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Ward J, Hardin-Fanning F, LaJoie AS, Harris L, Simpson A. Outdoor workers' perceptions of skin cancer prevention: a qualitative study. Ann Work Expo Health 2024; 68:636-646. [PMID: 38742833 DOI: 10.1093/annweh/wxae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Outdoor workers are at increased risk for skin cancer and melanoma. This qualitative study aimed to explore outdoor workers' perspectives and experiences of primary (i.e. sun protection) and secondary prevention, i.e. skin self-examination (SSE) of skin cancer. METHODS Purposive, snowball, and theoretical sampling was used to recruit outdoor workers in Kentucky and Indiana. Semi-structured interviews via telephone or videoconference of approximately 45 min were conducted with interviewer probes and questions about perceptions of cancer risk, prevention, and screening techniques conducted, perceived barriers and facilitators, and preferences for health dissemination venues. The recordings were transcribed verbatim and de-identified. Analysis involved constructivist grounded theory coding strategies. Using peer debriefing and consensus building around themes, the researcher established a codebook for all interviews to utilize within Dedoose software for systematizing and organizing data. RESULTS Eighteen interviews were conducted. Interviewees (N = 18) ranged in age from 35 to 78 yr, with 3 females. Outdoor industries included agriculture, maintenance, and grounds maintenance. Themes derived from the data showed the underlying factors and perceptions that influence outdoor workers to conduct primary and secondary cancer prevention activities. The level of alarm attributed to disease and the level of trust in information contribute to intentions to conduct activities. The intentions and trust toward healthcare institutions and providers drive the primary or secondary prevention behaviors. Cultural and contextual factors included masculinity and self-sufficiency, familial and occupational priorities, and community ties. CONCLUSIONS These data provide a basis for developing future communications and interventions to decrease skin cancer incidence in outdoor workers. They indicate that secondary prevention and building self-efficacy in conducting SSE should be emphasized in tandem or over primary skin cancer prevention methods in this population. Trusted local healthcare providers should primarily provide prevention information, and materials should utilize testimonials from the local community to best influence this population. Communications and training interventions are needed in this population to induce a proactive level of alarm about cancer and result in the performance of SSE.
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Affiliation(s)
- Jeanne Ward
- Department of Nursing, University of Louisville, 555 S. Floyd, Louisville, KY 40202, United States
| | - Frances Hardin-Fanning
- Department of Nursing, University of Louisville, 555 S. Floyd, Louisville, KY 40202, United States
| | - Andrew Scott LaJoie
- Department of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
| | - Lesley Harris
- Department of Social Work, University of Louisville, 2217 S. Third St., Louisville, KY 40292, United States
| | - Anna Simpson
- Department of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
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2
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Rönsch H, Rocholl M, Ludewig M, Staudt A, Langner M, Steeb T, Wilke A, John SM, Berking C, Beissert S, Bauer A. Sonnenschutz bei Beschäftigten im Freien. Entwicklung und Validierung von standardisierten Fragebögen für Verhalten und Wissen. J Dtsch Dermatol Ges 2024; 22:665-674. [PMID: 38730530 DOI: 10.1111/ddg.15378_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/11/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND OBJECTIVES Outdoor workers are at increased risk of developing non-melanoma skin cancer. We aimed to address the lack of validated German-language measurement instruments for outdoor workers' sun safety behavior and knowledge by compiling and validating two questionnaires. PARTICIPANTS AND METHODS By expert consensus, items for the assessment of protective behavior (OccuSun) were compiled based on existing instruments. For knowledge, a translation of the Skin Cancer and Sun Knowledge (SCSK) scale was selected. After a pre-test, a validation study including 68 outdoor workers (62% female) was conducted in 2020. RESULTS The retest reliability was r = 0.93 (95% confidence interval: 0.86-0.96) for the protection score and rs = 0.78 (0.67-0.86) for the knowledge score. Protective behaviors were correlated with respective diary data (0.38 ≤ rs ≤ 0.74, p < 0.001) and skin pigmentation changes (-0.23 ≥ rs ≥ -0.42, 0.007 ≤ p ≤ 0.165) but not with self-reported sunburn frequency (0.21 ≥ rs ≥ -0.04). CONCLUSIONS Among German outdoor workers, two questionnaires for the assessment of sun protection behavior (OccuSun) and knowledge (SCSK) demonstrated good reliability. The OccuSun had generally good validity. Both instruments are fit for subsequent validation to determine their sensitivity to change.
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Affiliation(s)
- Henriette Rönsch
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Marc Rocholl
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Michaela Ludewig
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Andreas Staudt
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät, Technische Universität Dresden
- Abteilung für Methoden der Community Medicine, Institut für Community Medicine, Universitätsmedizin Greifswald
| | - Mathias Langner
- Institut für Klinische Chemie und Laboratoriumsmedizin (IKL), Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Theresa Steeb
- Klinik für Dermatologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg, Erlangen
| | - Annika Wilke
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Swen Malte John
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Carola Berking
- Klinik für Dermatologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg, Erlangen
| | - Stefan Beissert
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Andrea Bauer
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
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3
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Rönsch H, Rocholl M, Ludewig M, Staudt A, Langner M, Steeb T, Wilke A, John SM, Berking C, Beissert S, Bauer A. Sun protection in outdoor workers - Development and validation of standardized questionnaires for behavior and knowledge. J Dtsch Dermatol Ges 2024; 22:665-673. [PMID: 38528320 DOI: 10.1111/ddg.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/11/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Outdoor workers are at increased risk of developing non-melanoma skin cancer. We aimed to address the lack of validated German-language measurement instruments for outdoor workers' sun safety behavior and knowledge by compiling and validating two questionnaires. PARTICIPANTS AND METHODS By expert consensus, items for the assessment of protective behavior (OccuSun) were compiled based on existing instruments. For knowledge, a translation of the Skin Cancer and Sun Knowledge (SCSK) scale was selected. After a pre-test, a validation study including 68 outdoor workers (62% female) was conducted in 2020. RESULTS The retest reliability was r = 0.93 (95% confidence interval: 0.86-0.96) for the protection score and rs = 0.78 (0.67-0.86) for the knowledge score. Protective behaviors were correlated with respective diary data (0.38 ≤ rs ≤ 0.74, p < 0.001) and skin pigmentation changes (-0.23 ≥ rs ≥ -0.42, 0.007 ≤ p ≤ 0.165) but not with self-reported sunburn frequency (0.21 ≥ rs ≥ -0.04). CONCLUSIONS Among German outdoor workers, two questionnaires for the assessment of sun protection behavior (OccuSun) and knowledge (SCSK) demonstrated good reliability. The OccuSun had generally good validity. Both instruments are fit for subsequent validation to determine their sensitivity to change.
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Affiliation(s)
- Henriette Rönsch
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Michaela Ludewig
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Mathias Langner
- Institute for Clinical Chemistry und Laboratory Medicine (IKL), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Theresa Steeb
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Annika Wilke
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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4
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Alamri GE, Bondagji MF, Kinkar LI, Almasoudi EA, Fageeh SM, Asiri LG, Bahashwan E. Knowledge and Attitude Regarding the Use of Sun Protection to Prevent Adverse Laser Events Among the General Population in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e50157. [PMID: 38186551 PMCID: PMC10771631 DOI: 10.7759/cureus.50157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Prolonged sun exposure has been linked with the development of numerous medical and dermatological complications, such as skin cancer. Photoprotection can help reduce ultraviolet radiation (UVR)-induced skin damage and skin cancer. This study aims to assess the knowledge about and attitude toward the use of sun protection to prevent laser adverse events among the general population in Saudi Arabia. Methodology This is a cross-sectional, analytical, community-based study carried out among the general population (sunscreen users) in Saudi Arabia. A total of 600 participants were enrolled in the study. Data were collected using a validated online self-administered questionnaire using Google Forms. Data were analyzed using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY). Results A total of 600 sunscreen users were enrolled in this study, with an overall poor knowledge rate of 471 (78.5%) regarding the use of sun protection methods. Their ages ranged from 18 years to >55 years. The majority of them were females (537, 89.5%), had Saudi Nationality (533, 88.8%), and had skin type III (313, 52.2%). Almost all the participants (491, 81.9%) had undergone laser treatment before; the most reported reason was hair removal (522, 87%). In addition, 267 (44.5%) participants used sunscreens five to six times a week, with 440 (73.3%) also using sunglasses. Notably, only 91 (15.2%) of the study participants were aware that sunscreen covers UVA and UVB, and 34 (5.7%) knew that PA+++ is used in sunscreen. A total of 149 (24.8%) reported that sunscreen should be applied 20 to 30 minutes before sun exposure, while 153 (25.5%) stated that it should be reapplied every two hours. Moreover, 484 (80.7%) participants reported using topical steroid application after laser treatment. The results also showed that young participants (P = 0.001), single participants (P = 0.001), post-graduate participants (P = 0.010), students rather than the unemployed group (P = 0.002), and those who used sunscreens five to six times per week compared to those who never used sunscreens (P = 0.001) demonstrated an overall good knowledge about sunscreens and laser treatment. Conclusions The study showed poor knowledge among the participants regarding the use of sun protection to prevent adverse laser events. Therefore, an increase in awareness among the general public about the protection through campaigns is highly recommended.
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Affiliation(s)
- Ghadeer E Alamri
- Medicine and Surgery, College of Medicine, Umm Al-Qura University (UQU), Makkah, SAU
| | - Mohammed F Bondagji
- Medicine and Surgery, College of Medicine, Umm Al-Qura University (UQU), Makkah, SAU
| | - Lina I Kinkar
- Medicine and Surgery, College of Medicine, Umm Al-Qura University (UQU), Makkah, SAU
| | | | - Sarah M Fageeh
- Medicine and Surgery, College of Medicine, Umm Al-Qura University (UQU), Makkah, SAU
| | - Lama G Asiri
- Medicine and Surgery, College of Medicine, King Khalid University, Abha, SAU
| | - Emad Bahashwan
- Internal Medicine, Dermatology, Faculty of Medicine, University of Bisha, Bisha, SAU
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5
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Diehl K, Battenberg MC, Jansen C, Görig T. Sun Protection Counseling at the Pharmacy: A German Qualitative Study on Status Quo, Potential Deficits, and Sources of Information. Healthcare (Basel) 2023; 11:1907. [PMID: 37444741 PMCID: PMC10341076 DOI: 10.3390/healthcare11131907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/02/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The sale of sunscreen products is lucrative for pharmacies, and many people buy sunscreen in pharmacies because they expect to receive good advice on sunscreen use and sun protection. However, little is known about the knowledge level of pharmacists and pharmacy technicians in the field of skin cancer prevention. By conducting a qualitative study in Germany, we aimed to explore what pharmacy personnel know about sun protection and the proper use of sunscreens, where they get their information from, and where they see deficits concerning these topics. We found that there is a need for education regarding the terms skin type and sun protection factor, both of which can be helpful tools when advising customers on sun protection. In addition, participants wished for more independent information from health authorities because sunscreen manufacturing companies, which offer product-specific information, are often the only source of information. Overall, it seems reasonable that pharmacy staff should be educated more about sun protection behavior and the proper use of sunscreen to be able to advise their customers correctly. Our findings offer a starting point for strengthening the role of pharmacies in skin cancer prevention. It seems to make sense to develop and offer tailored handouts for customer counseling. Since sunscreen products are perceived as seasonal products, an educational leaflet can help refresh knowledge about the use of sunscreen and the concepts of skin type and sun protection factor in early summer.
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Affiliation(s)
- Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Professorship of Epidemiology and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | | | - Charlotte Jansen
- Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Professorship of Epidemiology and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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6
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Schulte PA, Jacklitsch BL, Bhattacharya A, Chun H, Edwards N, Elliott KC, Flynn MA, Guerin R, Hodson L, Lincoln JM, MacMahon KL, Pendergrass S, Siven J, Vietas J. Updated assessment of occupational safety and health hazards of climate change. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:183-206. [PMID: 37104117 PMCID: PMC10443088 DOI: 10.1080/15459624.2023.2205468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Workers, particularly outdoor workers, are among the populations most disproportionately affected by climate-related hazards. However, scientific research and control actions to comprehensively address these hazards are notably absent. To assess this absence, a seven-category framework was developed in 2009 to characterize the scientific literature published from 1988-2008. Using this framework, a second assessment examined the literature published through 2014, and the current one examines literature from 2014-2021. The objectives were to present literature that updates the framework and related topics and increases awareness of the role of climate change in occupational safety and health. In general, there is substantial literature on worker hazards related to ambient temperatures, biological hazards, and extreme weather but less on air pollution, ultraviolet radiation, industrial transitions, and the built environment. There is growing literature on mental health and health equity issues related to climate change, but much more research is needed. The socioeconomic impacts of climate change also require more research. This study illustrates that workers are experiencing increased morbidity and mortality related to climate change. In all areas of climate-related worker risk, including geoengineering, research is needed on the causality and prevalence of hazards, along with surveillance to identify, and interventions for hazard prevention and control.
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Affiliation(s)
- P. A. Schulte
- Advanced Technologies and Laboratories International, Inc, Cincinnati, Ohio
| | - B. L. Jacklitsch
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - A. Bhattacharya
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - H. Chun
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Atlanta, Georgia
| | - N. Edwards
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Morgantown, West Virginia
| | - K. C. Elliott
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Anchorage, Alaska
| | - M. A. Flynn
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - R. Guerin
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - L. Hodson
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) (retired), Cincinnati, Ohio
| | - J. M. Lincoln
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - K. L. MacMahon
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - S. Pendergrass
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) (retired), Cincinnati, Ohio
| | - J. Siven
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
| | - J. Vietas
- Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
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7
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The Impact of the Circadian Clock on Skin Physiology and Cancer Development. Int J Mol Sci 2021; 22:ijms22116112. [PMID: 34204077 PMCID: PMC8201366 DOI: 10.3390/ijms22116112] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 12/13/2022] Open
Abstract
Skin cancers are growing in incidence worldwide and are primarily caused by exposures to ultraviolet (UV) wavelengths of sunlight. UV radiation induces the formation of photoproducts and other lesions in DNA that if not removed by DNA repair may lead to mutagenesis and carcinogenesis. Though the factors that cause skin carcinogenesis are reasonably well understood, studies over the past 10–15 years have linked the timing of UV exposure to DNA repair and skin carcinogenesis and implicate a role for the body’s circadian clock in UV response and disease risk. Here we review what is known about the skin circadian clock, how it affects various aspects of skin physiology, and the factors that affect circadian rhythms in the skin. Furthermore, the molecular understanding of the circadian clock has led to the development of small molecules that target clock proteins; thus, we discuss the potential use of such compounds for manipulating circadian clock-controlled processes in the skin to modulate responses to UV radiation and mitigate cancer risk.
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8
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Passeron T, Lim HW, Goh CL, Kang HY, Ly F, Morita A, Ocampo Candiani J, Puig S, Schalka S, Wei L, Dréno B, Krutmann J. Photoprotection according to skin phototype and dermatoses: practical recommendations from an expert panel. J Eur Acad Dermatol Venereol 2021; 35:1460-1469. [PMID: 33764577 PMCID: PMC8252523 DOI: 10.1111/jdv.17242] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022]
Abstract
Increasing evidence on the impact of the different wavelengths of sunlight on the skin demonstrates the need for tailored recommendations of sunscreen according to skin phototype and dermatoses, which is now possible due to advances in the filters and formulations of sunscreens. A selective literature search was performed by an international expert panel, focusing on the type of sunscreen to recommend for photoaging, skin cancers, photodermatoses, pigmentary disorders and skin inflammatory disorders. Protection against ultraviolet (UV)B is especially important for light skin as there is a high risk of sunburn, DNA damage and skin cancers. Darker skin may be naturally better protected against UVB but is more prone to hyperpigmentation induced by visible light (VL) and UVA. Protection against UVA, VL and infrared A can be helpful for all skin phototypes as they penetrate deeply and cause photoaging. Long‐wave UVA1 plays a critical role in pigmentation, photoaging, skin cancer, DNA damage and photodermatoses. Adapting the formulation and texture of the sunscreen to the type of skin and dermatoses is also essential. Practical recommendations on the type of sunscreen to prescribe are provided to support the clinician in daily practice.
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Affiliation(s)
- T Passeron
- Department of Dermatology, Côte d'Azur University, Nice University Hospital Center, Nice, France.,INSERM U1065, C3M, Côte d'Azur University, Nice, France
| | - H W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - C-L Goh
- National Skin Centre, Singapore, Singapore
| | - H Y Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - F Ly
- Department of Dermatology, Cheikh Anta Diop Dakar University, EPS Institute of Social Hygiene, Dakar, Senegal
| | - A Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - J Ocampo Candiani
- Department of Dermatology, Medical Faculty University Hospital of Nuevo León, Monterrey, Mexico
| | - S Puig
- Melanoma Unit, Dermatology Department, Barcelona University Hospital Clinic, Barcelona, Spain
| | - S Schalka
- Medcin Skin Research Center and Biochemistry Department, Chemistry Institute of São Paulo University, São Paulo, Brazil
| | - L Wei
- Department of Dermatology, The General Hospital of Air Force PLA, Beijing, China
| | - B Dréno
- Department of Dermato-Oncology, CIC 1413, CRCINA, Nantes University Hospital Center, Nantes, France
| | - J Krutmann
- IUF Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany.,Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
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9
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Wright CY, Norval M. Health Risks Associated With Excessive Exposure to Solar Ultraviolet Radiation Among Outdoor Workers in South Africa: An Overview. Front Public Health 2021; 9:678680. [PMID: 33996735 PMCID: PMC8113384 DOI: 10.3389/fpubh.2021.678680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Exposure of outdoor workers to high levels of solar ultraviolet radiation (UVR) poses significant, well-known health risks including skin cancer and eye diseases. In South Africa, little is known about how many workers are potentially overexposed to solar UVR and what the associated impacts on their health might be. In this overview, the geography and solar UVR environment in South Africa are considered, as well as the different outdoor occupational groups likely to be affected by excessive solar UVR exposure. Sunburn, pterygium, cataract, keratinocyte cancers, and melanoma are discussed in the context of outdoor workers. Few studies in South Africa have considered these health issues and the most effective ways to reduce solar UVR exposure for those working outside. Several countries have developed policies and guidelines to support sun safety in the workplace which include training and education, in addition to the provision of personal protective equipment and managerial support. Several gaps in occupational sun protection and workplace sun safety for South Africa are identified. Legislation needs to recognize solar UVR exposure as an occupational health hazard, with sun safety guidelines and training provided for employers and employees.
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Affiliation(s)
- Caradee Y Wright
- Environment and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
| | - Mary Norval
- Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, United Kingdom
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10
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Diehl K, Görig T, Jansen C, Hruby MC, Pfahlberg AB, Gefeller O. "I've Heard of It, Yes, but I Can't Remember What Exactly It Was"-A Qualitative Study on Awareness, Knowledge, and Use of the UV Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1615. [PMID: 33567704 PMCID: PMC7914494 DOI: 10.3390/ijerph18041615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
Pharmacists and pharmaceutical technicians play an important role in counselling customers regarding sunscreen use and sun protection measures. A potentially helpful tool that can be used during counselling is the ultraviolet index (UVI), which informs individuals when and what sun protection measures are needed at a specific place and time. Our aim in this qualitative study was to explore awareness, knowledge, and use of the UVI during counselling in pharmacies. We used semi-structured interviews with pharmacists and pharmaceutical technicians (n = 20) to answer our research questions. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. During the interviews pharmacists and pharmaceutical technicians revealed a lot of uncertainty and lack of knowledge regarding the UVI. Eight professionals were able to give a correct definition of UVI. Amongst others, the UVI was confused with sun protection factor. Overall, the UVI was hardly used during the counselling of customers. The UVI was developed to provide guidance when which type of sun protection is required to avoid detrimental effects of ultraviolet radiation. For effective implementation, both the general population and health professionals (e.g., pharmacists) have to increase their knowledge about the UVI. This would strengthen its use during professional counselling in pharmacies and may help to reduce the incidence of skin cancer over the long term.
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Affiliation(s)
- Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (K.D.); (T.G.); (C.J.); (M.C.H.)
| | - Tatiana Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (K.D.); (T.G.); (C.J.); (M.C.H.)
| | - Charlotte Jansen
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (K.D.); (T.G.); (C.J.); (M.C.H.)
| | - Maike Carola Hruby
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (K.D.); (T.G.); (C.J.); (M.C.H.)
| | - Annette B. Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
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11
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Duarte A, Mota I, Campo M, Correia O. Skin Cancer and UV Literacy - Outdoor Workers Study. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2018.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Cáncer de piel y alfabetización sobre UV: estudio en trabajadores al aire libre. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:531-533. [DOI: 10.1016/j.ad.2018.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022] Open
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13
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Sunscreen Use among a Population of Saudi University Students. Dermatol Res Pract 2020; 2020:4732721. [PMID: 32256562 PMCID: PMC7102484 DOI: 10.1155/2020/4732721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/15/2020] [Accepted: 02/24/2020] [Indexed: 11/17/2022] Open
Abstract
Results A total of 1,011 students were enrolled. Approximately half were males (n = 510). Half of the students used sunscreen (n = 515, 51%). Female gender, high family income, previous history of sunburn, tanning bed use, and use of other sun protection methods were factors independently associated with sunscreen use. The main reasons for using sunscreen were prevention of sunburns, dark spots, skin cancer, and overall skin darkening. Eighty percent of participants used other methods of sun protection. Sunscreen with a sun protection factor (SPF) > 30 was used in 59% of students. However, the majority did not know if the sunscreen they use provided broad-spectrum coverage or not. Only 35% of students apply sunscreen in both sunny and cloudy days. Most students apply sunscreen less than 10 minutes before going out and do not repeat the application throughout the day. More than 90% of students seem to apply insufficient amount of sunscreen. Conclusion Almost half of the population in the study use sunscreen. We have identified several areas of improper use of sunscreen. Increasing the awareness of effective sunscreen use in our community might be needed.
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14
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Ludewig M, Rocholl M, John SM, Wilke A. Secondary prevention of UV-induced skin cancer: development and pilot testing of an educational patient counseling approach for individual sun protection as standard procedure of patient care. Int Arch Occup Environ Health 2020; 93:765-777. [PMID: 32162123 PMCID: PMC7320965 DOI: 10.1007/s00420-020-01532-7] [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: 10/12/2019] [Accepted: 02/23/2020] [Indexed: 01/07/2023]
Abstract
Objective To outline the development and pilot testing of a patient counseling approach for individual sun protection for patients in outdoor professions diagnosed with squamous cell carcinoma or multiple actinic keratosis due to solar UV radiation. This is a secondary prevention measure as part of the standard procedure of patient care by the respective statutory accident insurance. Methods Results of guideline-based qualitative interviews with seven outdoor workers and a search of literature formed the basis for the counseling approach, which was compiled in a manual. Interdisciplinary experts (dermatologists and educators) reviewed and consented the final manual. The pilot testing was conducted in consecutive steps (N1 = 36 patients and N1 = 2 counselors; N4 = 12 patients and N4 = 6 counselors). The first two stages of the revised guideline ‘Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare (CReDECI 2)’ serve as background and structure for presenting the results. Results The ‘counseling approach for individual sun protection (ILB: Individuelle Lichtschutz-Beratung)’ consists of seven general and eight add-on modules. These can be combined and tailored according to the patient’s individual needs. Interactive, educational components (e.g. haptic experiments) are crucial elements of the counseling approach. Conclusions The special requirements of outdoor workers are hardly taken into consideration in Germany, even though the interest for an improved sun protection behavior of some occupational groups is high. The advantage of the presented approach is that the heterogeneous needs of patients can be specifically addressed with its various modules.
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Affiliation(s)
- Michaela Ludewig
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany. .,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany.
| | - Marc Rocholl
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
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15
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Görig T, Schneider S, Seuffert S, Greinert R, Diehl K. Does sunscreen use comply with official recommendations? Results of a nationwide survey in Germany. J Eur Acad Dermatol Venereol 2019; 34:1112-1117. [PMID: 31746063 DOI: 10.1111/jdv.16100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of sunscreen can reduce the risk of UV-induced skin lesions. Health authorities have provided recommendations for the correct use of sunscreen use: Sufficient amount of sunscreen should be applied at least 30 min before the sun exposure and should be reapplied every 2 h. OBJECTIVE We aimed to research the practice of sunscreen use in a population-based and representative sample in Germany. METHODS For this cross-sectional survey, 3000 German residents aged 14-45 years were surveyed in standardized telephone interviews in 2018. Survey participants provided data on the frequency of sunscreen use in summer, timing of (re-)application and their skin characteristics. The data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample. RESULTS Overall, 79.4% of respondents used sunscreen always, often or sometimes when being exposed to the sun. However, 87.2% of sunscreen users did not follow the recommendations on timing of application, 59.5% did not comply with the timing of reapplication. We also saw, that people potentially used too little sunscreen. These data did not differ noticeably by skin types of participants. CONCLUSION Our study revealed deficits in use of sunscreen in Germany, indicating that people here pay little attention to the recommendations of health authorities, regardless of their skin type. There is therefore an urgent need for targeted public information on this issue. Improving public knowledge on correct sunscreen use through educational campaigns or individual counselling by health professionals could be a first step.
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Affiliation(s)
- T Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - S Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - S Seuffert
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - R Greinert
- Association of Dermatological Prevention, Hamburg, Germany.,Center of Dermatology, Elbe Clinics, Buxtehude, Germany
| | - K Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
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Heckman CJ, Liang K, Riley M. Awareness, understanding, use, and impact of the UV index: A systematic review of over two decades of international research. Prev Med 2019; 123:71-83. [PMID: 30844501 PMCID: PMC6534479 DOI: 10.1016/j.ypmed.2019.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 11/28/2022]
Abstract
The ultraviolet radiation index (UVI) was adopted internationally to raise awareness about and encourage the public to protect their skin from skin cancer. The current paper is a systematic review of over 20 years of research investigating awareness, comprehension, use, and impact of the UVI. Thirty-one studies were included from the USA, Canada, Europe, Australia, New Zealand, and elsewhere. Awareness of the UVI varies by country, with samples from some countries demonstrating high awareness. However, comprehension and use of the UVI to inform sun safety behaviors are typically much lower. In fact, greater UVI awareness has sometimes been associated with riskier UV-related behaviors such as intentional tanning. Fewer studies have evaluated interventions, and their results have been mixed. In summary, more research is needed to determine how to help the public understand and use the UVI for effective skin protection. This review offers suggestions for future use of and research with the UVI.
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Affiliation(s)
- Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
| | - Katherine Liang
- Temple University, 3500 N Broad St, Philadelphia, PA 19140, USA
| | - Mary Riley
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
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17
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Ziehfreund S, Schuster B, Zink A. Primary prevention of keratinocyte carcinoma among outdoor workers, the general population and medical professionals: a systematic review updated for 2019. J Eur Acad Dermatol Venereol 2019; 33:1477-1495. [PMID: 30801774 DOI: 10.1111/jdv.15525] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/29/2019] [Indexed: 02/07/2023]
Abstract
Worldwide 2-3 million cases of keratinocyte carcinoma (KC) are diagnosed annually. Sun-related knowledge is essential for adequate protection against solar ultraviolet radiation (UVR), the main risk factor for KC. The goal was (i) to provide an updated overview of primary prevention against KC including skin cancer-related knowledge, attitudes and sun protection behaviour (SPB) of outdoor workers, the general population and medical professionals as well as (ii) to evaluate the effectiveness and acceptability of sun protection programmes. We conducted a systematic review of articles indexed for MEDLINE on PubMed using selected MeSH terms and keywords related to the studied topic as well as an extensive hand search of publications between 1 January 2012 and 31 December 2018. We identified 51 relevant cross-sectional studies and 22 interventional studies. Sun-related knowledge and attitude showed substantial differences with some alarming results, including people who had not even heard about skin cancer before. Reported SPB varied enormously between the included studies, with none of the studies providing an overall sufficient SPB in their examined sun protection measures. However, sun protection programmes using new technologies seem to have great potential to increase sun-related knowledge and SPB. In countries worldwide, particularly in those where KC is not yet a public health issue, UVR protection should be promoted by healthcare institutions and authorities, politicians, cancer foundations and dermatologists to increase awareness as well as SPB and to decrease the worldwide burden of KC.
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Affiliation(s)
- S Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - B Schuster
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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18
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Zink A, Schielein M, Wildner M, Rehfuess EA. 'Try to make good hay in the shade - it won't work!' A qualitative interview study on the perspectives of Bavarian farmers regarding primary prevention of skin cancer. Br J Dermatol 2019; 180:1412-1419. [PMID: 30861096 DOI: 10.1111/bjd.17872] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extensive exposure to solar ultraviolet radiation (UVR) is the main risk factor for keratinocyte carcinoma (KC), making outdoor workers, including farmers, a high-risk population for KC. The use of sun protection is crucial for KC prevention but is not typically implemented by outdoor workers during their daily tasks. OBJECTIVES To explore the attitudes of Bavarian farmers regarding sun-protective measures in their daily work and to understand perceived barriers and unmet needs. METHODS Farmers were recruited through the Bavarian Farmers Association in Bavaria, Southern Germany. Qualitative semi structured interviews were conducted with participants between December 2017 and March 2018. Interviews were recorded, transcribed verbatim and analysed using qualitative content analysis. RESULTS Twenty farmers (11 women, nine men; nine aged 18-30 years, 11 aged > 60 years) participated. Knowledge and awareness of UVR exposure and KC, perceived individual barriers to implementing sun-protective measures, individual experiences and farm life-specific circumstances emerged as key areas influencing the perspectives of farmers regarding the primary prevention of KC. Female farmers tended to take a more positive stance on sun protection, whereas male farmers showed a lower overall interest. CONCLUSIONS Knowledge and awareness of KC and UVR exposure is very limited in Bavarian farmers with serious perceived barriers due to the demands of daily agricultural work. Further qualitative studies are needed to identify intervention options that can increase skin cancer awareness and that can successfully overcome real barriers to implementing sun protection.
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Affiliation(s)
- A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - M Wildner
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany.,Bavarian Health and Food Safety Authority, Munich, Germany
| | - E A Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
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19
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Zink A. Trends in the treatment and prevention of keratinocyte carcinoma (non-melanoma skin cancer). Curr Opin Pharmacol 2019; 46:19-23. [PMID: 30660857 DOI: 10.1016/j.coph.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 12/11/2022]
Abstract
Keratinocyte carcinoma (KC), previously also known as non-melanoma skin cancer, is the most common malignancy worldwide. It comprises basal cell carcinoma, squamous cell carcinoma (SCC), and actinic keratoses as carcinoma in situ or precursors of SCC. With solar ultraviolet radiation being the main risk factor, several countries have accepted KC as an occupational disease of outdoor professions. The prevalence in these high-risk groups is substantial, but awareness and preventive behavior remains inadequate. Parallel to the development of improved treatments, such as daylight photodynamic therapy and PD1 inhibitors for progressive KC, target-oriented prevention strategies are requisite if the global burden of KC is to be lowered. Health-related communication, internet search analysis, and telemedicine could be the key to addressing this issue.
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Affiliation(s)
- Alexander Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany; Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany.
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20
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Toro-Huamanchumo CJ, Burgos-Muñoz SJ, Vargas-Tineo LM, Perez-Fernandez J, Vargas-Tineo OW, Burgos-Muñoz RM, Zentner-Guevara JA, Bada C. Awareness, behavior and attitudes concerning sun exposure among beachgoers in the northern coast of Peru. PeerJ 2019; 7:e6189. [PMID: 30671297 PMCID: PMC6338095 DOI: 10.7717/peerj.6189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/30/2018] [Indexed: 11/21/2022] Open
Abstract
Background Skin cancer incidence has increased over the last years, becoming a major public health problem. Objective To describe the awareness, behavior and attitudes concerning sun exposure among beachgoers in the northern coast of Peru. Methods We conducted a cross-sectional study in the Pimentel beach, Peru. The “Beach Questionnaire” was used and we surveyed all the beachgoers from 8 a.m. to 4 p.m. and from March 5 to March 19. For the statistical analysis, sun exposure habits, sunburns history, knowledge, attitudes and practices were crossed with sex using the chi2 test. Results We surveyed 410 beachgoers, the most frequent phototype was type III (40.5%). Only the 13.66% of the respondents correctly answered the seven knowledge questions related to sun exposure and skin cancer. Men more frequently agreed that “when they are tanned their clothes looks nicer” (p = 0.048). Likewise, regarding the questions “Sunbathing is relaxing” and “Sunbathing improves my mood”, men agreed or totally agreed with more frequency than women (63.64% vs. 46.15%, p < 0.001; and 61.36% vs 49.15%, p = 0.014, respectively). Regarding sun protection practices, women more frequently used sunshade (p = 0.001) and sunscreen (SPF ≥ 15) (p < 0.001) when compared to the male group. Conclusion Sun exposure is a potentially preventable risk factor for skin cancer. Thus, awareness of the risks of UVR overexposure and adequate sun-protective behaviors and attitudes are essential. Our results, however, are not as favorable as expected. Public health efforts should encourage sun-safety precautions and intervention campaigns should be carried out in recreational settings, such as the beaches.
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Affiliation(s)
- Carlos J Toro-Huamanchumo
- Universidad de San Martín de Porres, Facultad de Medicina, Centro de Investigación en Epidemiología Clínica y Medicina Basada en Evidencias, Lima, Peru
| | | | | | | | | | | | | | - Carlos Bada
- School of Medicine, Universidad de San Martín de Porres, Lima, Peru.,Clínica San Judas Tadeo, Lima, Peru
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21
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Larese Filon F, Buric M, Fluehler C. UV exposure, preventive habits, risk perception, and occupation in NMSC patients: A case-control study in Trieste (NE Italy). PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 35:24-30. [PMID: 30058127 DOI: 10.1111/phpp.12417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND UV exposure is strongly associated with the incidence of non melanoma skin cancers (NMSCs), both basal and squamous cell carcinomas. The aim of our study was to analyze risk perception, UV exposure, preventive habits, and occupation in 126 subjects affected by NMSC and 187 controls. METHODS Consecutive cases with incident NMSC were recruited in Dermatologic Unit at University of Trieste; controls were recruited in Unit of Occupational Medicine. All had a medical examination to define Fitzpatrick skin type and skin lesions, and filled a standardized questionnaire on sun exposure habits, sun protection, occupational exposures, and sunburns in adulthood and childhood. RESULTS In multivariate regression analysis, NMSC resulted significantly associated with age (OR: 1.03; 95% CI 1.01-1.05), with a positive feeling for tan (OR: 1.10; 95% CI 1.01-1.20), and sunbath numbers per year (OR: 1.02; 95% CI: 1.001-1.03). A protective effect was demonstrated for Fitzpatrick phototypes III-IV compared to I and II (OR: 0.31; 95% CI: 0.18-0.55), sunscreen use (OR: 0.35; 95% CI: 0.22-0.58), and risk perception (OR: 0.98; 95% CI: 0.97-0.99). In univariate analysis, we demonstrated an increased risk for fishermen, sailors, and lifeguards (OR: 4.3; 95% CI: 1.1-16.4); foundry and metallurgy workers (OR: 5.58; 95% CI: 1.14-27.3); and mechanics, fixers, and welders (OR: 8.2; 95% CI: 1.76-37.9). CONCLUSIONS Our study demonstrated that protective behavior must be implemented in people living in Trieste. Workers must avoid direct UV exposure and must use protective equipment. More efforts are needed to increase knowledge on this risk and to raise awareness among at-risk people.
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Affiliation(s)
- Francesca Larese Filon
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Masa Buric
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Catharina Fluehler
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
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22
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Determinants of Sunburn and Sun Protection of Agricultural Workers During Occupational and Recreational Activities. J Occup Environ Med 2018; 59:1089-1094. [PMID: 28858909 DOI: 10.1097/jom.0000000000001140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify determinants of occupational sunburn in agricultural workers and assess their occupational and recreational sun protection habits. METHODS Specific surveys of agricultural workers in Switzerland and France were conducted (N = 1538). Multivariate logistic regressions identified occupational sunburn determinants. Occupational and recreational sun protection habits were estimated and correlated. RESULTS One-year occupational and recreational sunburn prevalences were 19.8% and 11.5%, respectively. Occupational sunburn increased with having a recent recreational sunburn, highly sensitive skin, young age, high perceived skin cancer risk, using sunscreen, and not wearing a hat. Correlation between protection habits during work and leisure was substantial (rs 0.5 to 0.7). Skin health knowledge was high and pro-tanning attitude moderate. CONCLUSION Potentially modifiable sunburn determinants and suboptimal recreational and occupational sun protection practices were identified in agricultural workers. Refining and tailoring sun protection messages targeting the agricultural sector are needed.
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23
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Zink A, Thomé F, Schielein M, Spinner CD, Biedermann T, Tizek L. Primary and secondary prevention of skin cancer in mountain guides: attitude and motivation for or against participation. J Eur Acad Dermatol Venereol 2018; 32:2153-2161. [PMID: 29846981 DOI: 10.1111/jdv.15095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Outdoor professionals such as mountain guides are at a substantial risk of developing non-melanoma skin cancer (NMSC) due to solar ultraviolet radiation (UVR) exposure. Despite major recent primary prevention efforts, studies on secondary skin cancer prevention efforts are limited and corresponding data on outdoor workers scarce. OBJECTIVE To assess the sun protective behaviour and individual motivations for or against skin cancer screening examinations in the German mountain guide population to aid in the development of effective awareness and prevention strategies. METHODS A cross-sectional study among all registered mountain guides in Germany was conducted using a 35-item online questionnaire on primary and secondary prevention of NMSC as well as perceived barriers for prevention. RESULTS A total of 145 mountain guides participated in the study in January 2017. Of these, 86.2% reported using sunscreen often or always, 62.1% with a sun protection factor (SPF) of 30-50% and 60.7% had undergone dermatological examination by a medical professional. The most common reasons for using secondary prevention efforts were hope of an early diagnosis (77.3%), fear of skin cancer (73.9%) and the intention to be aware of one's own health (70.5%). The main reasons for not doing so were absence of conspicuous skin conditions (63.2%) and feeling healthy (59.6%). CONCLUSION Awareness of prevention strategies recommended by the scientific community is low among affected occupationally high-risk mountain guide populations. Understanding the specific needs of this high-risk group is essential for the development of sustainable awareness and prevention strategies.
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Affiliation(s)
- A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany
| | - F Thomé
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany
| | - C D Spinner
- Department of Medicine II, Technical University of Munich, Munich, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - L Tizek
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany
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24
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Jovanovic Z, Schornstein T, Sutor A, Neufang G, Hagens R. Conventional sunscreen application does not lead to sufficient body coverage. Int J Cosmet Sci 2017; 39:550-555. [DOI: 10.1111/ics.12413] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Z. Jovanovic
- Research & Development; Beiersdorf AG; Hamburg Germany
| | | | - A. Sutor
- Research & Development; Beiersdorf AG; Hamburg Germany
| | - G. Neufang
- Research & Development; Beiersdorf AG; Hamburg Germany
| | - R. Hagens
- Research & Development; Beiersdorf AG; Hamburg Germany
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Tizek L, Krause J, Biedermann T, Zink A. Satisfaction of mountain guides with high sun protection as a tool to prevent non-melanoma skin cancer. J Eur Acad Dermatol Venereol 2017; 31:1825-1827. [DOI: 10.1111/jdv.14405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/02/2017] [Indexed: 11/26/2022]
Affiliation(s)
- L. Tizek
- Department of Dermatology and Allergy; Technical University of Munich; Munich Germany
| | - J. Krause
- Department of Dermatology and Allergy; Technical University of Munich; Munich Germany
| | - T. Biedermann
- Department of Dermatology and Allergy; Technical University of Munich; Munich Germany
| | - A. Zink
- Department of Dermatology and Allergy; Technical University of Munich; Munich Germany
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Zink A, Wurstbauer D, Rotter M, Wildner M, Biedermann T. Do outdoor workers know their risk of NMSC? Perceptions, beliefs and preventive behaviour among farmers, roofers and gardeners. J Eur Acad Dermatol Venereol 2017; 31:1649-1654. [PMID: 28414878 DOI: 10.1111/jdv.14281] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC) was officially recognized in 2015 as an occupational disease for outdoor workers in Germany. Together with the enormous socioeconomic impact of NMSC, this has led to the continuous demand of evidence-based prevention. However, studies assessing the perceptions and beliefs along with risk behaviour of outdoor workers as an essential prerequisite for prevention are rare. OBJECTIVE To assess perceptions, beliefs, barriers, risk and preventive behaviours towards non-melanoma skin cancer among different outdoor groups as a basis for the development of sustainable prevention programmes. PATIENTS AND METHODS Cross-sectional study among outdoor workers of three different occupational groups (farmer, gardener, roofer) using a 20-question online survey on NMSC awareness, risk and preventive behaviours. RESULTS Between March and April 2016, 353 outdoor workers participated in the study. Of these, 153 (43.4%) reported never to use sunscreen during work. Wearing headgear and long pants were the most common sun protection measures. Poor use of sunscreen was more likely in males and farmers. A low perceived skin cancer risk was significantly associated with poor use of sunscreen, long-sleeved shirts, sunglasses and headgear. CONCLUSIONS Despite great evidence on NMSC risk in outdoor professions throughout the literature, high-risk groups in fact are not yet aware of the topic. Sustainable target group-oriented awareness prevention programmes are needed to lower the immense burden of NMSC.
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Affiliation(s)
- A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - D Wurstbauer
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M Rotter
- Research Unit of Molecular Epidemiology (AME), Helmholtz Zentrum München, Munich, Germany
| | - M Wildner
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Munich, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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27
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John SM, Trakatelli M, Gehring R, Finlay K, Fionda C, Wittlich M, Augustin M, Hilpert G, Barroso Dias JM, Ulrich C, Pellacani G. CONSENSUS REPORT: Recognizing non-melanoma skin cancer, including actinic keratosis, as an occupational disease - A Call to Action. J Eur Acad Dermatol Venereol 2016; 30 Suppl 3:38-45. [PMID: 26995022 DOI: 10.1111/jdv.13608] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
Abstract
1. Non-melanoma skin cancer (NMSC) is by far the most common cancer diagnosed in westernized countries, and one of the few almost preventable cancers if detected and treated early as up to 90% of NMSC may be attributed to excessive exposure to ultraviolet radiation. 2. The incidence of NMSC is increasing: 2-3 million people are diagnosed worldwide annually, with an average yearly increase of 3-8% among white populations in Australia, Europe, the US and Canada over the last 30 years. 3. The link between solar ultraviolet (UV) radiation and certain forms of NMSC is clearly recognized. It is estimated that outdoor workers are exposed to an UV radiation dose 2-3 times higher than indoor workers, and there is a growing body of research linking UV radiation exposure in outdoor workers to NMSC: I. Occupationally UV-exposed workers are at least at a 43% higher risk of basal cell carcinoma (BCC) and almost doubled risk of squamous cell carcinoma (SCC) compared to the average population, with risk increasing with decreasing latitude. II. The risk for BCC, SCC and actinic keratosis (AK) among workers who have worked outdoors for more than 5 years is 3-fold higher than the risk among those with no years of working outdoors. 4. Primary prevention, early detection, treatment and regular follow-up of skin cancer (NMSC and melanoma) are shown to be beneficial from a health economic perspective. 5. Action is needed at international, European and national level to legislate for recognizing AK and NMSC as an occupational disease, which has the potential to improve access to compensation and drive preventative activities. 6. This report is a Call to Action for: I. The engagement of key stakeholders, including supranational institutions, national governments, trade organizations, employers, workers and patient organizations to drive change in prevention and protection of at-risk groups. II. Employers should be obliged to prevent outdoor worker's UV exposure from exceeding limit values, and to implement occupational skin cancer screening programmes among the at-risk workforce. III. Educational programmes for the outdoor workforce are needed to improve health literacy and drive behavioural change. IV. Nationally, steps to improve notifications and surveillance of skin cancers through both occupational services and public health programmes are required. V. Future research activities should focus on the precise definition of at-risk groups among outdoor workers through increased data gathering, including UV-dosimetry, and evaluation.
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Affiliation(s)
- S M John
- Chair of EADV Media & PR Committee, and EU Horizon 2020 COST Action StanDerm, Department of Dermatology, Environmental Medicine, University of Osnabrueck, Germany
| | - M Trakatelli
- EPIDERM Researcher, Department of Dermatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece.,Department of Dermatology, St. Pierre Hospital, Brussels, Belgium
| | - R Gehring
- Political Secretary Safety and Health, European Federation of Building and Woodworkers, Brussels, Beligum
| | - K Finlay
- Save Your Skin Foundation, North Vancouver, Canada
| | - C Fionda
- Karen Clifford Skin Cancer Charity (Skcin), Nottingham, UK
| | - M Wittlich
- Institute for Occupational Safety and Health of the German Social Accident Insurance, St. Augustin, Germany
| | - M Augustin
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - G Hilpert
- German Federal Ministry of Labour and Social Affairs, Bonn, Germany
| | - J M Barroso Dias
- President of the Portuguese Society of Occupational Medicine, Lisbon, Portugal
| | - C Ulrich
- Skin Cancer Centre/HTCC, Hautklinik der Charité, Berlin, Germany
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Ulrich C, Salavastru C, Agner T, Bauer A, Brans R, Crepy M, Ettler K, Gobba F, Goncalo M, Imko-Walczuk B, Lear J, Macan J, Modenese A, Paoli J, Sartorelli P, Stageland K, Weinert P, Wroblewski N, Wulf H, John S. The European Status Quo in legal recognition and patient-care services of occupational skin cancer. J Eur Acad Dermatol Venereol 2016; 30 Suppl 3:46-51. [DOI: 10.1111/jdv.13609] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 12/01/2022]
Affiliation(s)
- C. Ulrich
- Department of Dermatology; Skin Cancer Centre; Charité Universitätsmedizin Berlin; Berlin Germany
| | - C. Salavastru
- Dermato-oncology Research Unit; Colentina Clinical Hospital, and Dermato-oncology Research Unit; Carol Davila University of Medicine and Pharmacy; Bucharest Romania
| | - T. Agner
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - A. Bauer
- Department of Dermatology; University Hospital Carl Gustav Carus; Technical University Dresden; Dresden Germany
| | - R. Brans
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); University of Osnabrueck; Osnabrueck Germany
| | - M.N. Crepy
- Department of Dermatology; Cochin Broca Hotel-Dieu Hospital; Paris France
| | - K. Ettler
- Faculty Hospital; Department of Dermatology; Charles University Prague; Prague Czech Republic
| | - F. Gobba
- Department of Occupational Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - M. Goncalo
- Hospital and Faculty of Medicine; Department of Dermatology; University of Coimbra; Coimbra Italy
| | - B. Imko-Walczuk
- Department of Dermatology; Hospital M. Kopernika; Gdansk Poland
| | - J. Lear
- Manchester Royal Infirmary (RMI); Central Manchester University Hospitals; Manchester UK
| | - J. Macan
- Institute for Medical Research and Occupational Health; Zagreb Croatia
| | - A. Modenese
- Department of Biomedical, Metabolic and Neural Sciences; University of Modena and Reggio Emilia; Modena Italy
| | - J. Paoli
- Department of Dermatology and Venereology; University of Gothenburg; Gothenburg Sweden
| | - P. Sartorelli
- Unit of Occupational Medicine; Department of Medical, Surgical and Neurological Sciences; University of Siena; Siena Italy
| | - K. Stageland
- Department of Dermatology; University of Stavanger; Stavanger Norway
| | - P. Weinert
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); University of Osnabrueck; Osnabrueck Germany
| | - N. Wroblewski
- Department of Dermatology; Skin Cancer Centre; Charité Universitätsmedizin Berlin; Berlin Germany
| | - H.C. Wulf
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - S.M. John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); University of Osnabrueck; Osnabrueck Germany
- Chair of EADV Media & PR Committee, and EU Horizon2020 COST Action StanDerm; Department of Dermatology and Environmental Medicine; University of Osnabrueck; Osnabrueck Germany
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29
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John S, Trakatelli M, Ulrich C. Non-melanoma skin cancer by solar UV: the neglected occupational threat. J Eur Acad Dermatol Venereol 2016; 30 Suppl 3:3-4. [DOI: 10.1111/jdv.13602] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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