Quantification of personal solar UV exposure of outdoor workers, indoor workers and adolescents at two locations in Southeast Queensland

Relationship between climate change and skin cancer and implications for prevention and management: a scoping review

OBJECTIVES

This study aimed to explore the published research on the relationship between climate change and skin cancer and the implications for prevention, management and further research.

STUDY DESIGN

Scoping review.

METHODS

This scoping review following JBI methodology reviewed English articles identified in searches of MEDLINE, Embase, CINAHL, Web of Science and Scopus on 14 April 2023. The screening of articles was completed by two independent reviewers. Data were extracted by a single reviewer and checked by another. A causal pathway diagram was iteratively developed throughout the review and was used to categorise the findings.

RESULTS

The search identified 1376 papers, of which 45 were included in the final review. Nine papers reported primary research, and 36 papers were reviews, perspectives, commentaries, editorials, or essays. The papers examined climate change influencing behaviours related to ultraviolet exposure (30 papers), ambient temperature (21 papers) and air pollution (five papers) as possible risk factors; occupational, rural, and contextual factors affecting skin cancer (11 papers); and prevention and access to health care in the context of climate change (seven papers). Most papers were published in journals in subject areas other than health.

CONCLUSIONS

This review identified ultraviolet radiation, occupation, rising temperature, individual behaviour and air pollution as possible influences on skin cancer rates. Furthermore, it highlights the complexity and uncertainties in the relationship between climate change and skin cancer and the need for further research on this relationship, including primary epidemiological research and reviews that follow recognised review guidelines and include assessment of health services and social determinants in the causal pathways of this relationship.

Ocular and Facial Far-UVC Doses from Ceiling-Mounted 222 nm Far-UVC Fixtures

Far-UVC radiation, defined in this paper as ultraviolet (UV) radiation with wavelengths from 200 to 235 nm, is a promising tool to help prevent the spread of disease. The unique advantage of far-UVC technology over traditional UV germicidal irradiation lies in the potential for direct application of far-UVC into occupied spaces since antimicrobial doses of far-UVC are significantly below the recommended daily safe exposure limits. This study used a ceiling-mounted far-UVC fixture emitting at 222 nm to directly irradiate an indoor space and then evaluated the doses received upon a manikin. Radiation-sensitive film was affixed to the head, nose, lip and eyes of the manikin, and the 8-h equivalent exposure dose was determined. Variables examined included manikin height (sitting or standing position), manikin offset from directly below the fixture, tilt of the manikin, the addition of glasses, the addition of hair and different anatomical feature sizes. Importantly, at the manikin position with the highest dose to eyes, the average eye dose was only 5.8% of the maximum directly measured dose. These results provide the first experimental analysis of possible exposure doses a human would experience from an indoor far-UVC installation.

Review on Occupational Personal Solar UV Exposure Measurements

During leisure time, people can decide if they want to expose themselves to solar ultraviolet (UV) radiation and to what extent. While working, people do not have this choice. Outdoor workers are exposed to solar UV radiation (UVR) on a daily basis. This may pose a certain health risk, which can be estimated when the personal solar UVR exposure (PE) is known. During past decades, a variety of studies were conducted to measure PE of outdoor workers and our knowledge of the PE of outdoor workers has increased remarkably. As shown by this review, studies clearly indicate that PE of most outdoor workers exceeds the internationally proposed threshold limit value, which is comparable to 1.0 to 1.3 standard erythema dose (SED), respectively, to 1.1 to 1.5 UV Index received over one hour. Besides working in a high UVR environ, monotonic workflow (limited movement, nearly static posture) is a risk factor. In such cases, PE can be higher than ambient UVR. In this review, we provide also a list of milestones, depicting the progress and the most important findings in this field during the past 45 years. However, in many respects our knowledge is still rudimentary, for several reasons. Different measuring positions have been used so that measured PE is not comparable. Few studies were designed to enable the extension of measured PE to other locations or dates. Although the importance of a proper calibration of the measuring devices in respect to the changing solar spectrum was pointed out from the beginning, this is often not performed, which leads to high uncertainties in the presented PE levels. At the end of our review, we provide some key points, which can be used to evaluate the quality of a study respectively to support the design of future studies.

Electronic Sun Journal Versus Self-report Sun Diary: A Comparison of Recording Personal Sunlight Exposure Methods

This research compared personal sunlight exposure times monitored electronically within suburban Australian environments against self-report paper journals for determining the timing and total duration of individual exposure to daily solar radiation. A total of 90 Electronic Sun Journal (ESJ) daily readings and self-report timing and duration estimates of exposure for weekend and weekdays were compared. A Wilcoxon ranked sign test showed a significant difference (V = 157, P < 0.001) between the duration of exposure recorded electronically and the duration of exposure that was self-reported in a diary. There was also found to be a statistically significant difference between total exposure time measured using both methods for weekends (V = 10, P < 0.001) and weekdays (V = 87, P < 0.001). General trends in outdoor exposure timing confirmed that the most frequent daily exposures received over the weekend occurred between 1 and 2 h earlier than the most frequent exposures received on weekdays. This preliminary research found that exposure durations as recorded by the ESJ were longer on the weekends compared to weekdays (W = 402, P < 0.001) and confirmed that the ESJ is a viable alternative to self-reporting diaries.

Prognostic Impact of Perineural Invasion in Cutaneous Squamous Cell Carcinoma: Results of a Prospective Study of 1,399 Tumors

Perineural infiltration (PNI) and desmoplasia are believed to be high-risk factors in the prognosis of squamous cell carcinoma (SCC). In the literature, dependences between PNI, de-differentiation, and desmoplasia remain unclear. The aim of this study was to analyze the respective prognostic impact of these factors in regard to local recurrence and metastasis. Between 2005 and 2015, 1,399 unselected primary SCCs of 1,434 patients were diagnosed. If a patient had multiple tumors, the tumor with the highest risk profile was selected. Histological sections of all tumors with a tumor thickness of ≥6 mm and desmoplastic SCC with a tumor thickness of 2.1-5.9 mm were re-examined for PNI. Median follow-up was 36.5 months. PNI was present exclusively within tumors of the desmoplastic type (14.5%). PNI was present significantly more often in patients developing lymph node metastasis (3% all non-desmoplastic SCC, 17% desmoplastic SCC, and 29% desmoplastic SCC with PNI) and local recurrence (3%, 26%, and 64%) and associated with overall tumor-specific death (4%, 25%, and 54%). Using a multivariate model of disease recurrence, tumor thickness ≥6 mm, tumor horizontal size ≥20 mm, immunosuppression, desmoplasia, and PNI remained significant factors. In conclusion, PNI was found to be an additional marker indicative of an unfavorable prognosis and an independent high-risk factor within the desmoplastic type of SCC.

Does Incident Solar Ultraviolet Radiation Lower Blood Pressure?

Background Hypertension remains a leading global cause for premature death and disease. Most treatment guidelines emphasize the importance of risk factors, but not all are known, modifiable, or easily avoided. Population blood pressure correlates with latitude and is lower in summer than winter. Seasonal variations in sunlight exposure account for these differences, with temperature believed to be the main contributor. Recent research indicates that UV light enhances nitric oxide availability by mobilizing storage forms in the skin, suggesting incident solar UV radiation may lower blood pressure. We tested this hypothesis by exploring the association between environmental UV exposure and systolic blood pressure (SBP) in a large cohort of chronic hemodialysis patients in whom SBP is determined regularly. Methods and Results We studied 342 457 patients (36% black, 64% white) at 2178 US dialysis centers over 3 years. Incident UV radiation and temperature data for each clinic location were retrieved from the National Oceanic and Atmospheric Administration database. Linear mixed effects models with adjustment for ambient temperature, sex/age, body mass index, serum Na+/K+ and other covariates were fitted to each location and combined estimates of associations calculated using the DerSimonian and Laird procedure. Pre-dialysis SBP varied by season and was ≈4 mm Hg higher in black patients. Temperature, UVA and UVB were all linearly and inversely associated with SBP. This relationship remained statistically significant after correcting for temperature. Conclusions In hemodialysis patients, in addition to environmental temperature, incident solar UV radiation is associated with lower SBP. This raises the possibility that insufficient sunlight is a new risk factor for hypertension, perhaps even in the general population.

The Early Days of Personal Solar Ultraviolet Dosimetry

In the early 1970s, environmental conservationists were becoming concerned that a reduction in the thickness of the atmospheric ozone layer would lead to increased levels of ultraviolet (UV) radiation at ground level, resulting in higher population exposure to UV and subsequent harm, especially a rise in skin cancer. At the time, no measurements had been reported on the normal levels of solar UV radiation which populations received in their usual environment, so this lack of data, coupled with increasing concerns about the impact to human health, led to the development of simple devices that monitored personal UV exposure. The first and most widely used UV dosimeter was the polymer film, polysulphone, and this review describes its properties and some of the pioneering studies using the dosimeter that led to a quantitative understanding of human exposure to sunlight in a variety of behavioral, occupational, and geographical settings.

Sun exposure of indoor workers in the UK – survey on the time spent outdoors

A lifestyle questionnaire has been used to obtain information on the time spent outdoors by indoor workers that could be used in combination with dosimetry studies in smaller targeted groups to quantify UV exposure for health risk/benefit analysis.

Low-Cost Flexible ZnO Microwires Array Ultraviolet Photodetector Embedded in PAVL Substrate

With the advent of wearable device technology, fabrication of inorganic semiconductor devices on flexible organic substrates is of great interest. In this paper, a fascinating method and a low-cost flexible substrate material polyvinyl alcohol (PVAL) have been utilized to embed ZnO microwire (MW) array to produce ultraviolet (UV) photodetector (PD) with decent photoresponsivity. The flexible PVAL substrate is relatively cheap and has better bendability as compared to polyethylene terephthalate (PET) and other traditional flexible substrate materials, which makes it unique in comparison to traditional devices. The device shows a current photoresponsivity of 29.6 A/W in the UV spectral range (350 to 380 nm) and maintains an excellent detection performance with even a bending angle of 180°. In dark, a low current of 1.4 μA at 5 V bias and response time of 4.27 ms was observed. In addition to the excellent device performance at wide bending angles, the fabricated device also performs well with the bending radii close to 0. Therefore, ZnO MW array PD has a great potential for the real-time monitoring of harmful UV exposure to warn the users for the appropriate arrangement avoidance.

Review on Nonoccupational Personal Solar UV Exposure Measurements

Solar ultraviolet (UV) radiation follows people during their whole life. Exposure to UV radiation is vital but holds serious risks, too. The quantification of human UV exposure is a complex issue. UV exposure is directly related to incoming UV radiation as well as to a variety of factors such as the orientation of the exposed anatomical site with respect to the sun and the duration of exposure. The use of badge-sensors allows assessing the UV exposure of differently oriented body sites. Such UV devices have been available for over 40 years, and a variety of measuring campaigns have been undertaken since then. This study provides an overview of those studies which reported measurements of the personal UV exposure (PE) during outdoor activities of people not related to their occupation. This overview is given chronologically to show the progress of knowledge in this research and is given with respect to different activities. Special focus is put on the ratio of personal exposure to ambient UV radiation. This ratio, when given as a function of solar elevation, allows estimating PE at any other location or date if ambient UV radiation is known.

Efficiency of ocular UV protection by clear lenses

Ocular UV doses accumulate all-day, not only during periods of direct sun exposure. The UV protection efficiency of three clear lenses was evaluated experimentally, validated by simulation, and compared to non-UV protection: a first spectacle lens with a tailored UV absorber, a second spectacle lens, minimizing UV back reflections, as well as a third spectacle lens, combining both. A tailored UV-absorber efficiently reduced overall UV irradiance to 7 %, whereas reduction of back-reflections still left UV irradiance at 42 %. Thus, clear lenses with a tailored UV absorber efficiently protect the eye from UV, supplementing sun glasses wear to an all-day protection scenario.

Duration of Casual Sunlight Exposure Necessary for Adequate Vitamin D Status in Indian Men

OBJECTIVES

To investigate the duration of casual sunlight ultraviolet-B (UVB) exposure required to maintain optimal Vitamin D status (25-hydroxyvitamin-D [25(OH)D]) >50 nmol/L in urban Indian men, using polysulfone (PSU) dosimeters and a sunlight exposure questionnaire.

METHODS

In healthy men (aged 40-60 years) from Pune (18.52° N, 73.86° E), India, serum 25(OH)D was measured using enzyme-linked immunosorbent assay. Sunlight exposure was assessed using PSU dosimeter and by questionnaire.

RESULTS

Of 160 men (48.3 ± 5.6 years), 26.8% were deficient and 40.6% had insufficient Vitamin D concentrations. A hyperbolic function for the relationship between PSU measured sunlight exposure in standard erythema dose (SED) and serum 25(OH)D concentrations (r = 0.87, P < 0.01) revealed that daily exposure of 1 SED was sufficient to maintain serum 25(OH)D concentrations over 50 nmol/L. The curve plateaued around 5 SED (80 nmol/L) and extrapolation of the curve (>5 SED) did not increase 25(OH)D concentrations above 90 nmol/L. Receiver operating curve analysis confirmed that 1 SED-UV exposure was sufficient to maintain 25(OH)D concentrations over 50 nmol/L. Based on the questionnaire data, >1 h of midday casual sunlight exposure was required to maintain serum 25(OH)D concentrations above 50 nmol/L. Duration of sunlight exposure assessed by questionnaire and PSU dosimeter showed a significant correlation (r = 0.517, P < 0.01).

CONCLUSION

In urban Indian men, >1 h of casual midday sunlight exposure daily was required to maintain serum 25(OH)D concentrations above 50 nmol/L, and >2 h of casual sunlight exposure was needed to maintain 25(OH)D concentrations above 75 nmol/L. Excess sunlight did not increase 25(OH)D linearly. The sunlight exposure questionnaire was validated for use in clinical studies and surveys.

All-inkjet-printed flexible ZnO micro photodetector for a wearable UV monitoring device

Fabrication of small-sized patterns of inorganic semiconductor onto flexible substrates is a major concern when manufacturing wearable devices for measuring either biometric or environmental parameters. In this study, micro-sized flexible ZnO UV photodetectors have been thoroughly prepared by a facile inkjet printing technology and followed with heat treatments. A simple ink recipe of zinc acetate precursor solution was investigated. It is found that the substrate temperature during zinc precursor ink depositing has significant effects on ZnO pattern shape, film morphology, and crystallization. The device fabricated from the additive manufacturing approach has good bendability, Ohmic contact, short response time as low as 0.3 s, and high on/off ratio of 3525. We observed the sensor's dependence of response/decay time by the illuminating UV light intensity. The whole process is based on additive manufacturing which has many benefits such as rapid prototyping, saving material, being environmentally friendly, and being capable of creating high-resolution patterns. In addition, this method can be applied to flexible substrates, which makes the device more applicable for applications requiring flexibility such as wearable devices. The proposed all-inkjet-printing approach for a micro-sized ZnO UV photodetector would significantly simplify the fabrication process of micro-sized inorganic semiconductor-based devices. A potential application is real-time monitoring of UV light exposure to warn users about unsafe direct sunlight to implement suitable avoidance solutions.

Equivalence between solar irradiance and solar simulators in aging tests of sunglasses

Background

This work is part of a broader research that focuses on ocular health. Three outlines are the basis of the pyramid that comprehend the research as a whole: authors’ previous work, which has provided the public to self-check their own sunglasses regarding the ultraviolet protection compatible to their category; Brazilian national survey in order to improve nationalization of sunglasses standards; and studies conducted on revisiting requirements of worldwide sunglasses standards, in which this work is inserted. It is still controversial on the literature the ultraviolet (UV) radiation effects on the ocular media, but the World Health Organization has established safe limits on the exposure of eyes to UV radiation based on the studies reported in literature. Sunglasses play an important role in providing safety, and their lenses should provide adequate UV filters. Regarding UV protection for ocular media, the resistance-to-irradiance test for sunglasses under many national standards requires irradiating lenses for 50 uninterrupted hours with a 450 W solar simulator. This artificial aging test may provide a corresponding evaluation of exposure to the sun.

Methods

Calculating the direct and diffuse solar irradiance at a vertical surface and the corresponding radiant exposure for the entire year, we compare the latter with the 50-h radiant exposure of a 450 W xenon arc lamp from a solar simulator required by national standards.

Results

Our calculations indicate that this stress test is ineffective in its present form.

Conclusions

We provide evidence of the need to re-evaluate the parameters of the tests to establish appropriate safe limits for UV irradiance.

Significance

This work is potentially significant for scientists and legislators in the field of sunglasses standards to improve the requirements of sunglasses quality and safety.

UVR exposure and vitamin D in a rural population. A study of outdoor working farmers, their spouses and children

BACKGROUND

Living and working in the countryside may result in excessive UVR exposure, with increased risk of skin cancer. Some sun exposure is, however, recommended, since vitamin D production is UVB-dependent.

OBJECTIVES

To examine UVR exposure and vitamin D levels in a rural population of outdoor working male farmers, their indoor working spouses and their children, expected to receive high UVR exposure.

METHODS

Prospective, cohort study. During the summer 2009 daily, personal UVR exposure and sun behaviour were recorded by dosimetry and diaries (17 403 days). Vitamin D was measured at the end of summer and the following winter.

RESULTS

Risk behaviour (= exposure of shoulders/upper body to the sun), beach days, sunscreen use and sunburns were infrequent. Farmers and boys had the highest daily UVR exposure (both 1.5 SED per day), likewise on work days. On non-work days the UVR exposure was even higher (up to 2.0 SED per day). Farmers, girls and boys had a higher chronic UVR exposure than the spouses, who had more intermittent high UVR exposure. Vitamin D levels did not differ between family members. At the end of summer 16% of the participants were vitamin D insufficient, the following winter, 61%. Some UVR exposure variables correlated positively, but weakly, with vitamin D levels.

CONCLUSIONS

UVR exposure was generally high among this study population, however, vitamin D levels still dropped below the recommended level during winter for most participants. Differences in UVR exposure between the groups did not result in differences in vitamin D levels.

Occupational exposure to solar radiation in Australia: who is exposed and what protection do they use?

OBJECTIVE

Solar ultraviolet radiation (UVR) exposure is widely recognised as a leading cause of skin cancer, with outdoor workers being particularly at risk. Little is known on a national level about how many workers are exposed to solar radiation, the circumstances in which they are exposed, or their use of protective measures.

METHODS

The Australian Work Exposures Study (AWES) was a cross-sectional telephone survey of 5,023 Australian workers aged 18 to 65. A subset of 1,113 respondents who indicated they worked outdoors was asked about their exposure to solar radiation in terms of the amount of time they spent working outdoors, their working location and their use of sun protective measures.

RESULTS

A total of 1,100 respondents (22% overall) were assessed as being exposed to solar radiation at work. Exposure was more likely among males and those residing in lower socioeconomic and regional areas. Sun protection was used by 95% of the respondents, although the level of protection varied among workers, with only 8.7% classified as fully protected.

CONCLUSIONS

This study provides valuable information regarding solar exposure that has not previously been available.

IMPLICATIONS

The results of this study will inform strategies for risk reduction.

The relationship between ambient ultraviolet radiation (UVR) and objectively measured personal UVR exposure dose is modified by season and latitude

Despite the widespread use of ambient ultraviolet radiation (UVR) as a proxy measure of personal exposure to UVR, the relationship between the two is not well-defined.

The AusD Study: a population-based study of the determinants of serum 25-hydroxyvitamin D concentration across a broad latitude range

Observational studies suggest that people with a high serum 25-hydroxyvitamin D (25(OH)D) concentration may have reduced risk of chronic diseases such as osteoporosis, multiple sclerosis, type 1 diabetes, cardiovascular disease, and some cancers. The AusD Study (A Quantitative Assessment of Solar UV Exposure for Vitamin D Synthesis in Australian Adults) was conducted to clarify the relationships between ultraviolet (UV) radiation exposure, dietary intake of vitamin D, and serum 25(OH)D concentration among Australian adults residing in Townsville (19.3°S), Brisbane (27.5°S), Canberra (35.3°S), and Hobart (42.8°S). Participants aged 18-75 years were recruited from the Australian Electoral Roll between 2009 and 2010. Measurements were made of height, weight, waist:hip ratio, skin, hair, and eye color, blood pressure, and grip strength. Participants completed a questionnaire on sun exposure and vitamin D intake, together with 10 days of personal UV dosimetry and an associated sun-exposure and physical-activity diary that was temporally linked to a blood test for measurement of 25(OH)D concentration. Ambient solar UV radiation was also monitored at all study sites. We collected comprehensive, high-quality data from 1,002 participants (459 males, 543 females) assessed simultaneously across a range of latitudes and through all seasons. Here we describe the scientific and methodological issues considered in designing the AusD Study.

Development and validation of sunlight exposure measurement questionnaire (SEM-Q) for use in adult population residing in Pakistan

Background

Vitamin D deficiency has been identified as a major public health problem worldwide. Sunlight is the main source of vitamin D and its measurement using dosimeters is expensive and difficult for use in population-based studies. Hence, the aim of this study was to develop and validate questionnaires to assess sunlight exposure in healthy individuals residing in Karachi, Pakistan.

Methods

Two questionnaires with seven important items for sunlight exposure assessment were developed. Fifty four healthy adults were enrolled based on their reported sunlight exposure (high = 17, moderate = 18, low = 19) from Aga Khan University, Karachi. Over four days, study participants were asked to wear a dosimeter between sunrise and sunset and report time spent and activities undertaken in the sun for questionnaire validation. Algorithm for item weightage was created as an average score based on ultraviolet B percentage received. Blood samples were obtained for serum vitamin D.

Results

The mean time (minutes) spent in sun over 4 days (±SD) was 69.5 (±32) for low, 83.5 (±29.7) for moderate and 329 (±115) for high exposure group. The correlation between average time (minutes) spent in sun over 4 days and mean change in absorbance of UV dosimeters for 4 days was 0.60 (p < 0.01). Correlation between average score and vitamin D levels was found to be 0.36 (p = 0.01) for short term questionnaire score, 0.43 (p = 0.01) for long term questionnaire score in summers and 0.48 (p = 0.01) in winters.

Conclusions

The sunlight exposure measurement questionnaires were valid tools for use in large epidemiological studies to quantify sunlight exposure.

A critical assessment of two types of personal UV dosimeters

Doses of erythemally weighted irradiances derived from polysulphone (PS) and electronic ultraviolet (EUV) dosimeters have been compared with measurements obtained using a reference spectroradiometer. PS dosimeters showed mean absolute deviations of 26% with a maximum deviation of 44%, the calibrated EUV dosimeters showed mean absolute deviations of 15% (maximum 33%) around noon during several test days in the northern hemisphere autumn. In the case of EUV dosimeters, measurements with various cut-off filters showed that part of the deviation from the CIE erythema action spectrum was due to a small, but significant sensitivity to visible radiation that varies between devices and which may be avoided by careful preselection. Usually the method of calibrating UV sensors by direct comparison to a reference instrument leads to reliable results. However, in some circumstances the quality of measurements made with simple sensors may be over-estimated. In the extreme case, a simple pyranometer can be used as a UV instrument, providing acceptable results for cloudless skies, but very poor results under cloudy conditions. It is concluded that while UV dosimeters are useful for their design purpose, namely to estimate personal UV exposures, they should not be regarded as an inexpensive replacement for meteorological grade instruments.

Estimating natural UV personal exposure with radiative transfer calculations

The following study has investigated whether straightforward radiative transfer calculations can be used to adequately document natural UV personal exposure. The method was evaluated by comparing the results with erythemal doses accumulated by polysulphone films positioned on mannequins. The calculations succeeded in reproducing the variability associated with changing solar zenith angle and atmospheric conditions. A possible use of the model has been illustrated by estimating the daily exposure during 1 y of a hypothetical office worker, according to a simple occupational schedule. The calculated daily exposures indicated the importance of holiday periods in the risk of acute overexposure and in the total yearly dose.

Vitamin D intake needed to maintain target serum 25-hydroxyvitamin D concentrations in participants with low sun exposure and dark skin pigmentation is substantially higher than current recommendations

Cutaneous cholecalciferol synthesis has not been considered in making recommendations for vitamin D intake. Our objective was to model the effects of sun exposure, vitamin D intake, and skin reflectance (pigmentation) on serum 25-hydroxyvitamin D (25[OH]D) in young adults with a wide range of skin reflectance and sun exposure. Four cohorts of participants (n = 72 total) were studied for 7-8 wk in the fall, winter, spring, and summer in Davis, CA [38.5 degrees N, 121.7 degrees W, Elev. 49 ft (15 m)]. Skin reflectance was measured using a spectrophotometer, vitamin D intake using food records, and sun exposure using polysulfone dosimeter badges. A multiple regression model (R(2) = 0.55; P < 0.0001) was developed and used to predict the serum 25(OH)D concentration for participants with low [median for African ancestry (AA)] and high [median for European ancestry (EA)] skin reflectance and with low [20th percentile, approximately 20 min/d, approximately 18% body surface area (BSA) exposed] and high (80th percentile, approximately 90 min/d, approximately 35% BSA exposed) sun exposure, assuming an intake of 200 iu/d (5 ug/d). Predicted serum 25(OH)D concentrations for AA individuals with low and high sun exposure in the winter were 24 and 42 nmol/L and in the summer were 40 and 60 nmol/L. Corresponding values for EA individuals were 35 and 60 nmol/L in the winter and in the summer were 58 and 85 nmol/L. To achieve 25(OH)D > or =75 nmol/L, we estimate that EA individuals with high sun exposure need 1300 iu/d vitamin D intake in the winter and AA individuals with low sun exposure need 2100-3100 iu/d year-round.

Geographic location and vitamin D synthesis

Most of the population receive their nutritional vitamin D requirements through exposure to solar ultraviolet (UV) radiation, with cutaneous synthesis estimated to provide 80-100% of the vitamin D requirements of the body. However, little is understood about the basic interaction of sunlight (UV) exposure and the subsequent photobiology and photochemistry of vitamin D production in humans. Low vitamin D (blood serum 25[OH]D) status has been linked to the development of a surprisingly wide range of diseases. Epidemiological data and animal studies indicate that low vitamin D is linked to rickets, bone mass loss, multiple sclerosis, hypertension, breast cancer, prostate cancer, colorectal cancer, insulin dependent diabetes and schizophrenia. Importantly some this emerging research associates such diseases with location and subsequent ultraviolet radiation exposures. This paper overviews concepts important to consider when assessing the impact of location and UV exposure on vitamin D synthesis.

Dosimetric and Spectroradiometric Investigations of Glass-Filtered Solar UV†

The aims of this paper were to investigate how glass-filtered UV irradiances vary with glass thickness, lamination of the glass and the effect of solar zenith angle (SZA), and to measure the glass-filtered UV exposures to different receiving planes with a newly developed UVA dosimeter. Spectroradiometric and dosimetric techniques were employed in the experimental approach. The percentage of the glass-filtered solar UV compared to the unfiltered UV ranged from 59% to 70% and was influenced to a small extent by the glass thickness and the SZA. The laminated glass transmitted 11 to 12% and the windscreen glass transmitted 2.5-2.6%. The influence of the SZA was less for the thicker glass than it was for the thinner glass. The change in transmission was less than 14% for the SZA between 48 degrees and 71 degrees. There was negligible influence due to the SZA on the glass-transmitted UV of the laminated and windscreen glass. The influence of the glass thickness in the range of 2-6 mm on the percentage transmission was less than 16%. The influences of the glass thickness and the SZA on the glass-transmitted UV have been incorporated in the use of a UVA dosimeter for the glass-transmitted UV exposures. The UVA dosimeter was employed in the field to measure the glass-filtered UV exposures to different receiving planes. The UVA dosimeter reported has the potential for personal solar UVA exposure measurements.

Occupational exposure to ultraviolet radiation: the duality dilemma

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.

The objective assessment of lifetime cumulative ultraviolet exposure for determining melanoma risk

Exposure to ultraviolet radiation has commonly been recognized as the most important environmental risk factor for melanoma. The measurement of UV exposure in humans, however, has proved challenging. Despite the general appreciation that an objective metric for individual UV exposure is needed to properly assess melanoma risk, little attention has been given to the issue of accuracy of UV exposure measurement. The present research utilized a GIS based historical UV exposure model (for which the accuracy of exposure estimates is known) and examined, in the case-control setting, the relative importance of UV exposure compared to self-reported time spent outdoors, in melanoma risk. UV estimates were coupled with residential histories of 820 representative melanoma cases among non-Hispanic white residents under 65 years of age from Los Angeles County and for 877 controls matched to cases by age, sex, race, and neighborhood of residence, to calculate the cumulative lifetime UV exposure and average annual UV exposure. For historical measures, when the participants resided outside the US, we also calculated UV estimates. While there was no increased risk of melanoma associated with self-reported time spent outdoors, the association between annual average UV exposure based on residential history and melanoma risk was substantial, as was the association between cumulative UV exposure based on residential history and melanoma. The time spent in outdoor activities appeared to have no significant effect on melanoma risk in any age strata, however, when adjusted for UV exposure based on residential history, time spent outdoors during young age significantly increased risk for melanoma. While there was some attenuation of risk when we excluded data from people resident overseas (as all other studies we are aware of have done), this did not significantly impact subsequent risk estimates of UV exposure on melanoma.

Youth solar ultraviolet radiation exposure, concurrent activities and sun-protective practices: a review

To assist standardization of procedures, facilitate comparisons, and help guide research efforts to optimally inform development of appropriately targeted interventions, there is a need to review methods used to quantify child and adolescent solar ultraviolet radiation (UV) exposure, related outdoor activities and sun-protective practices. This holistic approach is essential for comprehensive research that will provide all-inclusive, informative and meaningful messages for preventive measures of harmful UV exposure. Two databases were searched and 29 studies were retrieved, and these studies report measurement or assessment techniques documenting UV exposure patterns and related outdoor activities. Polysulfone film badges were the main measurement instrument used in 10 studies, with questionnaire, survey data, observation, a model, electronic dosimeters, biological dosimeters, colorimeter and UV colouring labels used in the remaining studies. Methods used to record activities included self-report, parental report, a logbook and observation. Measurement duration and unit of UV exposure varied in most studies, but a method common to 15 studies was measured UV exposure as a percentage of ambient UV. The studies reviewed do not provide sufficient information for the development and evaluation of targeted youth sun protection programs. Studies are required which document precise UV exposure, concurrent activities and sun protection usage for children and adolescents.

Compliance and data reliability in sun exposure studies with diaries and personal, electronic UV dosimeters

BACKGROUND/PURPOSE

Skin cancer risk estimations are based on sun exposure data. However, the reliability of collected data in personal ultraviolet (UV) dosimeters studies has not previously been validated. We aimed at investigating the data reliability and subject compliance in a study of sun exposure behaviour among 407 subjects (age range, 4-68 years) during 54 943 days based on time-stamped personal UV dosimeter readings and diary records.

METHODS

By comparing diary records and UV dosimeter readings on a daily basis, we investigated subject compliance, total sun exposure record, reasons for non-responding along with rates of diary completing errors. Efforts to improve compliance were described.

RESULTS

The subject compliance rate was median 93.5% (percent days where the diary was completed and the UV dosimeter was worn). The total sun exposure record rate was median 84.1% (percent of participation days with both UV dosimeter and diary records and where the UV dosimeter was worn). Children, adolescents and golfers had lower sun exposure record rates than the rest of the groups (P<0.05). No significant difference was found between males and females (P=0.15). The 17 non-responders were 10 children, three adolescents, one sun worshipper, two golfers and one gardener. Correctable diary completing mistakes were found in 3.1% of the days. Children made more completing mistakes than adults (P=0.001). The average estimated error rate was 3.3% and was higher for children (6.3%) and adolescents (3.6%) than the adult groups (2.4%).

CONCLUSION

High subject compliance rate and data reliability were obtained because the investigators were service minded but persistent, offering dosimeter maintenance service within 24 h and scrutinized data for errors and mistakes.

Ultraviolet radiation exposure pattern in winter compared with summer based on time-stamped personal dosimeter readings

BACKGROUND

Personal annual ultraviolet (UV) radiation data based on daily records are needed to develop protective strategies.

OBJECTIVES

To compare UV radiation exposure patterns in the winter half-year (October-March) and the summer half-year (April-September) for Danish indoor workers.

METHODS

Nineteen indoor workers (age range 17-56 years) wore personal UV dosimeters, measuring time-stamped UV doses continuously during a year. The corresponding sun exposure behaviour was recorded in diaries. Similar data were collected for 28 volunteers during sun holidays in the winter half-year. The relationship between UV dose and sun exposure behaviour was analysed.

RESULTS

The ambient UV dose during the winter in Denmark (at 56 degrees N) was 394 standard erythema doses (SED) or 10.5% of the annual ambient UV dose. In winter compared with summer the subjects had: (i) a lower percentage of ambient UV radiation, 0.82% vs. 3.4%; (ii) a lower solar UV dose in Denmark, 3.1 SED (range 0.2-52) vs. 133 SED (range 69-363); (iii) less time outdoors per day with positive dosimeter measurements, 10 min vs. 2 h; and (iv) no exposure (0 SED) per day on 77% vs. 19% of the days. Sun holidays outside Denmark in winter gave a median 4.3 SED per day (range 0.6-7.6) and 26 SED (range 3-71) per trip.

CONCLUSIONS

In the winter half-year indoor workers received a negligible UV dose from solar exposure in Denmark and needed no UV precautions. No UV precautions are needed from November to February during holidays to latitudes above 45 degrees N, while precautions are needed the whole year around at lower latitudes.

Ultraviolet exposure patterns of Irish and Danish gardeners during work and leisure

BACKGROUND

Skin cancer, caused by solar ultraviolet (UV) radiation, is a growing problem in Europe. Reliable data on occupational exposure of outdoor workers are needed to develop protective strategies.

OBJECTIVES

To compare UV radiation exposure patterns between outdoor workers in two European populations.

METHODS

Fifty-three gardeners, 31 Irish and 22 Danish (age range 24-69 years) wore personal UV dosimeters, measuring time-stamped UV doses continuously during a 4-month summer period. The current and historical sun exposure pattern was recorded by means of a diary and questionnaire. Assessment of pigmentation, naevi, freckles and solar lentigines was performed. The relationship between UV dose and sun exposure pattern was analysed.

RESULTS

Regarding work days, the Irish had a significantly lower percentage of ambient UV exposure than the Danes, 4.5% vs. 8.1%; a lower UV dose per day, 0.97 standard erythema dose (SED) vs. 1.6 SED; a lower UV dose between 12.00 and 15.00 h, 0.43 SED vs. 0.75 SED; and fewer hours with positive dosimeter measurements, 3.2 h vs. 4.8 h (all values are medians, P < 0.01). Regarding days off work, the same patterns emerged for both UV doses and exposure hours. The Irish had significantly fewer days off than the Danes, median 21 days vs. 49 days, and fewer days with risk behaviour (sunbathing/exposing upper body), median 0 days vs. 8 days (P < 0.01).

CONCLUSIONS

The lower UV exposure received by the Irish gardeners may have been due to indoor breaks during peak ambient UV. Other contributing factors may include differences in natural shade between the parks. Our data suggest that consideration of such factors in scheduling of outdoor work can significantly reduce the occupational UV exposure.

Proportion of lifetime UV dose received by children, teenagers and adults based on time-stamped personal dosimetry

Ultraviolet (UV) reduction campaigns since 1986 were based on the estimation that individuals get 80% of their cumulative lifetime UV dose by the age of 18. To investigate if this estimation is true, we compared annual UV doses received during life in 164 Danish volunteers: children, teenagers, indoor workers, and golfers (age range 4-67 y) who recorded sun exposure behavior in diaries and carried personal UV dosimeters, measuring time-stamped UV doses. The annual UV dose did not significantly correlate with age but the variation in annual UV dose was high (median 166 SED (standard erythema dose), 95% range: 37-551 SED). The annual UV dose did correlate with days with risk behavior (sunbathing/exposing upper body) (r=0.51, p<0.001) and in adults also with hours performing outdoor sports (r=0.39, p<0.001), gardening, and sun-bed sessions (r=0.26, p=0.02). Teenagers had significantly more days with risk behavior than adults (21 vs 13 d, p=0.006) but not than children (15 d). No differences in UV dose among the age groups were found on workdays. Only 25% of the lifetime UV dose was received before the age of 20 and the annual UV dose was thus independent of age. Reduction of cumulative lifetime UV dose could be obtained by minimizing risk behavior.

Potential of phenothiazine as a thin film dosimeter for UVA exposures

The research reported in this paper on the changes in absorbance and the calibration of a proposed UVA (320-400 nm) dosimeter have established the phenothiazine-mylar combination as a potential UVA dosimeter for population studies of UVA exposures. The change in optical absorbance at 370 nm was employed to quantify the UVA exposures. This change starts to saturate at a change in absorbance of approximately 0.3. This relates to solar UVA exposures at a sub-tropical site on a horizontal plane of approximately three to four hours. The shape of this calibration curve varies with the season. This can be overcome in the same manner as for polysulfone where the dosimeter is calibrated for the conditions that it will be employed to measure the UVA exposures.

UV Doses Worldwide†

UV radiation affects human health. Human exposure to UV radiation causes a few beneficial health effects like vitamin D3 formation but it causes many detrimental health effects: sunburn, ocular damage, photoaging, immune suppression, DNA damage and skin cancer. In countries with fair-skinned populations, skin cancer is the most diagnosed of all cancers. In the United States in 2002, there were over one million new skin cancer cases. That means one out of every 285 people got skin cancer. Skin cancer of fair-skinned individuals is increasing at an alarming rate (4-6% per year) around the world and has now reached so-called "pandemic" proportions. Thus, it is important to know what UV doses people around the world get throughout their lives. This review covers how the outdoor UV doses are weighted for different biological effects, the most commonly used measuring devices for terrestrial and personal UV doses, the natural and other effects on terrestrial and personal UV doses, the time people spend outside, their ambient exposures and the terrestrial and personal UV doses of adult outdoor and indoor workers as well as children and adolescents around the world. Overall, outdoor-working adults get about 10%, while indoor-working adults and children get about 3% (2-4%) of the total available annual UV (on a horizontal plane). People's UV doses increase with increasing altitude and decreasing latitude; most indoor-working adult Europeans get 10,000-20,000 J/m2 per year, Americans get 20,000-30,000 J/m2 per year and Australians are estimated to get 20,000-50,000 J/m2 per year (excluding vacation, which can increase the dose by 30% or more).

Personal Solar UV Exposure Measurements Employing Modified Polysulphone with an Extended Dynamic Range†¶

Polysulphone dosimeters using a simple to use filter have been developed and tested to provide an extended dynamic measurement range of personal solar UV exposures over an extended period (3 to 6 days). At a Southern Hemisphere subtropical site (27.6 degrees S, 151.9 degrees E), the dynamic range of the filtered polysulphone allowed measurements of erythemal exposures to approximately 100 minimum erythemal dose (MED) for a change in optical absorbance at 330 nm (deltaA330) of 0.35. In comparison, unfiltered polysulphone dosimeters were exposed to approximately 8 MED for the same deltaA330. The error associated with the use of the filtered polysulphone dosimeters is of the order of +/-15%, compared with +/-10% of the unfiltered variety. The developed filtered polysulphone dosimeter system allowed the measurement of erythemal UV exposures over 3 to 6 days at a subtropical site without the need to replace the dosimeters because of saturation. The results show that longer-term measurement programs of personal solar UV have been made more feasible with the use of these polysulphone dosimeters with an extended dynamic range compared with unfiltered polysulphone dosimeters.

UV doses of young adults

Since 1986, people have been informed that they get about 80% of their lifetime ultraviolet (UV) dose by the age of 18. This belief originated from the mathematical conclusion that diligent use of sunscreens (sun protection factor 15 or higher) during the first 18 years of life would reduce the lifetime incidence of nonmelanoma skin cancers by 78%. These data were misconstrued to mean that individuals also got about 80% of their lifetime dose of UV by the age of 18 (linear relationship). However, these calculations were based on the incidence of nonmelanoma skin cancers being related to the square of the UV dose. Careful analysis of UV exposure data shows that Americans actually get less than 25% of their lifetime UV dose by the age of 18. This finding also appears to be true worldwide because Australia, UK and The Netherlands report a similar UV exposure pattern. UV-initiated damage early in life can be promoted by subsequent exposures to progress into tumors later in life. For example, the nonmelanoma skin cancer, squamous cell carcinoma, is dependent on the cumulative UV dose. Thus, a better educational approach for reducing skin cancers would be to instruct fair-skinned individuals to protect themselves throughout their lives from being exposed to too much UV radiation.

Human UVA exposures estimated from ambient UVA measurements

The methods presented in this paper allow for the estimation of human UVA exposure using measured UVA irradiance values. Using measured broadband UVA irradiances over the period of a year, it was estimated that for humans in an upright posture and not moving the head with respect to the body, the nose received 26.5% of the available ambient UVA radiation, whilst the shoulders and vertex of the head received 81% and 100% respectively of the available ambient UVA radiation. Measurement of the exposure ratios for a series of solar zenith angles between 90 degrees and 0 degrees will allow extension of this technique to other latitudes.