Reliability testing of a sun exposure questionnaire for the Northern Ireland population.

BACKGROUND: Sunbathing and other types of exposure to ultraviolet radiation are the major preventable risk factors for skin cancer. Due to the continued increase in incidence of melanoma in Northern Ireland, we have conducted a questionnaire survey in an attempt to gather information about sunbathing habits and other forms of ultraviolet light exposure amongst the Northern Ireland population. AIM: The aim of this study was to examine the test-retest reliability of a questionnaire used in a large-scale cross-sectional population survey pertaining to sunbathing habits, use of sun screen, skin types, and frequencies of sunburn and to assess the responses given by the subjects to determine the nature of their sun-related behaviour. METHODS: Thirty control subjects were randomly selected from a population control sample participating in a large case-control study investigating melanoma in the Northern Ireland population. All participants completed the interview questionnaire on two occasions, with a median of 15 days (range, 12-42 days) between interviews. We randomly chose control subjects who had been visited by the same research nurse, thus ruling out interobserver bias in the analyses. We used the test-retest method. Kappa statistics were used to calculate the association between test and retest scores of all the individual items. If the items contained within the questionnaire are reliable, then repeated measurement after a fairly short period of time should result in high within-subject repeatability. RESULTS: Questions pertaining to hours spent in the sun and sun bed usage showed high reliability (kappa > 0.7). Questions about sunscreen usage showed moderately high reliability (kappa > 0.6) in all but one of the 10-year age bands and complete agreement (kappa = 1) in one age category (>50 years). CONCLUSION: This questionnaire is a reliable method of assessing sun-associated behaviour identifying high-risk sun-related behaviour and misconceptions about tanning, which can be targeted for improvement in public health.

Improved survival for melanoma in Northern Ireland: a comparison of two 5-year periods (1984-88 and 1994-98).

BACKGROUND: The incidence of cutaneous malignant melanoma has been rising steadily in Caucasian populations for several decades, with a doubling time of 10-14 years. An increase in incidence of about 5% per year has been reported in most Caucasian populations since the early 1960s. OBJECTIVES: This study was designed to determine the changing incidence of primary cutaneous malignant melanoma in Northern Ireland and to examine changes in survival rates from cutaneous malignant melanoma in two 5-year periods, 1984-88 and 1994-98. METHODS: One thousand three hundred and twenty-six patients with invasive primary cutaneous melanoma were included in the study. RESULTS: The age standardized rate of melanoma rose from 4.3 per 100,000 population per year in men and 8.6 per 100,000 population per year in women to 7.7 and 11.8, respectively, per 100,000 population per year in the 1994-98 period. Overall, the absolute 5-year survival for the 1984-88 period was 71.0% [95% confidence interval (CI) 66.9-75.1%] and 77.4% (95% CI 73.4-81.4%) for the 1994-98 period. Women consistently showed better survival at all ages and within almost all categories of thickness of primary tumour. Younger patients of both sexes showed better survival rates. CONCLUSIONS: When survival rates between the 1984-88 and 1994-98 periods were compared using multivariate analysis, we found that patients diagnosed in the second period had a one-third lower risk of dying than those in the earlier period. Much of this reduction was explained by changes in the number of melanomas of thin Breslow depth and ulcerated melanomas.

Association between long-term acitretin therapy and osteoporosis: no evidence of increased risk.

Osteoporosis has been observed with chronic hypervitaminosis A, leading some authors to hypothesize that systemic retinoids may have an effect on bone mineral density. Two previous small studies identified osteoporosis in patients who received long-term therapy with etretinate. Etretinate has now been superceeded by acitretin in clinical use. We hypothesized that bone mineral density is lower in patients taking long-term acitretin than control cases who had never taken acitretin. Thirty Caucasian patients receiving acitretin for a median of 3.6 years for a variety of dermatoses were studied. Bone mineral density measurements were determined using DEXA scanning at two standard sites, the lumbar spine and Ward's triangle. We did not find an association between daily dose of acitretin, total dose administered or overall duration of treatment and risk of osteopenia or osteoporosis. Acitretin appears to be safe for long-term use in patients with chronic dermatoses.

Childhood discoid lupus erythematosus: a report of two cases.

Discoid lupus erythematosus (DLE) is an uncommon disease in childhood. We present two patients initially diagnosed as impetigo and photosensitive eczema with impetigo, respectively, who failed to respond to topical and systemic antistaphylococcal agents and in whom a diagnosis of discoid lupus erythematosus subsequently became apparent.

Alcohol craving in rehabilitation: assessment of nutrition therapy.

If untreated, alcohol abuse, which often results from alcohol craving, causes major metabolic abnormalities, altered life-styles, lost productivity, and eventually death. Biochemical mechanisms that may contribute to alcohol craving include the stress response of the hypothalamic-pituitary adrenal axis, the endogenous opiate beta-endorphin system, neurotransmitter synthesis and release, hypoglycemia, and nutrient deficiencies. The macronutrient ratio of meals, the resulting insulin response, and nutrient blood levels can affect amino acid and nutrient transport across the blood-brain barrier. Researchers have reported that animals increase alcohol intake when fed nutrient-deficient diets or after stressful experience. A pilot study was designed to assess the effects of nutrition therapy added to a traditional rehabilitation program based on the 12-step program of Alcoholics Anonymous. One study group received traditional therapy; the other study group received traditional therapy and nutrition therapy consisting of modified menus and individualized nutrition counseling. Patients who received nutrition therapy reported significantly fewer hypoglycemic symptoms, lower sugar intake, less alcohol craving as well as significantly greater nutrient intakes; a greater number abstained from alcohol. These findings indicate that nutrition therapy can aid in the recovery from alcoholism.