Assessment of spatiotemporal variability of ultraviolet index (UVI) over Kerala, India, using satellite remote sensing (OMI/AURA) data

The spatial and temporal dynamics of daily ultraviolet index (UVI) for a period of 18 years (2004-2022) over the Indian state of Kerala were statistically characterised in the study. The UVI measurements used for the study were derived from the ultraviolet-B (UVB) irradiance measured by the Ozone Monitoring Instrument (OMI) of the AURA satellite and classified into different severity levels for analysis. Basic statistics of daily, monthly and seasonal UVI as well as Mann-Kendall (MK) statistical trend characteristics and the rate of change of daily UVI using Theil-Sen's slope test were also evaluated. A higher variability of UVI characteristics was observed in the Kerala region, and more than 79% of the measurements fell into the categories of very high and extreme UVI values, which suggests the need of implementation of appropriate measures to reduce health risks. Although the UVI measured during the study period shows a slight decrease, most of the data show a seasonal variation with undulating low and peak values. Higher UVI are observed during the months of March, April and September. The region also has higher UVI during the southwest monsoon (SWM) and summer seasons. Although Kerala region as a single whole unit, UVI show a non-significant decreasing trend (-0.83), the MK test revealed the increasing and decreasing trends of UVI ranging from -1.96 to 0.41 facilitated the delineation of areas (domains) where UVI are increasing or decreasing. The domain of UVI increase occupies the central and southern (S) parts, and the domains of decrease cover the northern (N) and S parts of the Kerala region. The rate of change of daily UVI in domain of increase and decrease shows an average rate of 0.34 × 10-5 day-1 and -2 × 10-5 day-1, respectively. The parameters (rainfall, air temperature, cloud optical depth (COD) and solar zenith angle (SZA)) that affect the strength of UV rays reaching the surface indicate that a cloud-free atmosphere or low thickness clouds prevails in the Kerala region. Overall, the study results indicate the need for regular monitoring of UVI in the study area and also suggest appropriate campaigns to disseminate information and precautions for prolonged UVI exposure to reduce the adverse health effects, since the study area has a high population density.

Pediatric Melanoma: Geographic Trends in Incidence, Stage, and Mortality in the United States

INTRODUCTION

Pediatric melanoma is the most commonly diagnosed skin cancer in children, with the annual incidence recently increasing by an average of 2% each year. Ultraviolet (UV) radiation from excessive sun exposure is an important carcinogenic risk factor, with penetration varying greatly throughout the country. Consequently, an individual's geographic location may play a role in how much exposure to high UV index rays they receive throughout their lifetime. The objective of this study was to use the surveillance, epidemiology, and end results SEER database to study geographic trends in incidence, staging, and mortality of pediatric melanoma between 2009 and 2019 and determine their relation to UV index in the United States.

MATERIALS AND METHODS

A retrospective analysis of pediatric patients from 0 to 19 years in the surveillance, epidemiology, and end results 22 registries incidence database (17 states) and 17 registries incidence-based mortality database (12 states) was conducted from 2009 to 2019 based on a diagnosis of melanoma of the skin using the International Classification of Childhood Cancer codes for malignant melanoma. Data regarding patient demographics and incidence, staging, and mortality per state were extracted. Incidence data were geographically mapped and mean UV index distribution from www.epa.gov was superimposed.

RESULTS

Incidence of pediatric melanoma was stratified regionally, with a total of 1665 new cases from 2009 to 2019. The Northeast had 393 new cases, with 244 (62.1%) localized cases, 55 (14.0%) lymph node-invasive and metastatic (advanced) cases, and 6/146 (4.1%) cases of mortality. The Midwest had 209 new cases, with 123 (58.9%) localized cases, 29 (13.9%) advanced cases, and 1/57 (1.8%) case of mortality. The South had 487 new cases, with 224 (46.0%) localized cases, 104 (21.4%) advanced cases, and 8/232 (3.4%) cases of mortality. The West had 576 new cases, with 364 (63.2%) localized cases, 82 (14.2%) advanced cases, and 23/551 (4.2%) cases of mortality. Mean UV index was 4.4 in the Northeast, 4.8 in the Midwest, 7.3 in the South, and 5.5 in the West from 2006 to 2020. The regional difference in incidence was not statistically significant. There was a statistically significant increased number of advanced cases in the South as compared to the Northeast (P = 0.005), West (P = 0.002), and Midwest (P = 0.02), with a significant correlation coefficient of 0.7204 between advanced cases and mean UV index in the South.

CONCLUSIONS

There is a statistically significant increased incidence of lymph node-invasive and metastatic pediatric melanoma cases in the South as compared to the West, Northeast, and Midwest regions of the United States. There is also a significant correlation between the incidence of lymph node-invasive and metastatic pediatric melanoma cases and UV index. In the pediatric population, there is no statistically significant association between total incidence and mortality of melanoma and geographic region. There is an increased prevalence of pediatric melanoma seen in White and female patients. This suggests that an individual's geographic location in the United States during childhood may play a role in their likelihood of malignant melanoma development, advanced-stage melanoma development, and mortality.

Sunscreen use amongst US adults: a national survey

One in five Americans will develop skin cancer before the age of 70. Consistent sunscreen use can help decrease the prevalence of this. This study assesses the general knowledge of United States citizens on sunscreen use, frequency of usage, common behaviors of sunscreen usage, and use of sunscreen based on knowledge of sun protection. We created a 14-question anonymous web-based survey that was distributed amongst a third-party polling service. The polling service conducted random recruitment of participants based on inclusion criteria. Results from 200 participants were then analyzed using JMP Pro 16 for the Mac [11]. Fishers two tailed exact test was used along with Wilcoxon's rank- sum test. The results of the survey found that 11% of the participants report not wearing sunscreen at all, 13.5% wear sunscreen daily, the most common reason for sunscreen use was avoidance of sunburns (50%, n = 100), most people learn about the importance of sunscreen from their parents/family members (46.5%, n = 93), and 66.5% of the participants feel that sunscreen education should be included in schools (n = 133). Furthermore, the participants in the lowest income bracket were less likely to apply sunscreen. In conclusion, our survey found that most US residents are aware about sunscreen's role in protection from UV rays, however, most citizens continue to use it inconsistently.

The epidemiology of skin cancer by UV index: cross-sectional analysis from the 2019 behavioral risk factor surveillance survey

The extent to which the Ultraviolet (UV) index is associated with the prevalence of melanoma and keratinocyte cancer in the United States is not clear. We conducted a cross-sectional study using the Center for Disease Control and Prevention's (CDC) 2019 Behavioral Risk Factor Surveillance System (BRFSS) telephone interview survey to investigate the epidemiology of skin cancer in the US including age, household income, education, and marital and employment status. Of non-Hispanic white respondents, 9.6% (N = 29,925) reported a being told of a skin cancer diagnosis. The prevalence of skin cancer was significantly higher in high UV (> / = 8) states (11.8%, N = 36,575) than in medium UV (6-7) (9.0%, N = 27,812) and lower UV (< / = 5) (7.8%, N = 24,083) states (p < .0001). Respondents from a medium UV or high UV state had higher odds (1.21 [1.15-2.27], 1.55[1.47-1.63], respectively) of reporting a skin cancer diagnosis than those from a low UV state. The association of UV index with lifetime skin cancer prevalence reinforces the importance of educating patients on preventive practices such as avoidance of tanning beds and usage of UV protection with clothing and sunscreen.

Modeling acute and cumulative erythemal sun exposure on vulnerable body sites during beach vacations utilizing behavior-encoded 3D body models

Vacationers in a high-solar-intensity beach setting put themselves at risk of ultraviolet radiation (UV) over-exposure that can lead to acute and chronic health consequences including erythema, photoaging, and skin cancer. There is a current gap in existing dosimetry work on capturing detailed time-resolved anatomical distributions of UV exposure in the beach vacation setting. In this study, a radiative transfer model of the solar conditions of Tampa Bay, St. Petersburg, Florida, USA (27.8°N, 82.8°W) is combined with an in silico three-dimensional body model and data on typical beach vacation behaviors to calculate acute and cumulative body-site-specific UV exposure risk during a beach vacation. The resulting cumulative UV exposure calculated for a typical mix of clothing choices, settings, and activities during a week-long (7-day) beach vacation is 172.2 standard erythemal doses (SED) at the forearm, which is comparable with the average total annual UV exposure of European and North American residents and consistent with existing dosimetry studies. This model further estimates that vacationers choosing to spend a full day exclusively in the beach or pool setting can experience UV exposure in excess of 50 SED a day at multiple body sites. Such exposure indicates that significant sun protective measures would be required to prevent sunburn across all skin types in this setting. This work clarifies the significant role that beach vacations play in UV exposure and corresponding acute and cumulative health risks and highlights the importance of behavioral choices (including clothing, activity and photoprotection) as crucial factors in differentiating personal solar exposure risks.

Relationship between ozone and biologically relevant UV at 4 NDACC sites

Clouds and aerosols, as well as overhead ozone, can have large effects on ultraviolet (UV) irradiances. We use statistical methods to remove cloud effects and mean aerosol effects from spectral UV irradiance measurements to investigate the relationship between UV and total column ozone. We show that for fixed solar zenith angles (SZA), seasonal changes in ozone lead to marked changes in clear-sky UV irradiances. Such effects are larger at mid-latitudes than in the tropics. At mid-latitudes, the minimum ozone amount over the course of a year can be about 50 percent of its maximum, with the lowest values in autumn and the highest values in spring. These seasonal ozone changes lead to UV Index (UVI) values in autumn that can exceed those in spring at the same SZA by nearly a factor of two. Differences are even larger for UV spectra weighted by the action spectra for DNA-damaging UV, and for cutaneous previtamin D production. In some cases, the seasonal increase exceeds a factor of 4. The analysis experimentally demonstrates the limits of applicability of the concept of constant Radiative Amplification Factors (RAFs) for estimating effects of changes in ozone for some weighting functions. Changes in DNA-weighted UV and erythemally weighted UV are well represented by the published RAFs. However, there are large SZA dependencies in the case of UVB and vitamin D-weighted UV. For all weightings considered, RAFs calculated from the observations as a function of SZA show similar dependencies between sites, in good agreement with published values, independently of the ozone data source. High quality measurements show that natural variations in ozone are responsible for huge variations in biologically damaging UV, with seasonal changes at fixed solar zenith angles sometimes exceeding a factor of four. The measured changes from thousands of spectra agree well with calculations over a wide range of solar zenith angles.

Evaluation of a Sunscreen Product Compared with Reference Standards P3, P5 and P8 in Outdoor Conditions: a Randomized, Double-Blinded, Intra-individual Study in Healthy Subjects

INTRODUCTION

The shortcomings of standardized sunscreen testing have been discussed in recent years, noting differences between how sunscreens perform in indoor clinical (in vivo) laboratory testing compared with real-life conditions. We previously developed an outdoor clinical method for ranking sunscreens by performance level. We used this method to test the performance of a new broad-spectrum sunscreen against International Organization for Standardization (ISO) reference products P3, P5 and P8.

METHODS

Sixty-five healthy volunteers with individual typology angle (ITA) ≥ 28° (light to intermediate skin colour) participated in an outdoor study in Mauritius. Test areas were marked on their backs, which were treated with the different products: one commercially available broad-spectrum sun protection factor (SPF) 50 sunscreen [investigational product (IP)] and the three reference products P3 (SPF 15), P5 (SPF 30) and P8 (SPF 50+) from ISO norm 24444:2019 for SPF testing. The test areas were exposed for 2-3 h, depending on the baseline skin colour. They were also compared with an unprotected positive control area and a non-exposed negative control area. Clinical and colorimetry assessment of erythema and pigmentation were performed at 24 h and 8 days, respectively.

RESULTS

Overall, according to this outdoor clinical testing method, the sunscreens' efficacy was ranked in an appropriate order given their established SPF levels, with higher SPFs giving greater protection against erythema and pigmentation. Between the different levels of SPF, the differences were statistically significant, for both clinical and colorimetry assessments. The new broad-spectrum SPF 50 IP performed similarly to the SPF 50+ (P8) reference product. Even the highest SPF products, SPF 50 and SPF 50+, had some instances of photoprotection failure.

CONCLUSION

These findings confirm the feasibility of this outdoor clinical testing method in ranking sunscreens and provide further evidence, in addition to standardized SPF and UVA protection factor (UVAPF) testing, on how this new broad-spectrum SPF 50 sunscreen performs in extreme outdoor solar exposure: in line with reference product P8 (SPF 50+).

TRIAL REGISTRATION NO

ISRCTN95394014.

Health risks of extended exposure to low-level UV radiation - An analysis of ground-based and satellite-derived data

This study aims to indicate the importance of revising current health recommendations concerning the duration of exposure and individual sensitivity of the skin to solar ultraviolet (UV) radiation. For this purpose, a 16-year data series (2005-2020) of erythemal radiant exposure (H_er) and UV index (UVI) for Serbia was analyzed. The UV-related risk was estimated for lighter skin (skin phototypes I-IV) under prolonged exposure on days when maximum UVI was below the recommended protection threshold (UVI_low days, for UVI < 3). Risk assessment was performed for seasonal exposure using satellite-derived data (OMUVBd product) previously validated by ground-based measurements in Novi Sad. The assessment of harmful effects included an analysis of the relation between the daily maximum UVI and the corresponding daily H_er, the occurrence of UVI_low days, the exceedance of minimal erythema dose (MED), and the minimum duration of exposure to induce erythema (t_MED) for all lighter skin phototypes. It was found that the share of UVI_low days in the total number of days in Serbia increases with the latitude, with the highest percentage in winter (up to 69.454%) and the lowest in summer (up to 3.468%). The results show that the daily H_er frequently exceeded the harmful threshold for lighter skin phototypes I-IV (on average by 91.521, 84.923, 70.556, and 56.515%, respectively) on UVI_low days. It was found that prolonged exposure on days with a maximum of UVI = 2 poses a significant risk of erythema for all lighter skin phototypes, even for a duration of 3 h in the middle of the day, as well as medium risk for UVI = 1, and an absence of risk for UVI = 0. The results suggest that health recommendations should be revised, especially in the mid-latitudes, where the share of UVI_low days is large, and in areas where the population is predominantly lighter-skinned.

The dynamic behaviour of sunscreens under in-service conditions

Discussion continues over various aspects of sunscreen science: regulation, test methods, sun protection factor (SPF), labelling claims, potentially harmful components, among others. In this paper the UV transmission properties of a number of commercial sunscreens have been determined at constant sunscreen film thickness under different local UV Index conditions. The data demonstrate difficulties facing the public and the sunscreen industry as a whole, even though SPF values and other data stated on the sunscreen packaging are assumed to be correct according to standard testing methods. This work has shown that at realistic application rates the critical factors are the intensity of the incident solar radiation and the accumulated erythema UV dose transmitted over time. In one example, on 'Extreme' UV Index days, an SPF 30 sunscreen under test transmitted one minimal erythema dose (MED) of UV in only 35 min. In another example, although it should not, in theory, transmit one MED until several hours of exposure, this level was reached in 1 h by an SPF 50 sunscreen under these typical Australian summer conditions (UV Index 12) in Wollongong, NSW (34.4°S). Such properties could have severe consequnces if these sunscreens were used by individuals with Fitzpatrick Skin Type 1, organ transplant recipients or other immuno-compromised individuals.

The Role of the Global Solar UV Index for Sun Protection of Children in German Kindergartens

More than twenty-five years ago, the Global Solar UV index (UVI) was introduced as a simple means of visualizing the intensity of ultraviolet radiation and to alert people to the need for sun protection. In our survey, among directors of 436 kindergartens in southern Germany we investigated the level of awareness and knowledge about the UVI as well as the practical consequences for sun protection in kindergartens. Less than half of the directors (n = 208, 47.7%) had ever heard of the UVI, and only a small minority of them (n = 34, 8.7%) used the daily UVI information to adapt sun protective measures in their kindergartens. Detailed knowledge about the UVI was a rarity among the respondents. The proportion of respondents with self-perceived detailed UVI knowledge was five times higher than the actual knowledge assessed by an in-depth structured interview using open-ended questions about the UVI (14.2% vs. 2.8%). No clear relationship between UVI awareness, knowledge, and use and directors' age and gender was found. The UVI-related variables also showed no association with directors' knowledge of risk factors for skin cancer and their attitudes towards tanned skin. Overall, the results paint a sobering picture regarding the penetration of the UVI into sun protection policies of German kindergartens. Future public health campaigns should aim to increase the awareness and understanding of the UVI as well as its relevance for sun protection of children.

Erythemal and vitamin D weighted solar UV dose-rates and doses estimated from measurements in mainland France and on Réunion Island

Solar UV radiation causes beneficial and detrimental changes in human health. International and national Health agencies recommend avoiding sun exposure when the solar rays are strongest (typically 2 h before and after solar noon). In this study we detail and refine such recommendations. We estimated biologically-effective radiation (inductive of erythema and pre-vitamin D) using spectral solar UV radiation measurements on a horizontal plane at three French sites equipped with spectroradiometers: Villeneuve d'Ascq (VDA) (North of France); Observatoire de Haute-Provence (OHP) (French Southern Alps); and Saint-Denis de La Réunion (SDR) on Réunion Island, in the Indian Ocean. These sites are very different: VDA is a semi-urban site in a flat region, OHP a rural mountainous site and SDR a coastal urban site on a small mountainous island. Biologically active radiation was analyzed by studying erythema induction and measuring pre-vitamin D synthesis. Dose-rates, doses and times for sunburn induction and vitamin D production were derived. Regarding the level of vitamin D dose considered here (1000 IU), we found that at mainland sites time required for vitamin D synthesis was relatively long, even around solar noon, in winter months this could be 2-3 h for phototype II individuals exposing their face and hands. In the tropics vitamin D could always be synthesized in a reasonable time (e.g. 20 min in winter). By contrast, in summer, the required duration times (exposing face, hands, arms and legs) are very short, approximately 2-4 min on the mainland and 1 min in the tropics for phototype II individuals. In all skin phototypes the duration of sun exposure required to induce erythema was generally longer than that to produce vitamin D. These quantitative results, obtained using an instrument measuring on a horizontal plane and with an unobstructed view, do not represent realistic values for human exposure. To account for realistic human body exposure, received doses and times of exposure were adjusted. Our study shows that, mostly in summer, the time periods where limited solar exposure is recommended should be extended, especially at low latitude locations.

A DNN-Based UVI Calculation Method Using Representative Color Information of Sun Object Images

As outdoor activities are necessary for maintaining our health, research interest in environmental conditions such as the weather, atmosphere, and ultraviolet (UV) radiation is increasing. In particular, UV radiation, which can benefit or harm the human body depending on the degree of exposure, is recognized as an essential environmental factor that needs to be identified. However, unlike the weather and atmospheric conditions, which can be identified to some extent by the naked eye, UV radiation corresponds to wavelength bands that humans cannot recognize; hence, the intensity of UV radiation cannot be measured. Recently, although devices and sensors that can measure UV radiation have been launched, it is very difficult for ordinary users to acquire ambient UV radiation information directly because of the cost and inconvenience caused by operating separate devices. Herein, a deep neural network (DNN)-based ultraviolet index (UVI) calculation method is proposed using representative color information of sun object images. First, Mask-region-based convolutional neural networks (R-CNN) are applied to sky images to extract sun object regions and then detect the representative color of the sun object regions. Then, a deep learning model is constructed to calculate the UVI by inputting RGB color values, which are representative colors detected later along with the altitude angle and azimuth of the sun at that time. After selecting each day of spring and autumn, the performance of the proposed method was tested, and it was confirmed that accurate UVI could be calculated within a range of mean absolute error of 0.3.

Ultraviolet Radiation Environment of a Tropical Megacity in Transition: Mexico City 2000-2019

Tropical regions experience naturally high levels of UV radiation, but urban pollution can reduce these levels substantially. We analyzed 20 years of measurements of the UV index (UVI) at several ground-level locations in the Mexico City Metropolitan Area and compared these data with the UVI values derived from the satellite observations of ozone and clouds (but not local pollution). The ground-based measurements were systematically lower than the satellite-based estimates by ca. 40% in 2000 and 25% in 2019. Calculations with a radiative transfer model using observed concentrations of air pollutants explained well the difference between satellite and ground-based UVI and showed specific contributions from aerosols, O3, NO2, and SO2 in decreasing order of importance. Such large changes in UV radiation between 2000 and 2019 have important implications ranging from human health (skin cancer and cataract induction) to air pollution control (photochemical smog formation).

Variation and correlation between ultraviolet index and tropospheric ozone during COVID-19 lockdown over megacities of India

Worldwide spread out of COVID-19 in a short-time has brought a significant decline of road traffic, tourist flow and industrial ventures. During this emergency period, the restricted human dealings with nature have appeared as blessing for health of the total environment. The variation of atmospheric O₃ may modulate the range of UV index (UVI) at any region of the earth. The objective of the study is to examine the variation of UV index over the megacities of India with respect to tropospheric O₃ level modification during COVID-19 lockdown. The meteorological or environmental data (temperature in °C, gust in km/h, wind speed km/h, relative humidity in %, air pressure in mb and cloud cover in okta) of four selective megacities of India (Kolkata, Chennai, Delhi, Mumbai) during and pre lockdown period have been obtained to comprehend about the variation of UV index and tropospheric O₃. The descriptive statistical applications i.e. standard deviation, standard errors and K-means clustering have been done through standard statistical software. In the present study, t-test has been used to understand level of significance of surface O₃ and UVI during pre-lockdown (2019) and lockdown (2020) phase. The result shows that the four major megacities in India namely New Delhi, Mumbai, Kolkata and Chennai have experienced the vibrant diminution in terms of the concentration of UV index with slightly increasing the tropospheric O₃ level during the lockdown phase. The higher accumulation of O₃ during the lockdown in the lower atmosphere of four megacities does not exceed the permissible limit. The excess amount of O₃ has remarkably contributed to trap the harmful UV radiation which has lowered the UVI in these worst polluted megacities of India. In the meantime, the prominent reduction of NO_x during the lockdown period decreases the titration impact to O₃ and this mechanism helps to revitalize the ozone concentration level. The uniqueness of the current study is highlighted the ground reality regarding reduction of UV index and amplification of tropospheric O₃ concentration during lockdown phase. This study definitely assists to make new environmental policy, act and law for recover the health of the total environment.

"I've Heard of It, Yes, but I Can't Remember What Exactly It Was"-A Qualitative Study on Awareness, Knowledge, and Use of the UV Index

Pharmacists and pharmaceutical technicians play an important role in counselling customers regarding sunscreen use and sun protection measures. A potentially helpful tool that can be used during counselling is the ultraviolet index (UVI), which informs individuals when and what sun protection measures are needed at a specific place and time. Our aim in this qualitative study was to explore awareness, knowledge, and use of the UVI during counselling in pharmacies. We used semi-structured interviews with pharmacists and pharmaceutical technicians (n = 20) to answer our research questions. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. During the interviews pharmacists and pharmaceutical technicians revealed a lot of uncertainty and lack of knowledge regarding the UVI. Eight professionals were able to give a correct definition of UVI. Amongst others, the UVI was confused with sun protection factor. Overall, the UVI was hardly used during the counselling of customers. The UVI was developed to provide guidance when which type of sun protection is required to avoid detrimental effects of ultraviolet radiation. For effective implementation, both the general population and health professionals (e.g., pharmacists) have to increase their knowledge about the UVI. This would strengthen its use during professional counselling in pharmacies and may help to reduce the incidence of skin cancer over the long term.

Impact of population density and weather on COVID-19 pandemic and SARS-CoV-2 mutation frequency in Bangladesh

Coronavirus disease-2019 (COVID-19) has caused the recent pandemic worldwide. Research studies are focused on various factors affecting the pandemic to find effective vaccine or therapeutics against COVID-19. Environmental factors are the important regulators of COVID-19 pandemic. This study aims to determine the impact of weather on the COVID-19 cases, fatalities and frequency of mutations in Bangladesh. The impacts were determined on 1, 7 and 14 days of the case. The study was conducted based on Spearman's correlation coefficients. The highest correlation was found between population density and cases (rs = 0.712). Among metrological parameters, average temperature had the strongest correlation (rs = -0.675) with the cases. About 82% of Bangladeshi isolates had D614G at spike protein. Both temperature and UV index had strong effects on the frequency of mutations. Among host factors, coinfection is highly associated with frequency of different mutations. This study will give a complete picture of the effects of metrological parameters on COVID-19 cases, fatalities and mutation frequency that will help the authorities to take proper decisions.

Sun Awareness and Sun Protection Practices

Background

The incidence of skin cancer has increased over the past few years, owing to excessive exposure to ultraviolet (UV) radiation. Over the past decade, protection against solar radiation has been highly encouraged in numerous public health education campaigns. The adopted sun protection practices include avoiding exposure to the sun, using protective clothing, and applying sunscreen. The aim of this paper was to analyze the awareness and attitudes towards sun protection practices in some regions of the Arabian Peninsula.

Objective

The main objective of this study is to estimate the level of sun protection practices and determine the factors that have a significant impact on the level of adoption of sun protection practices by residents in the Arabian Peninsula.

Methods

A 35-question self-reporting online questionnaire to evaluate the sun protection measures adopted by the residents was distributed in the Kingdom of Saudi Arabia and Kingdom of Bahrain. The survey was conducted from January 2018 to May 2019, and a total 830 responses were collected for analysis. The data were analyzed using the statistical software SPSS. The chi-squared test and Spearman's correlation were performed to determine the association of the sun protection level with factors concerning the socio-demographic characteristics, sun sensitivity, health-conscious lifestyle, adopted sun protection measures, and general awareness about the UV index, skin cancer, and vitamin D. Logistic regression classification was applied in developing the empirical model to predict the sun protection level of the residents.

Results

Based on the analysis, only 34% of the total 830 respondents use sunscreen and most of the sunscreen users are female. The three most popular sun protection practices are: 1) avoiding exposure to the sun during peak hours, 2) using protective clothing, and 3) using sunglasses. The results indicate that 22% of respondents use a low level of sun protection, 53% use a medium level of protection, while 25% of respondents use a high level of sun protection. Many of the respondents understand that exposure to the sun can cause skin cancer and skin aging, while 54% of the respondents still believe that a suntan can be healthy if sunburn is avoided. Thirty percent of the participants of this study are aware of the UV index, and only 20% of all respondents know the correct meaning of the UV index. The overall predictive accuracy of the constructed logistic regression model is 67%. Based on the results of the logistic regression model, the five most significant factors of the sun protection level are: 1) perception that the sun can cause skin aging, or not, 2) age, 3) awareness of the dangerous effects of sun exposure, 4) income with respect to expenses, and 5) taking the UV index into consideration during exposure to the sun.

Conclusion

Most of the respondents are aware about sun protection. However, the sun protection level of the residents is still inadequate. An efficient strategy of increasing the awareness of the effective use of sun protection systems must be established based on the significant factors to prevent skin cancer.

On the Relationship Between Sun Exposure and All-Cause Mortality

Increasing sun exposure is related to lower prevalence of death in cardiovascular disease (CVD), type 2 diabetes, and other noncancer non-CVD. In this chapter we aim to make a short update on the knowledge regarding sun exposure and all-cause mortality. Data support the hypothesis that low sun exposure habits are a major risk factor for all-cause mortality. Low sun exposure is related to an increased risk of death due to CVD and noncancer/non-CVD, and a minor reduction in risk of cancer. Active sun exposure habits have a dual effect; it increases the incidence of skin cancer, but also improves the prognosis in terms of all-cause mortality. In a low solar intensity region, we should carefully assess both risk and benefits of sun exposure in order to obtain balanced recommendations.

On the global trends and spread of the COVID-19 outbreak: preliminary assessment of the potential relation between location-specific temperature and UV index

The novel coronavirus, since its first outbreak in December, has, up till now, affected approximately 114,542 people across 115 countries. Many international agencies are devoting efforts to enhance the understanding of the evolving COVID-19 outbreak on an international level, its influences, and preparedness. At present, COVID-19 appears to affect individuals through person-to-person means, like other commonly found cold or influenza viruses. It is widely known and acknowledged that viruses causing influenza peak during cold temperatures and gradually subside in the warmer temperature, owing to their seasonality. Thus, COVID-19, due to its regular flu-like symptoms, is also expected to show similar seasonality and subside as the global temperatures rise in the northern hemisphere with the onset of spring. Despite these speculations, however, the systematic analysis in the global perspective of the relation between COVID-19 spread and meteorological parameters is unavailable. Here, by analyzing the region- and city-specific affected global data and corresponding meteorological parameters, we show that there is an optimum range of temperature and UV index strongly affecting the spread and survival of the virus, whereas precipitation, relative humidity, cloud cover, etc. have no effect on the virus. Unavailability of pharmaceutical interventions would require greater preparedness and alert for the effective control of COVID-19. Under these conditions, the information provided here could be very helpful for the global community struggling to fight this global crisis. It is, however, important to note that the information presented here clearly lacks any physiological evidences, which may merit further investigation. Thus, any attempt for management, implementation, and evaluation strategies responding to the crisis arising due to the COVID-19 outbreak must not consider the evaluation presented here as the foremost factor.

Inter-Comparison Campaign of Solar UVR Instruments under Clear Sky Conditions at Reunion Island (21°S, 55°E)

Measurement of solar ultraviolet radiation (UVR) is important for the assessment of potential beneficial and adverse impacts on the biosphere, plants, animals, and humans. Excess solar UVR exposure in humans is associated with skin carcinogenesis and immunosuppression. Several factors influence solar UVR at the Earth’s surface, such as latitude and cloud cover. Given the potential risks from solar UVR there is a need to measure solar UVR at different locations using effective instrumentation. Various instruments are available to measure solar UVR, but some are expensive and others are not portable, both restrictive variables for exposure assessments. Here, we compared solar UVR sensors commercialized at low or moderate cost to assess their performance and quality of measurements against a high-grade Bentham spectrometer. The inter-comparison campaign took place between March 2018 and February 2019 at Saint-Denis, La Réunion. Instruments evaluated included a Kipp&Zonen UVS-E-T radiometer, a Solar Light UV-Biometer, a SGLux UV-Cosine radiometer, and a Davis radiometer. Cloud fraction was considered using a SkyCamVision all-sky camera and the Tropospheric Ultraviolet Visible radiative transfer model was used to model clear-sky conditions. Overall, there was good reliability between the instruments over time, except for the Davis radiometer, which showed dependence on solar zenith angle. The Solar Light UV-Biometer and the Kipp&Zonen radiometer gave satisfactory results, while the low-cost SGLux radiometer performed better in clear sky conditions. Future studies should investigate temporal drift and stability over time.

Awareness, understanding, use, and impact of the UV index: A systematic review of over two decades of international research

The ultraviolet radiation index (UVI) was adopted internationally to raise awareness about and encourage the public to protect their skin from skin cancer. The current paper is a systematic review of over 20 years of research investigating awareness, comprehension, use, and impact of the UVI. Thirty-one studies were included from the USA, Canada, Europe, Australia, New Zealand, and elsewhere. Awareness of the UVI varies by country, with samples from some countries demonstrating high awareness. However, comprehension and use of the UVI to inform sun safety behaviors are typically much lower. In fact, greater UVI awareness has sometimes been associated with riskier UV-related behaviors such as intentional tanning. Fewer studies have evaluated interventions, and their results have been mixed. In summary, more research is needed to determine how to help the public understand and use the UVI for effective skin protection. This review offers suggestions for future use of and research with the UVI.

Time and Place as Modifiers of Personal UV Exposure

It is a common belief that, if we want to limit our sun exposure during outdoor recreational activities and holidays in order to avoid sunburn or reduce our risk of skin cancer, we need to reach for the bottle of sunscreen or cover up with clothing. As important as these measures are, there is another way to enjoy our time outdoors and still benefit from the experience. In this article, we consider the impact of time, place, and behaviour outdoors on our exposure to solar ultraviolet (UV) radiation. Some of the simple actions we can take in controlling our UV exposure include being aware of the position of the sun in the sky, understanding how we can use the UV index to guide our outdoor exposure, and the importance of reducing our sun exposure around the middle of the day. Finally we review our preferred holiday activities and destinations, and the influence of outdoor leisure pursuits. By planning where and when we spend our leisure time in the sun, we can maximise our enjoyment whilst limiting our UV exposure.

Comparison of Ground-Based and Satellite-Derived Solar UV Index Levels at Six South African Sites

South Africa has been measuring the ground-based solar UV index for more than two decades at six sites to raise awareness about the impacts of the solar UV index on human health. This paper is an exploratory study based on comparison with satellite UV index measurements from the OMI/AURA experiment. Relative UV index differences between ground-based and satellite-derived data ranged from 0 to 45% depending on the site and year. Most of time, these differences appear in winter. Some ground-based stations’ data had closer agreement with satellite-derived data. While the ground-based instruments are not intended for long-term trend analysis, they provide UV index information for public awareness instead, with some weak signs suggesting such long-term trends may exist in the ground-based data. The annual cycle, altitude, and latitude effects clearly appear in the UV index data measured in South Africa. This variability must be taken into account for the development of an excess solar UV exposure prevention strategy.

Sex differences in the association of cutaneous melanoma incidence rates and geographic ultraviolet light exposure

BACKGROUND

Cutaneous melanoma (CM) incidence rates continue to increase, and the reasons are unknown. Previously, we reported a unique age-specific sex difference in melanoma that suggested additional causes other than solar ultraviolet (UV) radiation.

OBJECTIVE

This study attempted to understand whether and how UV radiation differentially impacts the CM incidence in men and women.

METHODS

CM data and daily UV index (UVI) from 31 cancer registries were collected for association analysis. A second dataset from 42 US states was used for validation.

RESULTS

There was no association between log-transformed female CM rates and levels of UVI, but there was a significant association between male rates and UVI and a significant association between overall rates and UVI. The 5-year age-specific rate-UVI association levels (represented by Pearson's coefficient ρ) increased with age in men, but age-specific ρ levels remained low and unchanged in women. The significant rate-UVI association in men and nonassociation in women was validated in a population of white residents of the United States.

LIMITATIONS

Confounders, including temperature and latitude, are difficult to separate from UVI.

CONCLUSIONS

Ambient UVI appears to be associated with melanoma incidence in males but not in females.

Association between unprotected ultraviolet radiation exposure and recurrence of ocular herpes simplex virus

Studies have suggested that exposure to ultraviolet (UV) light may increase risk of herpes simplex virus (HSV) recurrence. Between 1993 and 1997, the Herpetic Eye Disease Study (HEDS) randomized 703 participants with ocular HSV to receipt of acyclovir or placebo for prevention of ocular HSV recurrence. Of these, 308 HEDS participants (48% female and 85% white; median age, 49 years) were included in a nested study of exposures thought to cause recurrence and were followed for up to 15 months. We matched weekly UV index values from the National Oceanic and Atmospheric Administration to each participant's study center and used marginal structural Cox models to account for time-varying psychological stress and contact lens use and selection bias from dropout. There were 44 recurrences of ocular HSV, yielding an incidence of 4.3 events per 1,000 person-weeks. Weighted hazard ratios comparing persons with ≥8 hours of time outdoors to those with less exposure were 0.84 (95% confidence interval (CI): 0.27, 2.63) and 3.10 (95% CI: 1.14, 8.48) for weeks with a UV index of <4 and ≥4, respectively (ratio of hazard ratios = 3.68, 95% CI: 0.43, 31.4). Though results were imprecise, when the UV index was higher (i.e., ≥4), spending 8 or more hours per week outdoors was associated with increased risk of ocular HSV recurrence.

Determinants of inadequate parental sun protection behaviour in their children--results of a cross-sectional study in Germany

OBJECTIVE

Unprotected sun exposure especially during childhood is a risk factor for skin cancer. A combined use of sun protection measures is recommended to protect children. However, the prevalence and determinants for combined use have been scarcely studied in children. The objective of this study was to identify determinants of parental sun protection behaviour.

METHODS

A cross-sectional survey was performed in five regions in Bavaria (Germany) during school entrance health examination (2010/2011). Parents of 4579 children (47% female, aged 5-6 years) completed a self-administered questionnaire (response 61%).

RESULTS

Most children were regularly protected with single measures (shade (69%), clothes (80%), hat (83%), sunscreen (89%), sunglasses (20%)). However, regarding regular and combined use, >50% of children were inadequately protected. Larger family size, lower household equivalent income, darker skin and sunburn history were associated with inadequate use of different sun protection measures. The less frequent use of one sun protection measure was associated with less frequent use of the others. Child's sex, migration background, parental education and sun exposure showed inconsistent results regarding the different sun protection outcomes.

CONCLUSION

Based on our results a regular, combined and correct use of multiple sun protection for children should be promoted independent of sociodemographic characteristics. Priority of shade, clothes and hat before sunscreen should be clarified.