Estudio de Hábitos de Fotoprotección, Conocimientos y Actitudes frente al Sol

Los baños de sol en la playa son actividades asociadas a una exposición solar de riesgo. Los bañistas constituyen uno de los grupos diana más estratégicos en la prevención del cáncer de piel. Conocer sus hábitos, actitudes y conocimientos es imperativo previo al desarrollo de intervenciones educativas dirigidas específicamente a este colectivo de riesgo. OBJETIVOS: Objetivo general: Estudiar los hábitos, actitudes y conocimientos relacionados con la exposición solar en la playa de los bañistas. Objetivos específicos: Analizar diferencias en los hábitos, actitudes y conocimientos de los bañistas según sus características sociodemográficas. Caracterizar a bañistas con mayor riesgo de quemadura solar. Identificar factores predictores de las conductas de fotoexposición y fotoprotección. METODOLOGÍA: Estudio transversal descriptivo basado en cuestionarios de salud, empleándose el "Cuestionario a pie de playa" validado en investigaciones previas en la misma población diana. Se realizó un análisis descriptivo de las variables sociodemográficas, tipo de piel, hábitos de exposición solar (HES), uso de lámparas de bronceado artificial, quemaduras solares (QS), prácticas de protección solar (PPS) (sombrilla, gafas de sol, ropa, sombrero, horario, cremas), actitudes y conocimientos relacionados con la exposición solar. Se evalúan diferencias en la distribución de variables principales (comportamientos, actitudes y conocimientos) en relación a las variables sociodemográficas y fenotípicas (edad, sexo, origen, residencia, nivel de estudios, estado civil, hijos menores y fototipo cutáneo). Se construyeron cuatro modelos de regresión logística multivariante para valorar los factores predictores de riesgo de QS (una o más QS en el último verano), conducta de exposición solar a mediodía (tomar el sol 1 o más horas entre las 12.00 a las 16.00 horas), uso de cremas fotoprotectoras (uso regular de cremas con FPS>15) y uso de medidas de al menos 3 PPS (uso regular de 3 o más PPS). RESULTADOS: Durante el verano de 2012 se reclutaron un total de 1.154 bañistas, de los que 1.079 cumplimentaron el cuestionario en español. De dichas encuestas, se tuvieron en cuenta para su análisis a 1.054 (97,7%), dado que en las 25 restantes no se había registrado la QS en el último verano. Del total de encuestados incluidos en el análisis, la edad media fue de 43,8 (DE: 18,7) años. El 61,2% eran mujeres, 86,1% de origen español. Respecto, al tipo de piel el color de piel más común fue la piel clara (41,3%), y los fototipos más presentes el tipo III (34%) y tipo IV (30,2%). Respecto a los HES, indicaron haber pasado 30 o más días en la playa en el último verano el 19,1%; 3 o más horas al día, el 17,3%; y una o más horas al mediodía, el 47,4%; el 46,9% refirió al menos un episodio de QS, y hasta el 10,4% 3 o más veces en el mismo año. En cuanto a las PPS, la más utilizada fue el uso de crema fotoprotectora, con un 68,1% de los casos que la usaban “habitualmente” o “siempre”, seguido del uso de gafas de sol en un 66,1%. La PPS menos utilizada fue llevar manga larga – pantalón largo (7,6%), seguida de evitar el sol al mediodía (42,2%). El 61,3% de los encuestados reflejo utilizar tres o más PPS de forma habitual. Para las dimensiones de actitudes relacionadas con la exposición solar, valoradas en puntuaciones estandarizadas, la dimensión actitud frente a la protección solar obtuvo la mayor puntuación con una media de 86,1 (DE: 16,2%), seguida de la dimensión actitud frente al bronceado con una media de 63,2 (DE: 18). La que obtuvo menor puntuación fue la dimensión actitud frente a las cremas con 58,4 (DE: 24,4). Respecto a los conocimientos, también valorado con puntuación estandarizada, se obtuvo un valor de 86,4 (DE: 14,2). Mediante el análisis multivariante, se halló un mayor riesgo de quemadura solar para los hombres, niveles de estudios secundarios o superiores, para los colores de piel clara-muy clara, los fototipos más bajos, y para el hábito de estar 1 o más horas en las horas centrales del día, y la actitud frente al bronceado; mientras que se hallaron como protectores, la edad, las PPS (uso habitual o siempre) de gafas de sol, evitar el medio día y fotoprotector (FPS>=15), junto con los conocimientos. CONCLUSIONES: Los resultados de este estudio confirman el riesgo de la exposición solar en la playa revelan necesidades educativas de los bañistas así como claves para modificar sus comportamientos. Estos hallazgos tiene gran interés para el desarrollo de futuras intervenciones de prevención primaria del cáncer de piel en bañistas de playa

Sun exposure habits, sun protection practices, knowledge and attitudes of andalusian teenagers

La historia de quemaduras solares y la exposición solar acumulativa durante la infancia y la adolescencia son los factores de riesgo más importantes para el desarrollo de cáncer de piel. Se conoce que el 85% de esta neoplasia podría evitarse reduciendo la exposición solar, especialmente durante la adolescencia. En este grupo de edad se han intensificado las prácticas de riesgo relacionadas con la exposición solar, motivadas por el deseo del bronceado, el tiempo que pasan al aire libre, la baja percepción del riesgo a desarrollar cáncer de piel y la falta de control paterno. Las campañas de prevención de cáncer de piel tienen como objetivo mejorar los hábitos de exposición solar, reducir las quemaduras solares y la incidencia de cáncer de piel. Los adolescentes son un grupo prioritario al que debe ir dirigidas estas campañas. En el presente trabajo se realiza un recorrido por los hallazgos más significativos sobre los hábitos de exposición solar, las prácticas de protección solar, las actitudes y comportamientos de riesgo de los adolescentes, de las intervenciones educativas que se han llevado a cabo en Andalucía y las perspectivas futuras.A history of sunburn and cumulative sun exposure during childhood and adolescence are the most important risk factors for the development of skin cancer. Nevertheless, 85% of the cases of skin cancer could be prevented by reducing sun exposure, particularly during adolescence. In fact, persons in this age group have now increased their sun exposure practices, motivated by the desire for a suntan, and the fact that they spend more time outdoors, have a poor perception of the risk of developing skin cancer, and the lack of parental control. Skin cancer prevention campaigns aim to improve sun protection habits, and reduce sunburns and incidence of skin cancer. In this work, we do a summary about the most significant findings on the sun exposure habits, sun protection practices, attitudes and risk behaviors of adolescents, as well as, educational interventions that have been carried out in Andalusia and the future prospects.Los autores agradecen el apoyo del equipo de investigación del Hospital Costa del Sol y al Programa del Doctorado de Medicina Clínica y Salud Pública de la Universidad de Granad

Assessment of Quality of Life Following Diagnosis in Patients with Cervicofacial Non-melanoma Skin Cancer

Non-melanoma skin cancer (NMSC) is the most common neoplasm. The characteristics of this disease (location in aesthetically sensitive areas, the appearance of successive tumors during follow-up, and high rates of survival) are such that the concept of health-related quality of life (HRQoL) is of particular importance. The aim of the present study was to describe and analyses patient quality of life following diagnosis with cervicofacial NMSC. A descriptive cross-sectional study was conducted on patients with cervicofacial NMSC, confirmed by skin biopsy. In each case, when the definitive diagnosis of NMSC was established, the patient completed the Skin Cancer Index questionnaire and demographic data, health status, and sun exposure habits were recorded. The study population was composed of 220 patients with histologically confirmed cervicofacial NMSC. The mean score obtained for the Skin Cancer Index questionnaire was 54.1 (SD 21.9), in which the social-aesthetic component had a mean score of 76.7 (SD 26.2), while the emotional component had a mean score of 23 (SD 25.1). Male patients, those with secondary or higher education, and those who had no history of anxiety or depression had significantly higher mean scores for HRQoL. This study demonstrated that the diagnosis of cervicofacial NMSC significantly impacts HRQoL and that certain population groups (women, persons with only primary or no education qualifications, and those a history of anxiety or depression) are more susceptible. The questionnaire scores obtained were lower than those reported in previous studies on this topic and reflect a particularly strong impact on emotional aspects of patient quality of life

Assessment of Quality of Life Following Diagnosis in Patients with Cervicofacial Non-melanoma Skin Cancer

Non-melanoma skin cancer (NMSC) is the most common neoplasm. The characteristics of this disease (location in aesthetically sensitive areas, the appearance of successive tumors during follow-up, and high rates of survival) are such that the concept of health-related quality of life (HRQoL) is of particular importance. The aim of the present study was to describe and analyses patient quality of life following diagnosis with cervicofacial NMSC. A descriptive cross-sectional study was conducted on patients with cervicofacial NMSC, confirmed by skin biopsy. In each case, when the definitive diagnosis of NMSC was established, the patient completed the Skin Cancer Index questionnaire and demographic data, health status, and sun exposure habits were recorded. The study population was composed of 220 patients with histologically confirmed cervicofacial NMSC. The mean score obtained for the Skin Cancer Index questionnaire was 54.1 (SD 21.9), in which the social-aesthetic component had a mean score of 76.7 (SD 26.2), while the emotional component had a mean score of 23 (SD 25.1). Male patients, those with secondary or higher education, and those who had no history of anxiety or depression had significantly higher mean scores for HRQoL. This study demonstrated that the diagnosis of cervicofacial NMSC significantly impacts HRQoL and that certain population groups (women, persons with only primary or no education qualifications, and those a history of anxiety or depression) are more susceptible. The questionnaire scores obtained were lower than those reported in previous studies on this topic and reflect a particularly strong impact on emotional aspects of patient quality of life

Sun exposure and protection habits in transplant athletes: an international survey

Background: Transplant recipients are particularly prone to the development of skin cancer, and overexposure to UV radiation during outdoor activities increases the risk of carcinogenesis. Objective: The aim of this study was to analyze sun-related behaviors and knowledge in transplant athletes, examine the equency of sunburns, and explore associations with a history of skin cancer. Materials and methods: Cross-sectional descriptive study. Participants (n = 170) in the XXI World Transplant Games from >50 countries completed a questionnaire on sun protection habits and knowledge, type of transplant, immunosuppressive therapy, and personal history of skin cancer. Results: The most common transplanted organs were the kidney (n = 79), the liver (n = 33), and the heart (n = 31). Overall, 61.3% of athletes had been doing sport for >15 years and 79.5% spent >1–2 h a day outdoors. Fifteen % of athletes had a history of skin cancer. The prevalence of sunburn in the previous year was 28.9%, higher in athletes aged <50 years (37.2%); without a primary school education (58.3%), not taking cyclosporin (32.6%), and athletes who played basketball (75%). The main sun protection measures used were sunscreen (68.9%) and sunglasses (67.3%). Use of a hat or cap was the only measure significantly associated with a reduced prevalence of sunburn. Conclusions: Despite high awareness that sun exposure increases the risk of skin cancer, sunburn was common in transplant athletes. Efforts should be made to strengthen multidisciplinary sun protection education strategies and ensure periodic dermatologic follow-up to prevent sun-induced skin cancer in this population.This work has been supported by the project no. PID2020-117224RB-100 of State Programs of Generation of Knowledge and Scientific and Technological Strengthening of the System from the Spanish Ministry of Science and Innovation. This is part of the research of the Institute of Biomedicine of Málaga (IBIMA) and the Junta de Andalucía working group CTS-162. Funding for open access charge: Universidad de Málaga/CBUA

Impact of a Community Intervention for Early Skin Cancer Diagnosis Implementing Teledermatology

The principal cause of skin cancer is sun exposure. In areas with high sun exposure levels, early diagnosis and sun protection education strategies must be developed. Aim of the study was to evaluate the impact of an early skin cancer diagnosis intervention implementing teledermatology. Transversal descriptive study on a population in the Western Costa del Sol. Primary care physicians were instructed on skin cancer diagnosis. They recruited consecutive at-risk patients and held four workshops for early skin cancer diagnosis and education on sun protection. The resulting variables on participants’ satisfaction and intention to change were collected. 393 patients were recruited. The mean age was 52.9 years, and 65.4% were women. Suspicious lesions were detected in 24.1% of participants, and 11.7% were attended to via teledermatology. Of these, 65.2% were evaluated in person at the Dermatology Department. Fourteen basal cell carcinomas, 5 squamous cell carcinomas, and 2 melanomas were diagnosed. Regarding patient satisfaction, 67.7% found all aspects of the workshops of interest, 41.7% found the skin check-up of interest, and 26.4% found sun and skin cancer prevention information of interest. Of the patients attended to via teledermatology, 100% stated it was good or very good and 100% would consult again via this method. The intervention was successful in terms of participation, skin cancer diagnosis, and satisfaction, especially compared with other international campaigns. Therefore, although the data cannot be extrapolated to all environments, this initiative may be used as the basis for the development of future interventions

Impact of a Community Intervention for Early Skin Cancer Diagnosis Implementing Teledermatology

The principal cause of skin cancer is sun exposure. In areas with high sun exposure levels, early diagnosis and sun protection education strategies must be developed. Aim of the study was to evaluate the impact of an early skin cancer diagnosis intervention implementing teledermatology. Transversal descriptive study on a population in the Western Costa del Sol. Primary care physicians were instructed on skin cancer diagnosis. They recruited consecutive at-risk patients and held four workshops for early skin cancer diagnosis and education on sun protection. The resulting variables on participants’ satisfaction and intention to change were collected. 393 patients were recruited. The mean age was 52.9 years, and 65.4% were women. Suspicious lesions were detected in 24.1% of participants, and 11.7% were attended to via teledermatology. Of these, 65.2% were evaluated in person at the Dermatology Department. Fourteen basal cell carcinomas, 5 squamous cell carcinomas, and 2 melanomas were diagnosed. Regarding patient satisfaction, 67.7% found all aspects of the workshops of interest, 41.7% found the skin check-up of interest, and 26.4% found sun and skin cancer prevention information of interest. Of the patients attended to via teledermatology, 100% stated it was good or very good and 100% would consult again via this method. The intervention was successful in terms of participation, skin cancer diagnosis, and satisfaction, especially compared with other international campaigns. Therefore, although the data cannot be extrapolated to all environments, this initiative may be used as the basis for the development of future interventions

Sensitivity to change of the Beach Questionnaire to behaviour, attitudes and knowledge related to sun exposure: quasi-experimental before-after study

Background: Health questionnaires must present accredited measurement properties such as validity, reliability and sensitivity to change, the latter being essential for interventions to be planned and for evaluating their effectiveness. The aim of this study was to evaluate the sensitivity to change of a Beach Questionnaire.Methods: Quasi-experimental before-after study carried out in 2011, for a study population of adolescents attending schools in the Costa del Sol. First, the questionnaire was administered to the adolescents, after which a multicomponent educational intervention was carried out; finally, three months later, the same questionnaire was re-administered to the same adolescents. Changes were assessed in the categories of each item, using the McNemar test, and the changes in the scores, standardised to a range of 0–100, using the Student t test for paired samples, and including the mean of the differences and the 95% confidence interval. The level of statistical significance was set at p < 0.05.Results: 228 adolescents, aged 14–17 years, and 55.3% were girls. Statistically significant changes were observed in sunburn experiences, exposure to the sun at mid-day and attitudes to sun exposure and suncreams. For the seven items related to knowledge about sun exposure, a higher rate of correct answers was observed. The analysis of changes, within the standardised range, revealed a significant improvement in the scores for sun exposure habits (MD 4.33; CI 95% 2.2-6.5), attitudes to sun exposure (MD 2.22; CI 95% 1.2-3.2) and knowledge (MD 9.10; CI 95% 7.1-11.1), but not in those for sun-protection practices (MD 0.23; CI 95% -1.2-1.7).Conclusions: The Beach Questionnaire on behaviour, attitudes and knowledge related to sun exposure is the first such instrument in Spanish language to provide sufficient sensitivity to change. It constitutes a useful tool for epidemiologic research into photoprotection and for skin cancer prevention programmes.The authors would like to acknowledge support from the Research Department of the Costa del Sol Hospital

A facility and community-based assessment of scabies in rural Malawi.

Background Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. Methodology/principal findings From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. Conclusions/significance Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control

Photoprotection in Outdoor Sports: A Review of the Literature and Recommendations to Reduce Risk Among Athletes.

Solar exposure, for long hours and often at peak times with limited shade available, predisposes athletes to episodic sunburn and chronic damage, causing increased risk of precancerous lesions and skin cancer. Environmental factors and training intensity affect risk. Clothing provides good protection, but changing established "uniforms" may not be possible for reasons of practicality, safety, or simply custom. Although physical activity should be encouraged for its physical and mental benefits, risk of skin damage should be minimised. We review existing behaviours, skin cancer risk, and campaigns in the sporting population and highlight key recommendations to help sun protection practices become engrained in sports practice