Factors Influencing Sun Protection Behaviors among Patients with Skin Cancer: An Application of the Information-Motivation-Behavioral Skills Model

© 2019 by the Dermatology Nurses\u27 Association. This study aimed to assess predictors of sun protection behaviors based on the information-motivation-behavioral skills (IMB) model among people diagnosed with nonmelanoma skin cancer (NMSC). For this descriptive, cross-sectional study, a convenience sample of 311 patients with NMSC was recruited at a medical center in Mississippi. Patients were invited to complete a face- A nd content-valid, IMB-model-based questionnaire. The average age of the participants was 64.12 (±12.02) years, and most (58.8%) were male. Most participants indicated not using sun protection behaviors while outdoors. Findings showed that sun protection behaviors were directly predicted by self-efficacy (standardized path coefficient = 0.504, p \u3c.001) and social support (standardized path coefficient = 0.199, p =.010). In addition, sun protection behavior was indirectly predicted (through self-efficacy) by social support (standardized indirect effect = 0.160, p \u3c.001) and attitudes (standardized indirect effect = 0.192, p =.001). The explained variances for self-efficacy and sun protection behaviors were 43% and 35.4%, respectively. In conclusion, the IMB model appears to be a useful theoretical framework for predicting sun protection behaviors among patients with NMSC. Sun safety intervention programs should be developed based on this theoretical model for patients with NMSC

Sun protection behaviors of state park workers in the southeastern USA

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Occupational Hygiene Society. Background: Due to the nature of their work, state park workers receive substantial exposure to sunlight, putting them at an increased risk of developing skin cancer. Increased use of sun protection behaviors can reduce this risk. Objectives: Using the health belief model (HBM) as a theoretical framework, the purpose of this study was to assess factors associated with sun protection behaviors among state-park workers. Methods: In this cross-sectional study, a convenience sample of participants were recruited from 23 state parks in the Southeastern USA to complete a self-administered questionnaire based on the constructs of the HBM. Results: The sample comprised 310 state park workers. The majority of participants were non-Hispanic White (61.6%), male (63.5%), and were aged 39.56 (±13.97) years on average.The average duration of sun exposure during the workday was reported as 3.51 h (±1.88). Nearly 12% of the participants reported that their workplace had a sun-safety policy and ~10% reported receiving sun-safety training at their workplace.The majority of participants reported that they did not sufficiently use sun protection methods. Factors associated with sun protection behaviors included the HBM constructs of perceived benefits outweighing perceived barriers (standardized coefficient = 0.210, P = 0.001), self-efficacy (standardized coefficient = 0.333, P \u3c 0.001), and cues to action (standardized coefficient = 0.179, P = 0.004). Conclusion: Future research should explore the barriers to adopting and enforcing sun-safety policies in the workplace. HBM appears to be efficacious in explaining sun protection behaviors among state park workers. HBM constructs should be considered in future interventions aimed at increasing sun protection behaviors in this population

A prospective, randomized clinical trial of antiretroviral therapies on carotid wall thickness

Objective: This article compares the effects of initiating three contemporary antiretroviral therapy (ART) regimens on progression of carotid artery intima-media thickness (IMT) over 3 years. Design: Randomized clinical trial. Setting: Multicenter (26 institutions). Patients: ART-naive HIV-infected individuals (n ¼ 328) without known cardiovascular disease or diabetes mellitus. Intervention: Random assignment to tenofovir/emtricitabine along with atazanavir/ ritonavir (ATV/r), darunavir/ritonavir (DRV/r), or raltegravir (RAL). Main outcome measures: Right-sided carotid IMT was evaluated by B-mode ultrasonography before ART initiation, and then after 48, 96, and 144 weeks. Comparisons of yearly rates of change in carotid IMT used mixed-effects linear regression models that permitted not only evaluation of the effects of ART on carotid IMT progression but also how ART-associated changes in traditional risk factors, bilirubin, and markers of HIV infection were associated carotid IMT progression. Results: HIV-1 RNA suppression rates were high in all arms (>85%) over 144 weeks. Modest increases in triglycerides and non-high-density lipoprotein cholesterol levels were observed in the protease inhibitor-containing arms compared with decreases with RAL. In contrast, carotid IMT progressed more slowly on ATV/r [8.2, 95% confidence interval (5.6, 10.8) mm/year] than DRV/r [12.9 (10.3, 15.5) mm/year, P ¼ 0.013]; changes with RAL were intermediate [10.7 (9.2, 12.2) mm/year, P ¼ 0.15 vs. ATV/r; P ¼ 0.31 vs. DRV/r]. Bilirubin and non-high-density lipoprotein cholesterol levels appeared to influence carotid IMT progression rates. Conclusion: In ART-naive HIV-infected individuals at low cardiovascular disease risk, carotid IMT progressed more slowly in participants initiating ATV/r than those initiating DRV/r, with intermediate changes associated with RAL. This effect may be due, in part, to hyperbilirubinemia

2017 Sounding Rockets Video

The video shows activity within the Sounding Rockets Program, including a high level look at design work, fabrication, integration, testing, and launch operations

The ethical foundation for honesty and the focused use of deception in dermatology

Physicians have a fiduciary duty to be honest and to act in the patients' best interest. There are times when these two duties conflict. Honesty is paramount in supporting the physician-patient relationship and loss of patient trust is devastating. Furthermore, even minor deception can suggest a return to the physician authoritarianism of the past century that has been decried by modern ethicists. Nonetheless, circumstances can arise in which good judgement may require less than complete honesty to avoid harm to the patient. If the benefit for the patient is large and the risk from deception is small, thoughtful application of minor deception could be designed to benefit patients. Of course, research is required to fully assess this strategy

The ethical foundation for honesty and the focused use of deception in dermatology

Physicians have a fiduciary duty to be honest and to act in the patients' best interest. There are times when these two duties conflict. Honesty is paramount in supporting the physician-patient relationship and loss of patient trust is devastating. Furthermore, even minor deception can suggest a return to the physician authoritarianism of the past century that has been decried by modern ethicists. Nonetheless, circumstances can arise in which good judgement may require less than complete honesty to avoid harm to the patient. If the benefit for the patient is large and the risk from deception is small, thoughtful application of minor deception could be designed to benefit patients. Of course, research is required to fully assess this strategy