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Baeza-Moyano D, Sola Y, Bueno-Fernández S, Gómez-López M, González-Lezcano RA. Effect of the ultraviolet unweighted irradiance on the compliance of sunbeds in Spain. Photochem Photobiol Sci 2023; 22:2553-2562. [PMID: 37658252 DOI: 10.1007/s43630-023-00469-3] [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: 12/28/2022] [Accepted: 08/09/2023] [Indexed: 09/03/2023]
Abstract
The use of tanning devices in Spain is regulated by the Royal Decree 1002/2002, which is based on the European standard EN60335-2-27. The European standard establishes that the total unweighted irradiance between 200 and 280 nm must not exceed 0.003 Wm-2, a requirement that the Spanish regulation modified to 0.03 Wm-2 from 250 to 295 nm. With these differences, the compliance consideration of an artificial tanning device can vary. Spectral irradiance measurements of 41 tanning devices performed with a high-resolution spectroradiometer were analyzed. None of the tanning devices had irradiances higher than 0.003 Wm-2 between 250 (the shortest wavelength measured by the spectroradiometer) and 280 nm, but the limit required by Spanish regulation was exceeded by 11 devices, of which one would have been considered compliant according to the European standard since the effective irradiance was lower than 0.3 Wm-2. Beyond noting the differences that can occur in sunbed inspections according to the established criteria, this work has shown the differences in the spectral and total values of devices in use in Spain, validating the need for periodic inspections.
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Affiliation(s)
- David Baeza-Moyano
- Departamento de Química Y Bioquímica, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28668, Alcorcón, Madrid, Spain.
- Futuro Tecnológico Español FUTTEC S.L, Velázquez 15, 28001, Madrid, Spain.
| | - Yolanda Sola
- Grup de Meteorologia, Departament de Física Aplicada, Universitat de Barcelona, Martí I Franquès 1 7Th Floor, 08028, Barcelona, Spain
| | - Sara Bueno-Fernández
- Departamento de Química Y Bioquímica, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28668, Alcorcón, Madrid, Spain
| | - Miguel Gómez-López
- Futuro Tecnológico Español FUTTEC S.L, Velázquez 15, 28001, Madrid, Spain
| | - Roberto Alonso González-Lezcano
- Departamento de Arquitectura Y Diseño, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28668, Alcorcón, Madrid, Spain
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2
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Diehl K, Breitbart EW, Greinert R, Hillhouse J, Stapleton JL, Görig T. Nationwide Analysis on Intentional Indoor and Outdoor Tanning: Prevalence and Correlates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12309. [PMID: 36231611 PMCID: PMC9564845 DOI: 10.3390/ijerph191912309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Outdoor and indoor tanning are considered as risk factors for the development of skin cancer. The aims of this nationwide representative study were to quantify both behaviors in a sample with a wide age range, to identify those showing both behaviors and to explore and compare determinants of both behaviors. We used data from the fifth wave (2019) of the National Cancer Aid Monitoring (NCAM). We surveyed the representative sample including 4000 individuals, aged 16-65 years, living in Germany. Data were collected through telephone interviews. In addition to descriptive statistics, we used logistic regression analyses to identify determinants. The one-year-prevalence of tanning bed use was 7.5%, while 31.9% tanned (very) often intentionally outdoors in at least one situation (weekdays, holidays, and weekends). A total of 3.2% reported both risk behaviors. Regression analyses revealed that tanning bed use is associated with employment, an increased number of naevi, and lack of risk awareness. Intentional outdoor tanning was associated with male sex, younger age, past tobacco use, and low risk awareness of UV radiation. Our findings suggest that only a minority of subjects showed both risk behaviors. This implies that individuals seem to perform either one behavior or the other. In addition, the associated determinants differed between both behaviors, implying that specific preventive measures tailored to address to each tanning behavior are needed.
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Affiliation(s)
- Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | | | - Rüdiger Greinert
- Arbeitsgemeinschaft Dermatologische Prävention, 21614 Buxtehude, Germany
| | - Joel Hillhouse
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Jerod L. Stapleton
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY 40506, USA
| | - Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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3
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Bonilla C, Mejia-Lancheros C. The Skin We Live in: Pigmentation Traits and Tanning Behaviour in British Young Adults, an Observational and Genetically-Informed Study. Genes (Basel) 2022; 13:896. [PMID: 35627282 PMCID: PMC9140533 DOI: 10.3390/genes13050896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
Skin cancer incidence has been increasing worldwide, representing a particularly high burden for populations of European ancestry. Outdoor and indoor tanning using ultraviolet (UV) radiation devices are major risk factors for skin cancer. While tanning behaviours can be modified by targeted interventions to reduce skin cancer rates, there is insufficient evidence on the motivations for tanning preferences and their relationship with pigmentation phenotypes. The present observational and genetically-informed study investigates motives for tanning and the role that pigmentation phenotypes play on outdoor and indoor tanning behaviour in British young adults. This study included 3722 participants from the Avon Longitudinal Study of Parents and Children in South West England, with data on pigmentation features, tanning ability and preferences, and SNP genotypes. Liking to tan and outdoor tanning were strongly influenced by pigmentary traits and tanning ability. However, the association of these phenotypes with UV indoor tanning was weaker. Our results provide evidence to support the implementation of skin cancer preventative interventions that consider individual biological characteristics and motives for undergoing outdoor and indoor tanning.
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Affiliation(s)
- Carolina Bonilla
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo CEP 01246-903, Brazil
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada;
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4
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Tanda ET, Croce E, Spagnolo F, Zullo L, Spinaci S, Genova C, Rossi G. Immunotherapy in Adolescents and Young Adults: What Remains in Cancer Survivors? Front Oncol 2021; 11:736123. [PMID: 34631569 PMCID: PMC8495150 DOI: 10.3389/fonc.2021.736123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022] Open
Abstract
Immunotherapy has changed the landscape of treatments for advanced disease in multiple neoplasms. More and more patients are long survivors from a metastatic disease. Most recently, the extension of indications and evidence of efficacy in early disease settings, such as the adjuvant and neoadjuvant setting in breast cancer, lung cancer, glioma, and gastric cancer, places more attention on what happens to patients who survive cancer. In particular, we evaluated what happens in young patients, a population in whom some immune-related effects are still poorly described. Immunotherapy is already a reality in early disease settings and the scientific community is lagging in describing what to expect in adolescent and young adult (AYA) patients. For instance, the impact of these therapies on female and male fertility is not clear, similarly to the interaction that may occur between these drugs and pregnancy. This review aims to highlight these little-known topics that are difficult to evaluate in ad hoc studies.
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Affiliation(s)
- Enrica Teresa Tanda
- Istituto di Ricovero e Cura A Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino-Oncologia Medica 2, Genova, Italy.,Genetics of Rare Cancers, Department of Internal Medicine and Medical Specialties, University of Genoa, Genova, Italy
| | - Elena Croce
- Istituto di Ricovero e Cura A Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino-Oncologia Medica 2, Genova, Italy
| | - Francesco Spagnolo
- Istituto di Ricovero e Cura A Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino-Oncologia Medica 2, Genova, Italy
| | - Lodovica Zullo
- Istituto di Ricovero e Cura A Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino-Oncologia Medica 2, Genova, Italy
| | - Stefano Spinaci
- Division of Breast Surgery, Ospedale Villa Scassi, Genova, Italy
| | - Carlo Genova
- UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), Università degli Studi di Genova, Genoa, Italy
| | - Giovanni Rossi
- Medical Oncology Department, Ospedale Padre Antero Micone, Genoa, Italy.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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5
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Karlsson E, Hübner IM, Haluza D, Falk M. Validation of SEPI in German-A German Translation of the Sun Exposure and Protection Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176172. [PMID: 32854416 PMCID: PMC7504206 DOI: 10.3390/ijerph17176172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
The Sun Exposure and Protection Index (SEPI) is a brief instrument for scoring of sun exposure habits and propensity to increase sun protection, previously validated in English and in Swedish, as well as in two different outdoor sun intensity environments (Australia and Northern Europe). The aim of the present study was to study reliability and validity of a German translated version of the SEPI to be used in German-speaking populations. Data was collected at University of Flensburg and at Hamburg University of Applied Sciences from November 2018 to April 2019. Participants (n = 205) filled out the SEPI and also a selection of corresponding questions from the Austrian Vienna UV Questionnaire in German. After three weeks, the participants filled out the SEPI once again in order to assess test–retest stability. Of the 205 participants completing the baseline questionnaire, 135 participants completed it once again after three weeks. Internal consistency, by Cronbach’s alpha, for the baseline responses was 0.70 (95% C.I: 0.63–0.76) for SEPI part 1 (sun exposure habits) and 0.72 (95% C.I: 0.66–0.78) for part 2 (propensity to increase sun protection). Test–retest stability was high, with weighted Kappa >0.6 for all items but one, and the instrument correlated well with the previously validated German-language UV Skin Risk Survey Questionnaire. In conclusion, the German version of SEPI can reliably be used for mapping of individual sun exposure patterns.
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Affiliation(s)
- Elias Karlsson
- Department of Medicine, Health and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden; (E.K.); (M.F.)
| | - Inga-Marie Hübner
- Association of Dermatological Prevention [ADP], 20457 Hamburg, Germany
- Correspondence:
| | - Daniela Haluza
- Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Magnus Falk
- Department of Medicine, Health and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden; (E.K.); (M.F.)
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6
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Suppa M, Gandini S, Bulliard JL, Daxhelet M, Zamagni M, Forsea AM, Longo MI, Del Marmol V. Who, why, where: an overview of determinants of sunbed use in Europe. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:6-12. [PMID: 30811690 DOI: 10.1111/jdv.15318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/20/2018] [Indexed: 12/28/2022]
Abstract
Although exposure to indoor tanning has been established as a clear risk factor for skin cancer, sunbeds are still commonly used in Europe. Understanding the determinants of sunbed use in Europe is key to plan educational interventions, behavioural strategies and legislative measures, which should be tailored to subgroups with different risk profiles. Evidences show that the typical sunbed users in Europe are young-adult women, with intermediate skin type, a current employment and a medium/high socio-economic status. Typical users display sun-seeking behaviours and other risky behaviours such as smoking. Indoor tanning seems more common in northern than southern Europe. However, sunbed use remains common in fair-skinned individuals and among adolescents/pre-adolescents. Commonly reported reasons for sunbed use in Europe include aesthetic motives (i.e. looking attractive), the pursue of a prevacation tan, the influence of peers/parents engaging in the same habit, and the treatment of health conditions. The most commonly reported places to get an artificial tan in Europe are tanning studios and beauty salons. However, sunbeds are also available in sport venues, such as swimming pools and gyms, hotels and private houses. All these factors should be taken into account when planning educational, behavioural and legislative interventions to reduce the popularity of artificial tanning in Europe.
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Affiliation(s)
- M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - J L Bulliard
- Cancer Epidemiology Unit, University Institute of Social and Preventive Medicine, Lausanne, Switzerland
| | - M Daxhelet
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M Zamagni
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A M Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - M I Longo
- Department of Dermatology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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7
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Sunbeds use – tanning pattern and UV protective behaviour of adults of the Turiec Region. ACTA MEDICA MARTINIANA 2018. [DOI: 10.2478/acm-2018-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Recent worldwide researches dealing with artificial sources of ultraviolet radiation have noticed an increased incidence of skin cancer, conjunctivitis, or decreased immunity. Melanoma is the most serious disease that may be caused by sunbeds.
Goal: The main goal of the study was to coherently process public health issues of sunbeds and find out a level of information and attitude of adult population in the Turiec Region.
Material and method: In the II. half of 2016 we carried out a questionnaire survey focused on information and attitude of adult population towards sunbeds and their negative effect on humans. The total sample consisted of 121 adult participants (74 females and 47 males) from the Turiec Region.
Results: The age range of participants was 36 ± 6.5 years and the age range of sunbed users was 31 ± 4.8 (x ± SD). From the total sample of 121 participants 34 (28.1%) visit sunbed and 87 (71.9%) do not. Sunbeds are visited more by women (85.3%), but men (p 0.05) take longer sunbaths than women. Women (p 0.05) were more informed about their phototype than men. Only 51 (42.2%) of participants were aware of their skin phototype and better informed were participants with higher education. From the survey only 13 (38.2%) participants used the combination of protective sunglasses and sunscreens.
Conclusion: The results show that visitors of sunbeds had a higher level of information than non-visitors. A negative aspect is that the participants didn’t know the phototype of their skin and didn’t use all protective aids. Most participants said that information on sunbed are inadequate. From the public health view it is very important to focus on prevention, spread information about diseases influenced by artificial source of UV radiation, and educate the population.
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8
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Augustin M, Schäfer I, Krensel M, Reusch M, Mohr P, Greinert R, John SM, Zander N. Decreasing sunbed use in the German population between 2001 and 2015: survey in 155 679 working persons. J Eur Acad Dermatol Venereol 2018; 33:541-545. [PMID: 30408254 DOI: 10.1111/jdv.15309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk. OBJECTIVE To evaluate the proportion of regular sunbed use in Germany based on large-scale population-based surveys over 15 years. METHODS Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behaviour related to sunburns and sunbeds. RESULTS Among 155 679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (P < 0.001). There were significantly higher rates of sunbed use in women (12.5%/2.0%) vs. men (7.3%/1.3%; P < 0.001), in younger persons and in participants with darker skin (type II and III) vs. fair skin (type I). Individuals with sunburns in childhood were significantly more often sunbed users (5.1% vs. 4.6%; P = 0.002). A remarkable decline of sunbed use was observed after 2009 (7.0% in 2001-2008 and 2.2% in 2009-2015). This reduction occurred in the time of a legal ban of sunbed use for minors but also with the start of the national skin cancer screening programme. CONCLUSION Use of sunbeds in the German adult population has dropped by more than 85% in the past decade. Primary prevention, including the large public awareness following the legal ban of sunbed use for young people and the effects of the statutory skin cancer screening programme may have contributed to this.
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Affiliation(s)
- M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - I Schäfer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Reusch
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Dermatological Practice Tibarg, Hamburg, Germany
| | - P Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - R Greinert
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - S M John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - N Zander
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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9
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Diehl K, Görig T, Schilling L, Greinert R, Breitbart EW, Schneider S. Profile of sunless tanning product users: Results from a nationwide representative survey. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 35:40-46. [PMID: 30113096 DOI: 10.1111/phpp.12419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/26/2018] [Accepted: 08/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sunless tanning products (STPs) are often seen as "healthy alternative" to sunbathing and indoor tanning. However, STP use may entail indirect risks such as overestimating an individual's natural skin type, resulting in risky (natural and artificial) tanning behavior. We aimed to explore STP use in combination with other health-related risk behaviors (eg, smoking), skin cancer risk, risk awareness of ultraviolet radiation, and preventive behavior. METHODS We used data from the NCAM, a nationwide representative cross-sectional sample (n = 3000, aged 14-45, 48.6% female) interviewed via telephone. Differences between STP users and nonusers regarding the abovementioned aspects were identified using chi²-test. RESULTS The 1-year prevalence of STP use was 7.5%. Tanning bed users showed a higher prevalence of STP use than past and never users (16.1% vs 9.6% vs 5.8%, P < 0.05). Although STP users had a higher skin cancer risk based on individual characteristics, they were less likely to have participated in a skin cancer screen. CONCLUSION The identified parallel use of STPs and tanning beds can have severe health consequences, since the "fake tan" of STPs may lead to an overestimation of the individual's skin type, which may result in overdosed UV exposure. The lower risk awareness among STP users accompanied with their higher skin cancer risk calls for target group-specific prevention.
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Affiliation(s)
- Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tatiana Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Schilling
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rüdiger Greinert
- Association of Dermatological Prevention (ADP), Hamburg, Germany.,Center of Dermatology, Elbe Clinics, Buxtehude, Germany
| | | | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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10
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Gajda M, Kamińska-Winciorek G, Wydmański J, Tukiendorf A, Kowalska M. Behaviors of active sunbeds users and their knowledge on the potential health risks; results of cross-sectional study in Poland. J Cosmet Dermatol 2018; 17:538-544. [DOI: 10.1111/jocd.12548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Maksymilian Gajda
- Department of Epidemiology; School of Medicine in Katowice Medical University of Silesia; Katowice Poland
| | - Grażyna Kamińska-Winciorek
- The Department of Bone Marrow Transplantation and Onco-Hematology; Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology Gliwice Branch; Gliwice Poland
| | - Jerzy Wydmański
- Department of Conventional and Intraoperative Radiotherapy; Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology Gliwice Branch; Gliwice Poland
| | - Andrzej Tukiendorf
- Department of Biostatistics; Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology Gliwice Branch; Gliwice Poland
| | - Małgorzata Kowalska
- Department of Epidemiology; School of Medicine in Katowice Medical University of Silesia; Katowice Poland
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11
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Wehner MR, Cidre Serrano W, Nosrati A, Schoen PM, Chren MM, Boscardin J, Linos E. All-cause mortality in patients with basal and squamous cell carcinoma: A systematic review and meta-analysis. J Am Acad Dermatol 2018; 78:663-672.e3. [PMID: 29146125 PMCID: PMC5886016 DOI: 10.1016/j.jaad.2017.11.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 08/29/2017] [Accepted: 11/07/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are varying reports of the association of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) with mortality. OBJECTIVE To synthesize the available information on all-cause mortality after a diagnosis of BCC or SCC in the general population. METHODS We searched PubMed (1966-present), Web of Science (1898-present), and Embase (1947-present) and hand-searched to identify additional records. All English articles that reported all-cause mortality in patients with BCC or SCC were eligible. We excluded case reports, case series, and studies in subpopulations of patients. Random effects model meta-analyses were performed separately for BCC and SCC. RESULTS The searches yielded 6538 articles, and 156 were assessed in a full-text review. Twelve studies met the inclusion criteria, and 4 were included in the meta-analysis (encompassing 464,230 patients with BCC and with 175,849 SCC), yielding summary relative mortalities of 0.92 (95% confidence interval, 0.83-1.02) in BCC and 1.25 (95% confidence interval, 1.17-1.32) in SCC. LIMITATIONS Only a minority of studies controlled for comorbidities. There was significant heterogeneity in meta-analysis (χ2P < .001, I2 > 98%), but studies of SCC were qualitatively concordant: all showed statistically significant increased relative mortality. CONCLUSIONS We found that patients with SCC are at higher risk for death from any cause compared with the general population.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wilmarie Cidre Serrano
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Stanford University, Stanford, California
| | - Adi Nosrati
- Dermatology Service, Veterans Affairs Medical Center, San Francisco, California; Department of Dermatology, University of California, San Francisco, California
| | | | - Mary-Margaret Chren
- Dermatology Service, Veterans Affairs Medical Center, San Francisco, California; Department of Dermatology, University of California, San Francisco, California
| | - John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco, California.
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12
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Vienneau D, de Hoogh K, Hauri D, Vicedo-Cabrera AM, Schindler C, Huss A, Röösli M. Effects of Radon and UV Exposure on Skin Cancer Mortality in Switzerland. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:067009. [PMID: 28686556 PMCID: PMC5744747 DOI: 10.1289/ehp825] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/28/2016] [Accepted: 11/15/2016] [Indexed: 05/17/2023]
Abstract
BACKGROUND Skin cancer incidence in Switzerland is among the highest in the world. In addition to exposure to ultraviolet (UV) radiation, radon alpha particles attached to aerosols can adhere to the skin and potentially cause carcinogenic effects. OBJECTIVES We investigated the effects of radon and UV exposure on skin cancer mortality. METHODS Cox proportional hazard regression was used to study the association between exposures and skin cancer mortality in adults from the Swiss National Cohort. Modeled radon exposure and erythemal-weighted UV dose were assigned to addresses at baseline. Effect estimates were adjusted for sex, civil status, mother tongue, education, job position, neighborhood socioeconomic position, and UV exposure from outdoor occupation. RESULTS The study included 5.2 million adults (mean age 48 y) and 2,989 skin cancer deaths, with 1,900 indicating malignant melanoma (MM) as the primary cause of death. Adjusted hazard ratios (HR) for MM at age 60 were 1.16 (95% CI: 1.04, 1.29) per 100 Bq/m3 radon and 1.11 (1.01, 1.23) per W/m2 in UV dose. Radon effects decreased with age. Risk of MM death associated with residential UV exposure was higher for individuals engaged in outdoor work with UV exposure (HR 1.94 [1.17, 3.23]), though not statistically significantly different compared to not working outdoors (HR 1.09 [0.99, 1.21], p=0.09). CONCLUSIONS There is considerable variation in radon and UV exposure across Switzerland. Our study suggests both are relevant risk factors for skin cancer mortality. A better understanding of the role of the UV radiation and radon exposure is of high public health relevance. https://doi.org/10.1289/EHP825.
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Affiliation(s)
- Danielle Vienneau
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , Basel, Switzerland ; University of Basel , Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kees de Hoogh
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , Basel, Switzerland ; University of Basel , Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Dimitri Hauri
- Federal Statistical Office, Neuchâtel, Switzerland
- ImmoCompass AG, Zurich, Switzerland
| | - Ana M Vicedo-Cabrera
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , Basel, Switzerland ; University of Basel , Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , Basel, Switzerland ; University of Basel , Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anke Huss
- Institute for Risk Assessment Sciences, University Utrecht, Utrecht, the Netherlands
| | - Martin Röösli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , Basel, Switzerland ; University of Basel , Basel, Switzerland
- University of Basel, Basel, Switzerland
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Moshammer H, Simic S, Haluza D. UV-Radiation: From Physics to Impacts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020200. [PMID: 28218687 PMCID: PMC5334754 DOI: 10.3390/ijerph14020200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022]
Abstract
Ultraviolet (UV) radiation has affected life at least since the first life forms moved out of the seas and crawled onto the land. Therefore, one might assume that evolution has adapted to natural UV radiation. However, evolution is mostly concerned with the propagation of the genetic code, not with a long, happy, and fulfilling life. Because rickets is bad for a woman giving birth, the beneficial effects of UV-radiation outweigh the adverse effects like aged skin and skin tumors of various grades of malignancy that usually only afflict us at older age. Anthropogenic damage to the stratospheric ozone layer and frighteningly high rates of melanoma skin cancer in the light-skinned descendants of British settlers in Australia piqued interest in the health impacts of UV radiation. A changing cultural perception of the beauty of tanned versus light skin and commercial interests in selling UV-emitting devices such as tanning booths caught public health experts off-guard. Counseling and health communication are extremely difficult when dealing with a “natural” risk factor, especially when this risk factor cannot (and should not) be completely avoided. How much is too much for whom or for which skin type? How even measure “much”? Is it the (cumulative) dose or the dose rate that matters most? Or should we even construct a more complex metric such as the cumulative dose above a certain dose rate threshold? We find there are still many open questions, and we are glad that this special issue offered us the opportunity to present many interesting aspects of this important topic.
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Affiliation(s)
- Hanns Moshammer
- Department for Environmental Health, Center for Public Health, Medical University of Vienna, Vienna 1090, Austria.
| | - Stana Simic
- Institute for Meteorology, University of Natural Resources and Life Sciences, Vienna 1180, Austria.
| | - Daniela Haluza
- Department for Environmental Health, Center for Public Health, Medical University of Vienna, Vienna 1090, Austria.
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Moshammer H, Simic S, Haluza D. UV "Indices"-What Do They Indicate? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13101041. [PMID: 27783061 PMCID: PMC5086780 DOI: 10.3390/ijerph13101041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 12/11/2022]
Abstract
Ultra-Violet (UV) radiation covers the spectrum of wavelengths from 100 to 400 nm. The potency and biological activity for a variety of endpoints differ by wavelength. For monitoring and communication purposes, different UV action spectra have been developed. These spectra use different weighting functions. The action spectrum for erythemal dose is the most widely used one. This erythemal dose per time or dose-rate has been further simplified into a “UV index”. Following this example, in our review we use the term “index” or (plural) “indices” in a more general description for all simplified single-value measures for any biologically effective UV dose, e.g., for human non-melanoma skin cancer and for previtamin D production rate. Ongoing discussion about the existence of an increased melanoma risk due to UV-A exposure underscores the uncertainties inherent in current weighting functions. Thus, we performed an online literature search to review the data basis for these indices, to understand their relevance for an individual, and to assess the applicability of the indices for a range of exposure scenarios. Even for natural (solar) UV, the spectral composition varies spatially and temporally. Artificial UV sources and personal protection introduce further variation to the spectral composition. Many biological effects are proposed for UV radiation. Only few endpoints have been studied sufficiently to estimate a reliable index. Weighting functions for chronic effects and most importantly for cancer endpoints have been developed in animal models, and often for proxy endpoints only. Epidemiological studies on biological effects of UV radiation should not only depend on single-value weighted UV dose estimates (indexes) but should strive for a more detailed description of the individual exposure. A better understanding of the adverse and beneficial effects of UV radiation by wavelength would also improve medical counseling and health communication regarding individual health-supportive behavior.
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Affiliation(s)
- Hanns Moshammer
- Institute for Environmental Health, Center for Public Health, Medical University of Vienna, Vienna 1090, Austria.
| | - Stana Simic
- Institute for Meteorology, University of Natural Resources and Life Sciences, Vienna 1180, Austria.
| | - Daniela Haluza
- Institute for Environmental Health, Center for Public Health, Medical University of Vienna, Vienna 1090, Austria.
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