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Photoprotection awareness and practices among patients with systemic lupus erythematosus and its association with disease activity and severity

Abdul Kadir WD, Jamil A, Shaharir SS, Md Nor N, Abdul Gafor AH

Lupus, 2018 Jul;27(8):1287-1295.
PMID: 29665756 DOI: 10.1177/0961203318770016

Objective The objective of this paper is to determine photoprotection awareness, knowledge, practices, and its relationship with disease activity and damage in patients with systemic lupus erythematosus (SLE).
Methods A cross-sectional study was performed. Data were acquired from in-person interviews and medical records.
Results A total of 199 (89.6%) females and 23 (10.4%) males were recruited. Median age was 39.00 (interquartile range (IQR) 18) years, disease duration 12.12 (IQR 8) years, Fitzpatrick skin phototype III 119 (53.6%) and IV 81 (36.5%). Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) was 2.95 (IQR 4) while Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC-ACR DI) was 1.20 (IQR 2). The majority 205 (92.3%) were aware of sun exposure effects on SLE. Photoprotection methods were shade seeking 209 (94.1%), sun avoidance 212 (95.5%), long pants 168 (75.7%), long sleeves 155 (69.8%), sunscreen 116 (52.3%), sunglasses 114 (51.4%) and head cover 103 (46.4%). Significantly higher photoprotection practice scores (PPS) were observed in females, Malays, and individuals with higher education level and internet accessibility. PPS were not significantly correlated with SLICC-ACR DI and SLEDAI-2 K. Independent predictors for good photoprotection practice (GPP) were ethnicity (OR = 3.66, 95% CI 1.78-7.53), awareness (OR = 3.77, 95% CI 1.09-13.08) and cutaneous involvement (OR = 2.43, 95% CI 1.11-5.28). Photoprotection methods and GPP were not predictors for disease activity or damage.
Conclusion Photoprotection awareness and knowledge was good. Shade seeking and sun avoidance were the common photoprotection methods practised. The use of sunscreen requires improvement. Photoprotection awareness and cutaneous manifestation were predictors for GPP. Neither photoprotection methods nor GPP were associated with disease activity or damage.
Study site: Nephrology, Rheumatology and Dermatology clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Sunlight/adverse effects
Relationship between sunlight and the age of onset of bipolar disorder: an international multisite study

Bauer M, Glenn T, Alda M, Andreassen OA, Angelopoulos E, Ardau R, et al.

J Affect Disord, 2014;167:104-11.
PMID: 24953482 DOI: 10.1016/j.jad.2014.05.032

The onset of bipolar disorder is influenced by the interaction of genetic and environmental factors. We previously found that a large increase in sunlight in springtime was associated with a lower age of onset. This study extends this analysis with more collection sites at diverse locations, and includes family history and polarity of first episode.

Matched MeSH terms: Sunlight/adverse effects*
Sun exposure and the risk of prostate cancer in the Singapore Prostate Cancer Study: a case-control study

Chia SE, Wong KY, Cheng C, Lau W, Tan PH

Asian Pac J Cancer Prev, 2012;13(7):3179-85.
PMID: 22994730

BACKGROUND: Most of the epidemiology studies on the effects of sun exposure and prostate cancer were conducted among the temperate countries of North America and Europe. Little is known about the influence on Asian populations. The purpose of current study was to evaluate any association of sun exposure with risk of prostate cancer in Chinese, Malays and Indians who reside in the tropics.
METHODS: The Singapore Prostate Cancer Study is a hospital-based case-control study of 240 prostate cancer incident cases and 268 controls conducted in Singapore between April 2007 and May 2009. Detailed information on outdoor activities in the sun, skin colour, sun sensitivity and other possible risk factors were collected in personal interviews. Cases were further classified by Gleason scores and TNM staging. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression analysis, adjusted for age, ethnicity, education, family history of any cancers, BMI and skin colour.
RESULTS: We found that prostate cancer risk was increased in subjects with black/dark-brown eyes (OR 5.88, 95%CI 3.17-10.9), darker skin colour e.g. tan/dark brown/black (OR 7.62, 95%CI 3.41-17.0), frequent sunburn in lifetime (OR 4.30, 95%CI 1.7-11.2) and increased general sun exposure in adulthood per week (OR 2.03, 95%CI 1.09-3.81). The increased risk was consistent for high grade tumours and advanced stage prostate cancers.
CONCLUSION: The findings from this study suggest that excessive sun exposure is a risk factor for prostate cancer in Asians.

Matched MeSH terms: Sunlight/adverse effects*
Fulltext Perceptions and opinions towards skin cancer prevention in Malaysia: a qualitative approach

Al-Naggar RA, Al-Naggar TH, Bobryshev YV

Asian Pac J Cancer Prev, 2011;12(4):995-9.
PMID: 21790240

INTRODUCTION: Malignant melanoma in particular is one of the few remaining cancers with an increasing incidence.

OBJECTIVES: The objective of this study is to explore the perceptions and opinions of young Malaysians towards skin cancer prevention.

METHODOLOGY: Focus group discussions were conducted among 33 medical science students from Management and Science University (MSU), Shah Alam, Malaysia, using convenience sampling. Students were divided into 4 focus groups consisting of 8, 8, 9 and 8 students respectively. The facilitator wrote down the conversations and data obtained were classified into various categories and analyzed manually.

RESULTS: The majority of the participants mentioned that overexposure to ultraviolet light is the commonest cause of skin cancer but also that the most benefit we get from sun ight is vitamin D synthesis. The majority mentioned that the best prevention measure for skin cancer is using a sunscreen, followed by limit exposure to the sun.

CONCLUSION: The present study demonstrated there is a lack of knowledge regarding screening methods and prevention measures of skin cancer. Therefore, there is a need to establish health education unit in all universities to educate all university students regarding various health problems including skin cancer prevention.

Matched MeSH terms: Sunlight/adverse effects