that Michigan Operating Engineers (heavy equipment operators) spend an average of 4-5 hours in the sun, about one-third reported getting sun burned at least once a summer, and over half burned more than once a summer. About three-quarters of the sample never or only sometimes used sun block. METHODS/DESIGN Using the Health Belief Model as a guide, this randomized controlled trial (RCT) will test the efficacy of four sun protection interventions targeting Operating Engineers: a) education only; b) education and mailed sunscreen; c) education and text message reminders; and, d) education, mailed sunscreen, and text message reminders. Participations in the study will be offered during regularly scheduled safety trainings at the Local 324 Training Center. Pre- and post-intervention surveys will be collected to determine changes in sunscreen use and sun burning, the primary dependent variables. The analyses will include: a) paired t-tests to determine changes over time (from pre-intervention to post-intervention) in outcome variables (sunscreen use and burning) separately in the 4 intervention groups, b) Repeated Measures Analysis of Variance (RM-ANOVA) to compare the changes in outcomes across the 4 groups, and c) t-tests on change scores as follow-ups to the RM-ANOVA to determine exactly which groups differ from each other. DISCUSSION Based on the outcome of this study, we will develop a RO1 for wider scale testing and dissemination in conjunction with the International Training Center which services North America (including the US, Mexico, and Canada). Wide scale dissemination of an efficacious sun protection intervention has the potential to substantially impact skin cancer rates among this population. The ultimate goal is for high reach, high efficacy, and low cost. TRIAL REGISTRATION NCT01804595.
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Affiliation(s)
- Sonia A Duffy
- School of Nursing, Department of Otolaryngology and Psychiatry, University of Michigan, Ann Arbor VA Center for Clinical Management Research, 400 North Ingalls Building #3178, Ann Arbor, MI 48109-5482, USA.
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Duffy SA, Choi SH, Hollern R, Ronis DL. Factors associated with risky sun exposure behaviors among operating engineers. Am J Ind Med 2012; 55:786-92. [PMID: 22692974 DOI: 10.1002/ajim.22079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective of this study was to determine the factors associated with sun exposure behaviors among Operating Engineers (heavy equipment operators). METHODS Operating Engineers (N = 498) were asked to complete a cross-sectional survey. Linear and logistic regression analyses were used to determine health behavioral, perceptional, and demographic factors associated with sun exposure behavior (sun burns, blistering, use of sunscreen, and interest in sun protection services). RESULTS Almost half reported two or more sunburns/summer and the median times blistering was 2 with a range of 0-100. About one-third never used sun block, while just over one-third rarely used sun block. Almost one-quarter were interested in sun protection guidance. Multivariate analyses showed that perceptions of skin type, alcohol problems, fruit intake, BMI, sleep quality, age, sex, and race were significantly associated with at least one of the outcome variables (P < 0.05). CONCLUSIONS Operating Engineers are at high risk for skin cancer due to high rates of exposure to ultraviolet light and low rates of sun block use. Subgroups of Operating Engineers are particularly at risk for sun damage. Interventions are needed to decrease sun exposure among Operating Engineers.
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Affiliation(s)
- Sonia A Duffy
- University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
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19
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Abstract
The increase in skin cancer prevalence globally has prompted a range of health promotion sun safety initiatives. An area where evidence has been lacking is on the long-term impact of some of these initiatives on the attitudes and sun protection behaviour of young adults and of the sun protection measures used by people using city parks. This article disseminates a study that examined the knowledge, attitude and behaviour of 18- to 28-year-old Caucasian park users. An interview questionnaire was used with behaviour validation incorporated to corroborate the results and reduce recall bias. A cross comparison of answers and placement into pre-coded responses were made at regular intervals to ensure consistency of data collection. Knowledge of risks associated with sun exposure and knowledge of sun protection methods was high. The most common sources of knowledge on skin cancer prevention were parents and family, followed by television, then magazines and newspapers. Surprisingly, the citing of school sun safety health promotion initiatives as a source of knowledge was low. The vast majority of females and males felt that a suntan had aesthetic qualities and made them look more attractive and healthy. Only a small number of the participants' sun protection behaviour in the park corresponded with their reported normal sun protection behaviour. Males in this study use sunscreen less than females. Females also used sunscreen with a higher sun protection factor. Seeking a tan is intentional behaviour undertaken by the majority of the participants, although females were more likely to seek a tan in comparison to males. The majority of participants had experienced sunburn in the summer period with some reporting severe sunburn. Recommendations are made for a gender specific health promotion approach, which targets familial education with a supportive environment in the school or public domain.
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Affiliation(s)
- Trudy Hedges
- HCML Health & Case Management Limited, Melrose House, 42 Dingwall Road, Croydon, Surrey, CR0 2NE, United Kingdom.
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20
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Sun protection intervention for highway workers: long-term efficacy of UV photography and skin cancer information on men's protective cognitions and behavior. Ann Behav Med 2010; 38:225-36. [PMID: 20049658 PMCID: PMC2819486 DOI: 10.1007/s12160-009-9151-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The risk for skin cancer is increased among older males and outdoor workers who have high levels of ultraviolet (UV) exposure. Purpose This study was designed to examine the long-term efficacy of UV photography interventions on male outdoor workers, the potential mediators of its impact, and the efficacy of UV photography and skin cancer vs. aging information with this population. Methods One hundred forty-eight male outdoor workers were randomly assigned to one of four intervention conditions or a control condition in a two by two plus one factorial design. The men in the intervention conditions received or did not receive a UV photo of their face and watched either a photoaging or skin cancer educational video. Participants completed pre-intervention, immediate post-intervention, and 2-month and 1-year follow-up assessments. Results Analysis of covariance and structural equation modeling revealed that participants in the UV photography and cancer information interventions reported higher levels of sun protection cognitions, which were significant partial mediators of increases in sun protection behaviors and decreases in skin color. Conclusions This study provides evidence for effective sun protection interventions on male outdoor workers that may help reduce skin cancer risk.
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21
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Kütting B, Drexler H. UV-induced skin cancer at workplace and evidence-based prevention. Int Arch Occup Environ Health 2010; 83:843-54. [PMID: 20414668 DOI: 10.1007/s00420-010-0532-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 04/06/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE The present review is aimed at providing an overview of skin cancer with particular focus on occupational concern and giving evidence-based recommendation for effective prevention at workplace. METHODS We performed a systematic search of literature using PubMed and the Cochrane Library. RESULTS Outcome of preventive strategies depends either on efficacy of the strategy itself but also on acceptance and implementation of protective means among the persons at possible risk for hazardous health effects. Epidemiological studies have reported significantly more non-melanoma skin cancer in men than in women. Life-style choices and difference in immunosuppression play a major role in this gender disparity. Tumor biology of skin cancer is diverging: severe blistering sunburns corresponding to intermittent intense UV exposures are associated with an increased risk for both melanoma and basal cell carcinoma (BCC); whereas the risk of squamous cell carcinoma (SCC) and actinic keratoses (AK) is strongly associated with chronic UV exposure. Several clinical trials give evidence that long-term use of sunscreen prevents the appearance of non-melanotic skin cancer such as AK and SCC, but not of BCC. All technical and organizing measures aimed at reducing UV exposure at workplace belong to first-line prevention; however, there is much room for improvement. The efficacy of personal protection means (second-line strategy) strongly depends on the workers' compliance which is quite low at workplace. CONCLUSION Evidence-based data confirming the benefit of sun protective strategies are scarce, general recommendations are mainly based on the avoidance of UV radiation being identified as potential risk factor for non-melanoma skin cancer in epidemiological studies. Occupational screenings should include regular interventions aimed at enhancing a clear understanding of risk factors for individuals and finally improving the acceptance and maintenance for UV-protective means at workplace.
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Affiliation(s)
- Birgitta Kütting
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen- Nuremberg, Schillerstr. 25 + 29, 91054, Erlangen, Germany.
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Glanz K, Buller DB, Saraiya M. Reducing ultraviolet radiation exposure among outdoor workers: state of the evidence and recommendations. Environ Health 2007; 6:22. [PMID: 17686155 PMCID: PMC1995198 DOI: 10.1186/1476-069x-6-22] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 08/08/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Outdoor workers have high levels of exposure to ultraviolet radiation and the associated increased risk of skin cancer. This paper describes a review of: 1) descriptive data about outdoor workers' sun exposure and protection and related knowledge, attitudes, and policies and 2) evidence about the effectiveness of skin cancer prevention interventions in outdoor workplaces. DATA SOURCES Systematic evidence-based review. DATA SYNTHESIS We found variable preventive practices, with men more likely to wear hats and protective clothing and women more likely to use sunscreen. Few data document education and prevention policies. CONCLUSION Reports of interventions to promote sun-safe practices and environments provide encouraging results, but yield insufficient evidence to recommend current strategies as effective. Additional efforts should focus on increasing sun protection policies and education programs in workplaces and evaluating whether they improve the health behavior of outdoor workers.
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Affiliation(s)
- Karen Glanz
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, Georgia, 30322, USA
| | | | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, Georgia, USA
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Antoine M, Pierre-Edouard S, Jean-Luc B, David V. Effective exposure to solar UV in building workers: influence of local and individual factors. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2007; 17:58-68. [PMID: 16926862 DOI: 10.1038/sj.jes.7500521] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Excessive exposure to solar UV light is the main cause of skin cancers in humans. UV exposure depends on environmental as well as individual factors related to activity. Although outdoor occupational activities contribute significantly to the individual dose received, data on effective exposure are scarce and limited to a few occupations. A study was undertaken in order to assess effective short-term exposure among building workers and characterize the influence of individual and local factors on exposure. The effective exposure of construction workers in a mountainous area in the southern part of Switzerland was investigated through short-term dosimetry (97 dosimeters). Three altitudes, of about 500, 1500 and 2500 m were considered. Individual measurements over 20 working periods were performed using Spore film dosimeters on five body locations. The postural activity of workers was concomitantly recorded and static UV measurements were also performed. Effective exposure among building workers was high and exceeded occupational recommendations, for all individuals for at least one body location. The mean daily UV dose in plain was 11.9 SED (0.0-31.3 SED), in middle mountain 21.4 SED (6.6-46.8 SED) and in high mountain 28.6 SED (0.0-91.1 SED). Measured doses between workers and anatomical locations exhibited a high variability, stressing the role of local exposure conditions and individual factors. Short-term effective exposure ranged between 0 and 200% of ambient irradiation, indicating the occurrence of intense, subacute exposures. A predictive irradiation model was developed to investigate the role of individual factors. Posture and orientation were found to account for at least 38% of the total variance of relative individual exposure, and were also found to account more than altitude on the total variance of effective daily exposures. Targeted sensitization actions through professional information channels and specific prevention messages are recommended. Altitude outdoor workers should also benefit from preventive medical examination.
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Affiliation(s)
- Milon Antoine
- Institute of Occupational Health Sciences IST, Lausanne, Switzerland
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Kimlin MG, Tenkate TD. Occupational exposure to ultraviolet radiation: the duality dilemma. REVIEWS ON ENVIRONMENTAL HEALTH 2007; 22:1-37. [PMID: 17508696 DOI: 10.1515/reveh.2007.22.1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Human exposure to ultraviolet (UV) radiation is a component of everyday life and a significant hazard for outdoor workers. In addition, a large range of artificial sources also has the potential to provide extreme occupational UV exposure. Even though the human health risks of overexposure to UV are well documented, to date relatively little is known quantitatively about UV exposure. For example, the evidence indicates that workers who are exposed to particular sources (for example, welding arcs) are exposed to extreme UV exposures, despite the use of current control measures. In contrast, increasing evidence points to significant health impacts resulting from underexposure to UV, particularly with the production (or more correctly lack of production) of vitamin D in the skin. The latter poses a serious issue for the work-force, with specific risks for workers lacking adequate sun exposure-underground miners, long-haul flight crews, shift workers, and perhaps indoor workers. Using a risk-management approach, this paper provides a comprehensive review of occupational UV sources, health impact of occupational UV exposure, occupational exposure standards, and levels of exposure in various settings, and discusses the appropriate control measures. In addition, the duality aspect of health impacts from overexposure and underexposure to UV and the associated occupational health implications are specifically explored.
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Affiliation(s)
- Michael G Kimlin
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Laporte J. Sensibilisation des salariés du bâtiment et des travaux publics au risque solaire : pour une prévention efficace. ARCH MAL PROF ENVIRO 2006. [DOI: 10.1016/s1775-8785(06)70486-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lewis EC, Mayer JA, Slymen D. Postal workers' occupational and leisure-time sun safety behaviors (United States). Cancer Causes Control 2006; 17:181-6. [PMID: 16425096 DOI: 10.1007/s10552-005-0482-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Accepted: 09/06/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES United States Postal Service letter carriers are exposed to long bouts of UVR and thus are vulnerable to skin cancer. While previous studies have shown that occupational sun protection is often deficient, few studies have examined outdoor workers' behavior during leisure time. METHODS Subjects (n = 2,660) self-reported widebrim hat and sunscreen use over the past five workdays and past two non-working days using Likert-type scales. Generalized linear mixed models and generalized estimating equations were used to compare hat and sunscreen rates and predictors during occupational and leisure time. RESULTS On average, carriers spent 3.9 h outside during workdays and 3.3 h during non-working days. Sunscreen and widebrim hat use during the workday is low and rates of use are significantly lower during non-working days. CONCLUSIONS Sun safety interventions for carriers should encourage sun protection at all times when outdoors.
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Affiliation(s)
- Elizabeth C Lewis
- Graduate School of Public Health, San Diego State University, Hardy Tower 119, San Diego, CA, 92182-4162, USA
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