The GENESIS-UV study on ultraviolet radiation exposure levels in 250 occupations to foster epidemiological and legislative efforts to combat nonmelanoma skin cancer

Cross-sectional study protocol to assess ultraviolet radiation exposure among military outdoor workers in Lohatla, Northern Cape Province of South Africa

INTRODUCTION

The sun is one of the primary natural sources of ultraviolet radiation (UVR) and a known human carcinogen. It has been related to melanoma and several skin cancers, such as squamous cell carcinoma and basal cell carcinoma. Non-melanoma skin cancers are prevalent in South Africa, with high reported incidence rates in both genders. Due to its diversified population, South Africa experiences extreme ultraviolet index (UVI) levels, reaching 13 in the summer (a UVI of 11+ is considered extreme). Most summer workdays expose outdoor workers to repeated UVR exposure, which can lead to health risks like sunburn, premature ageing, cataracts, and an increased risk of skin cancer. This study aims to evaluate UV radiation exposure among outdoor military workers.

METHODS AND ANALYSIS

A cross-sectional quantitative study will occur at the Lohatla military base in Kathu, Northern Cape province of South Africa, using personal electronic dosimeters for solar UVR assessment. Additionally, a self-administered questionnaire will assist in assessing health effects and perceived exposure behaviours. The study addresses a critical public health concern, exploring significant risks associated with UVR exposure among outdoor military workers across different demographics.

ETHICS AND DISSEMINATION

The ethical approval for this study was obtained from the Health Sciences Research Committees of the University of Free State (UFS-HSD2023/1227/2811). The confidential data will be accessed by the named researchers and stored in secure password-protected platforms. In addition, the findings will be disseminated through high-impact publications in various formats to government departments and the broader scientific community.

Implementation of an Occupational Sun Safety Intervention: A Comparison of Two Scalability Strategies

OBJECTIVE

Two methods for scaling up an evidence-based occupational sun protection program were compared.

METHODS

Regional districts ( n = 138) in 21 state Departments of Transportation throughout the United States were randomized to receive the Go Sun Smart at Work program via in-person or digital scalability methods in 2019-2022 in 1:2 ratio. Managers completed pretest and posttest surveys and employees completed posttest surveys. Because of the COVID pandemic, only posttest measures were analyzed ( n = 255 managers; n = 1387 employees).

RESULTS

After scale-up, more employees reported training (b = 0.381, P = 0.021) and communication (b = 0.112, P = 0.049) at workplaces in in-person rather than digital strategy. There were no differences in managers' reports of sun protection training, communication, or actions by scalability method ( P > 0.05).

CONCLUSIONS

Occupational sun protection was implemented during program scale up and employees recalled training/communication more in the in-person than digital strategy.

Is the threat of malignant melanoma in the UK still increasing? A comprehensive analysis of 30 years of historical data and Bayesian age-period-cohort model projections for 2030

Malignant melanoma, a highly aggressive skin cancer, though less common, significantly contributes to cancer-related mortality. In the UK, it is of growing concern with an aging population, making it crucial to analyze historical trends and forecast future burdens. We used Joinpoint regression and age-period-cohort models to analyze trends in incidence, prevalence, and mortality of malignant melanoma in the UK from 1990 to 2021. Bayesian age-period-cohort model was applied to predict the disease burden for different age groups by 2030. From 1991 to 2021, melanoma incidence and prevalence in the UK exhibited distinct temporal patterns: a significant upward trend until 2015, particularly pronounced in individuals aged 60 and older, followed by a downward trend after 2015. By 2030, incidence and prevalence are projected to decrease, particularly in younger and middle-aged populations, with incidence expected to fall from 20.78/100 000 in 2020 to 11.90/100 000, and prevalence from 167.80/100 000 to 80.13/100 000. Mortality is also expected to decrease. However, high-risk groups, especially those aged 85 and above, are predicted to maintain higher incidence and prevalence rates. Despite a historical rise, melanoma incidence, prevalence, and mortality have declined since 2015 and are projected to continue declining through 2030. However, the elderly population remains at higher risk, underscoring the need for targeted public health interventions.

Reduction of biofilm and pathogenic microorganisms using curcumin-mediated photodynamic inactivation to prolong food shelf-life

Pathogenic microbial contamination (bacteria and fungi) in food products during production poses a significant global health risk, leading to food waste, greenhouse gas emissions, and aesthetic and financial losses. Bacteria and fungi, by forming solid biofilms, enhance their resistance to antimicrobial agents, thereby increasing the potential for cross-contamination of food products. Curcumin molecule-mediated photodynamic inactivation (Cur-m-PDI) technology has shown promising results in sterilizing microbial contaminants and their biofilms, significantly contributing to food preservation without compromising quality. Photosensitizers (curcumin) absorb light, leading to a chemical reaction with oxygen and producing reactive oxygen species (ROS) that effectively reduce bacteria, fungi, and biofilms. The mechanism of microorganism inhibition is caused by exposure to ROS generated via the type 1 pathway involving electron transfer (such as O2•-, H2O2, -OH•, and other radicals), the type 2 pathway involving energy transfer (such as 1O2), secondary ROS, and weakening of antioxidant enzymes. The effectiveness of the inactivation of microorganisms is influenced by the concentration of curcumin, light (source type and energy density), oxygen availability, and duration of exposure. This article reviews the mechanism of reducing microbial food contamination and inhibiting their biofilms through Cur-m-PDI. It also highlights future directions, challenges, and considerations related to the effects of ROS in oxidizing food, the toxicity of PDI to living cells and tissues, conditions/types of food products, and the stability and degradation of curcumin.

Warmer Temperatures Are More Predictive Than Solar Radiation for the Number of Skin Cancer Removal Procedures

BACKGROUND

Solar radiation is the primary risk factor for skin cancer, with personal exposure influenced by environmental and behavioral factors. At higher temperatures, behavioral changes increase solar radiation exposure.

OBJECTIVES

Examine the relationships between solar radiation, ambient temperature, age, and skin cancer.

METHODS

For the contiguous United States, we obtained the state mean global horizontal irradiance (GHI), daily maximum temperature, and number of skin cancer removals in the Medicare population. For skin cancer removals, we defined more sun-exposed skin as the head, neck, hands, and feet, and less sun-exposed skin as the trunk, arms, and legs.

RESULTS

By comparing the temperature thresholds 17°C, 20°C, 24°C, 27°C, 31°C, and 34°C, we found that the annual number of days above 24°C was the strongest temperature-related predictor of skin cancer removals. Multivariable linear regression showed that the number of days above 24°C predicted more skin cancer removals for all body locations and less sun-exposed skin (p = 0.008 and p = 0.003, respectively), while GHI did not (p = 0.1 and p = 0.8, respectively). GHI only predicted more skin cancer removals for more sun-exposed skin (p = 0.02).

CONCLUSION

More days above 24°C was a better predictor of skin cancer removals than GHI for all skin locations and less sun-exposed skin, suggesting that the behavioral changes occurring at warmer temperatures are more predictive of skin cancer removals than solar irradiance. Due to rising global temperatures, skin cancer incidence may further increase. Temperature-related behavioral changes represent a potential target for skin cancer prevention efforts.

Ultraviolet (UV) radiation: a double-edged sword in cancer development and therapy

It has long been widely acknowledged that ultraviolet (UV) light is an environment risk factor that can lead to cancer, particularly skin cancer. However, it is worth noting that UV radiation holds potential for cancer treatment as a relatively high-energy electromagnetic wave. With the help of nanomaterials, the role of UV radiation has caught increasing attention in cancer treatment. In this review, we briefly summarized types of UV-induced cancers, including malignant melanoma, squamous cell carcinoma, basal cell carcinoma, Merkel cell carcinoma. Importantly, we discussed the primary mechanisms underlying UV carcinogenesis, including mutations by DNA damage, immunosuppression, inflammation and epigenetic alterations. Historically limited by its shallow penetration depth, the introduction of nanomaterials has dramatically transformed the utilization of UV light in cancer treatment. The direct effect of UV light itself generally leads to the suppression of cancer cell growth and the initiation of apoptosis and ferroptosis. It can also be utilized to activate photosensitizers for reactive oxygen species (ROS) production, sensitize radiotherapy and achieve controlled drug release. Finally, we comprehensively weigh the significant risks and limitations associated with the therapeutic use of UV radiation. And the contradictory effect of UV exposure in promoting and inhibiting tumor has been discussed. This review provides clues for potential clinical therapy as well as future study directions in the UV radiation field. The precise delivery and control of UV light or nanomaterials and the wavelength as well as dose effects of UV light are needed for a thorough understanding of UV radiation.

[Prevention and health promotion in dermatology]

The term prevention includes measures that are used to avoid illnesses or damage to health as well as to reduce the risk of illness or to delay its occurrence. Preventive measures can be classified based on various criteria: temporal differentiation (primary, secondary, and tertiary prevention), context (behavioral and relational prevention), and recipient (general and individual prevention). Health promotion is used when appropriate measures are intended to strengthen and increase human health potential and resources. This includes, among other things, measures to develop health-promoting behavior (empowerment) and measures regarding the planning and implementation of health-promoting behavior (participation). One goal of these measures is generally to increase health literacy. This article describes examples of prevention and health promotion measures for occupational skin cancer (counseling approach for individual sun protection for outdoor workers; "individuelle Lichtschutzberatung" [ILB]) as well as occupational hand eczema within the meaning of German occupational disease number 5101 (outpatient and inpatient individual prevention measures). These are supplemented by the example of outpatient age-adapted small group trainings for patients with atopic dermatitis according to the multicenter evaluated concept of AGNES e. V. ("Arbeitsgemeinschaft Neurodermitisschulung") and ARNE ("Arbeitsgemeinschaft Neurodermitisschulung im Erwachsenenalter"). These examples also address aspects of sustainability and digitalization (eHealth, eLearning) in the areas of prevention and health promotion.

[Skin cancer from solar ultraviolet radiation exposure at work]

Due to their professional activities, outdoor workers are exposed to an increased risk of developing occupational skin cancer caused by solar ultraviolet (UV) radiation as defined by occupational disease (OD) number 5103. Since the amendment to the Occupational Diseases Ordinance ("Berufskrankheitenverordnung", BKV) in 2015, squamous cell carcinomas or multiple actinic keratoses of the skin caused by natural UV radiation in outdoor workers in Germany can be recognized as occupational disease in the sense of OD number 5103. The main cause of nonmelanoma skin cancer (NMSC) is solar UV radiation; it is the most relevant occupational carcinogen in terms of the number of exposed workers (i.e., outdoor workers). Circumstances associated with climate change include increased terrestrial UV radiation, an increase in the number of cloudless days and therefore the number of hours of direct sunshine, adverse meteorological effects to the stratospheric ozone layer, and so-called low ozone events and associated more intense UV radiation. In the future, comprehensive considerations will have to be made as to how prevention concepts can be effectively designed to avoid the development of occupational skin cancer in outdoor workers. The treatment of future cases of skin cancer will be a particular challenge due to their high number and only a limited number of dermatologists available. Hopefully, prevention of skin cancer will become even more important in the future.

Deciphering the roles of aryl hydrocarbon receptor (AHR) in regulating carcinogenesis

Aryl hydrocarbon receptor (AHR) is a ligand-dependent receptor that belongs to the superfamily of basic helix-loop-helix (bHLH) transcription factors. The activation of the canonical AHR signaling pathway is known to induce the expression of cytochrome P450 enzymes, facilitating the detoxification metabolism in the human body. Additionally, AHR could interact with various signaling pathways such as epidermal growth factor receptor (EGFR), signal transducer and activator of transcription 3 (STAT3), hypoxia-inducible factor-1α (HIF-1α), nuclear factor ekappa B (NF-κβ), estrogen receptor (ER), and androgen receptor (AR) signaling pathways. Over the past 30 years, several studies have reported that various chemical, physical, or biological agents, such as tobacco, hydrocarbon compounds, industrial and agricultural chemical wastes, drugs, UV, viruses, and other toxins, could affect AHR expression or activity, promoting cancer development. Thus, it is valuable to overview how these factors regulate AHR-mediated carcinogenesis. Current findings have reported that many compounds could act as AHR ligands to drive the expressions of AHR-target genes, such as CYP1A1, CYP1B1, MMPs, and AXL, and other targets that exert a pro-proliferation or anti-apoptotic effect, like XIAP. Furthermore, some other physical and chemical agents, such as UV and 3-methylcholanthrene, could promote AHR signaling activities, increasing the signaling activities of a few oncogenic pathways, such as the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) and mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) pathways. Understanding how various factors regulate AHR-mediated carcinogenesis processes helps clinicians and scientists plan personalized therapeutic strategies to improve anti-cancer treatment efficacy. As many studies that have reported the roles of AHR in regulating carcinogenesis are preclinical or observational clinical studies that did not explore the detailed mechanisms of how different chemical, physical, or biological agents promote AHR-mediated carcinogenesis processes, future studies should focus on conducting large-scale and functional studies to unravel the underlying mechanism of how AHR interacts with different factors in regulating carcinogenesis processes.

Occupational skin cancer: measurements of ultraviolet radiation exposure bring knowledge for prevention

Outdoor workers are at higher risk for keratinocyte cancer. Data-base of UV-exposure generated in the Genesis-UV study will facilitate specific prevention measures and workers’ health surveillance in outdoor occupations.