Daphne Reinau

Outdoor workers’ sun‐related knowledge, attitudes and protective behaviours: a systematic review of cross‐sectional and interventional studies

Sun protection is a major concern for outdoor workers as they are particularly exposed to solar ultraviolet radiation and therefore at increased risk of developing some forms of skin cancer, cataract and ocular neoplasm. In order to provide an overview of outdoor workers’ sun‐related knowledge, attitudes and protective behaviours as reported in the literature and to evaluate the effectiveness of sun‐safety education programmes in outdoor occupational settings, we conducted a systematic review of the literature by searching three electronic databases (PubMed, Embase, PsycINFO) from their inception up to 25 April 2012. An extensive hand search complemented the database searches. We identified 34 relevant articles on descriptive studies and 18 articles on interventional studies. Considerable numbers of outdoor workers were found to have sun‐sensitive skin types; sunburn rates per season ranged from 50% to 80%. Data concerning outdoor workers’ sun‐related knowledge and attitudes were scarce and controversial. The reported sun‐protective behaviours were largely inadequate, with many workers stating that they never or only rarely wore a long‐sleeved shirt (50–80%), sun‐protective headgear (30–80%) and sunscreen (30–100%) while working in the sun. However, there is growing evidence that occupational sun‐safety education is effective in increasing outdoor workers’ sun‐protection habits and presumably in decreasing sunburn rates. Occupational sun‐safety education programmes offer great potential for improving outdoor workers’ largely insufficient sun‐protective behaviours. It is hoped that, in the future, committed support from healthcare authorities, cancer foundations, employers and dermatologists will open the way for rapid and uncomplicated implementation of sun‐safety education programmes.

Nonsteroidal anti-inflammatory drugs and the risk of nonmelanoma skin cancer

Nonsteroidal anti‐inflammatory drugs (NSAIDs) have been assigned a promising role in the chemoprevention of various malignancies. However, epidemiological data on the association between NSAID use and nonmelanoma skin cancer (NMSC) are limited. To explore whether patients regularly exposed to systemic NSAIDs are at a reduced risk of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC), we conducted a population‐based case‐control analysis using the Clinical Practice Research Datalink, a United Kingdom primary care database. We identified 65,398 patients with incident BCC and 7,864 patients with incident SCC diagnosed between 1995 and 2013 and matched 1 and 4 NMSC‐free controls to each BCC and SCC case, respectively, on age, sex, general practice, calendar time and years of history in the database. We compared prior NSAID exposure between cases and controls using multivariate conditional logistic regression analyses controlling for several potential confounders. Overall, we found no association between NSAID use and BCC, but when looking exclusively at users of single NSAID substances there was a suggestion of a reduced BCC risk in regular users of aspirin and ibuprofen (adjusted odds ratio [adj. OR]: 0.92, 95% confidence interval [CI]: 0.85–0.99 and adj. OR: 0.61, 95% CI: 0.48–0.78, respectively). The risk of SCC was slightly decreased in regular users of any NSAIDs (adj. OR: 0.89, 95% CI: 0.82–0.97), with the strongest risk reduction observed in current users of coxibs (adj. OR: 0.77, 95% CI: 0.62–0.95). These findings provide evidence that patients predisposed to NMSC might benefit from chemoprevention with NSAIDs.

Sun protective behaviour of vacationers spending holidays in the tropics and subtropics

The development of malignant melanoma has been associated with intense episodic sun exposure, as it typically occurs during holidays in high ultraviolet (UV)‐index countries.

The meaning and implication of sun protection factor

The Sun Protection Factor (SPF) was introduced in 1962 and has become a worldwide standard for measuring efficacy of sunscreen products in shielding the sun’s ultraviolet radiation (UVR) and thereby protecting the skin against sunburn. We have noticed that among many healthcare professionals, organizations, and agencies a persistent confusion prevails on its meaning and implication. The SPF is defined as the ratio of the UVR dose that induces the first perceptible erythema on sunscreen-protected skin to the UVR dose that induces the same erythema on unprotected skin.

Skin Cancer Prevention, Tanning and Vitamin D: A Content Analysis of Print Media in Germany and Switzerland.

Background: Print media are a major source of health information. Objectives: To analyse press coverage related to skin cancer prevention. Methods: We conducted a content analysis of print media articles pertaining to skin cancer prevention, solaria and vitamin D published in Germany and Switzerland over a 1-year period between 2012 and 2013. Results: Overall, 2,103 articles were analysed. Applying sunscreen was by far the most common sun protection recommendation. A considerable number of articles on solaria and vitamin D advocated exposure to ultraviolet radiation to enhance physical appearance and vitamin D photosynthesis, often without mentioning any precaution measures. In total, 26.8% of the articles contained misleading or erroneous statements mostly related to sunscreen use and vitamin D issues. Conclusions: Print media can serve as powerful education tools to foster skin cancer prevention. However, misleading or erroneous reports may negatively impact sun-safe behaviour.

Evaluation of a sun safety education programme for primary school students in Switzerland

The incidence of skin cancer has increased worldwide, with rates being especially high in Switzerland compared with other European countries. Extensive sun exposure during childhood is considered a key factor for skin carcinogenesis. The aim of the study was to evaluate the impact of a school-based sun safety education programme developed by the Swiss Cancer Leagues on primary school students’ sun-related knowledge, protective behaviours and sunburn rates. In summer 2011, 1-h sun safety education sessions were held at 33 primary schools throughout the Canton of Zurich (North-Eastern Switzerland). Children in the participating school classes (first, second and third graders) answered a questionnaire on their sun-related knowledge, behaviours and sunburn experience shortly before and 1 year after the intervention. Overall, 3110 completed pretest and 1738 post-test questionnaires were eligible for analysis. The evaluation of pretest data showed considerable room for improvement in terms of sun-related knowledge, considering that merely a good half of the children were conscious that the sun may present a hazard to health. Overall, more than 95% of students benefited from the protection of sunscreen (application by parents: 73%; application by child: 66%), but only 36% stated that they generally sought shade on sunny days. After the intervention, knowledge increased considerably and significantly (P<0.0001), but there was no change in sun-protective behaviours (use of sunscreen, seeking shade). However, we observed a nonsignificant trend towards decreased sunburn rates. The brief one-time sun safety education sessions were effective in sustainably improving children’s sun-related knowledge and possibly to some extent in decreasing their sunburn rates.

Internet forums as an information source on sun protection.

Recent estimates suggest that more than half of the European population uses the Internet for health purposes, and its perceived importance as a source of health information is rapidly rising. Internet health users increasingly utilize the Internet in interactive ways, with approximately every fifth individual participating more than once a year in health-related online communications with peers [1, 2]. It was the goal of our study to gain insight into online communications in Internet forums on the topic of sun protection. In particular, we aimed first at identifying people’s most frequently asked questions about sunscreens and secondly at analyzing the content and quality of answers to questions about the sun protection factor (SPF) and the safety of UV filters. For this purpose, we arbitrarily selected three German-language Internet forums that contain a large number of contributions on sunscreen and also provide a search function as well as access to postings from the previous five years [3–5]. Within these forums, we used the search term “sunscreen” to retrospectively identify relevant questions and answers posted between the years 2009 and 2013. Overall, we analyzed 603 questions. The majority (79.6 %) was posted during summer seasons (April–September), and on average the questioners received 3.9 answers to each question. Most questions were related to personal recommendations for or experiences with specific sunscreen products (33.7 %). This was followed by sunscreen labeling including the SPF (24.9 %), correct sunscreen application (22.6 %), the relationship between sunscreen use and tanning (9.8 %), the sunscreens’ mechanism of action (5.1 %), and the safety of UV filters (4.0 %). The ten most frequently asked questions are presented in Table 1. The content of the questions did not markedly change over the 5-year observation period. Furthermore, we evaluated 432 answers to 106 questions about the SPF and 84 answers to 22 questions about the safety of UV filters. Overall, most answers (79.7 %) were posted on the same day as the corresponding question. We considered 68.4 % of the answers correct, 7.0 % misleading without being demonstrably wrong, and 9.7 % factually incorrect (the quality of 15.3 % was not assessed, since they commented rather than answered the questions or contained references to external sources such as websites). The 164 answers recommending a specific (minimum) SPF were quite varied, but almost all generally suggested an SPF of at least 15, which is in accordance with the World

Glucocorticoids and the Risk of Peptic Ulcer Bleeding: Case–Control Analysis Based on Swiss Claims Data

IntroductionControversy exists as to whether glucocorticoids (GC) are ulcerogenic per se and may thus cause peptic ulcer bleeding (PUB) independent of concomitantly prescribed nonsteroidal anti-inflammatory drugs (NSAIDs).ObjectiveTo investigate the association between GC use and PUB with or without co-medication with NSAIDs.MethodsWe conducted a case–control study using administrative claims data from the Swiss health insurance company Helsana. We identified 1191 cases with incident PUB between 2012 and 2016 and matched up to 10 PUB-free controls to each case on age, sex, region and number of years insured with Helsana. We compared prior GC exposure between cases and controls using multivariate conditional logistic regression analyses controlling for several potential confounders. Patients with or without concomitant NSAID exposure were analysed separately.ResultsPatients with prior exposure to both GC and NSAIDs were five times more likely to experience PUB than patients who neither used GC nor NSAIDs (adjusted odds ratio [adj. OR] 4.80, 95% CI 3.55–6.71). Although the risk of PUB among patients who used NSAIDs without GC was increased threefold (adj. OR 3.20, 95% CI 2.59–3.95), we observed only a moderately increased risk among patients who used GC alone without NSAIDs (adj. OR 1.63, 95% CI 1.20–2.42).ConclusionsThe use of NSAIDs with or without GC was associated with a markedly higher risk of PUB compared with GC monotherapy. Use of GC alone was associated with a moderately increased risk of PUB, which might be causal or attributed to confounding by indication.

Adverse events profile of oral corticosteroids among asthma patients in the UK: cohort study with a nested case-control analysis

BackgroundTo evaluate the adverse events profile of oral prednisolone among adult asthma patients in the UK.MethodsUsing data from the UK-based Clinical Practice Research Datalink, we conducted a series of cohort studies to quantify incidence rates and incidence rate ratios, and a series of nested case-control analyses to estimate crude and adjusted odds ratios, of 11 different potential corticosteroid-related adverse events (bone-related conditions, hypertension, peptic ulcer, severe infections, herpes zoster, diabetes mellitus type 2, cataract, glaucoma, chronic kidney disease, affective disorders, and cardiovascular events).ResultsBetween 165,900 and 269,368 asthma patients were included in each of the 11 cohorts, of whom between 836 and 16,192 developed an outcome of interest. Incidence rates per 1000 person-years of potential corticosteroid-related adverse events in patients with new current use of oral prednisolone ranged from 1.4 (95% confidence interval [CI], 1.0–1.8) for peptic ulcer to 78.0 (95% CI, 74.8–81.2) for severe infections. After adjusting for confounding, current oral prednisolone use was most strongly associated with an increased risk of severe infection, compared with non-use of prednisolone; OR 2.16 (95% CI, 2.05–2.27). There were smaller elevated risks of peptic ulcer, affective disorders, and cataract at higher doses, and marginally increased risks of herpes zoster, cardiovascular events, diabetes mellitus type 2, and bone related conditions, compared with non-use of prednisolone. We did not observe an association between oral prednisolone use and glaucoma, chronic kidney disease, or hypertension.ConclusionOral prednisolone use is associated with infections, gastrointestinal, neuropsychiatric, ocular, cardiovascular, metabolic, and bone-related complications among adult asthma patients.

Internetforen als Informationsquelle zum Thema Sonnenschutz

jüngere Schätzungen legen nahe, dass mehr als die Hälfte der europäischen Bevölkerung das Internet für Gesundheitszwecke nutzt und seine Bedeutung als wichtige Quelle für Gesundheitsinformationen in der Wahrnehmung der Menschen rapide zunimmt. Web-Nutzer, die an Gesundheitsfragen interessiert sind, nutzen das Internet zunehmend auf interaktive Weise, wobei etwa jeder Fünfte mehr als einmal pro Jahr an gesundheitsbezogenen Online-Kommunikationen mit Gleichgesinnten teilnimmt [1, 2]. Ziel unserer Studie war es, Einblick in die Online-Diskussionen im Internet zum Thema Sonnenschutz zu gewinnen. Insbesondere beabsichtigten wir, in unserer UnterClinical Letter suchung erstens die am häufigsten gestellten Fragen über Sonnenschutzmittel zu identifizieren und zweitens Inhalt und Qualität der Antworten auf Fragen zum Thema Sonnenschutzfaktor (sun protection factor, SPF) und Sicherheit von UV-Filtern zu beurteilen. Zu diesem Zweck wählten wir willkürlich drei Internetforen in deutscher Sprache mit einer großen Anzahl an Beiträgen über Sonnenschutzmittel aus, die außerdem eine Suchfunktion und Zugang zu Beiträgen aus den letzten fünf Jahren bieten [3–5]. In diesen Foren verwendeten wir den Suchbegriff „Sonnenschutzmittel“, um retrospektiv relevante Fragen und Antworten zu finden, die in den Jahren 2009 bis 2013 gepostet wurden. Insgesamt werteten wir 603 Fragen aus. Die Mehrzahl der Fragen (79,6 %) wurde in der Sommersaison (April bis September) gestellt und die Fragesteller erhielten im Durchschnitt 3,9 Antworten auf ihre Frage. Die meisten Fragen bezogen sich auf persönliche Empfehlungen für spezielle Sonnenschutzmittel oder Erfahrungen damit (33,7 %). Diese waren gefolgt von Fragen bezüglich der Beschriftung von Sonnenschutzmitteln, einschließlich SPF (24,9 %), der korrekten Anwendung von Sonnenschutzmitteln (22,6 %), dem Zusammenhang zwischen der Anwendung von Sonnenschutzmitteln und der Bräunung (9,8 %), dem Wirkmechanismus von Sonnenschutzmitteln (5,1 %) und der Sicherheit von UV-Filtern (4,0 %). Die zehn am häufigsten gestellten Fragen sind in Tabelle 1 aufgeführt. Der Inhalt der Fragen änderte sich nicht wesentlich im Lauf des 5-jährigen Beobachtungszeitraums.