Clima, estilo de vida e áreas verdes em cidades: análises geoepidemiológicas sobre status de vitamina D em mulheres / Climate, lifestyle and green areas in cities: geoepidemiological analyzes on vitamin D status in women

Introdução: Associada com uma considerável quantidade de doenças crônicas, agudas e mais recentemente, a Covid 19, a deficiência de vitamina D tem se tornado cada vez mais prevalente até em regiões de baixa latitude. Objetivo geral: Identificar e caracterizar a associação entre clima, estilo de vida e áreas verdes com os status de vitamina D em mulheres. Objetivos específicos: Avaliar a associação entre concentrações séricas de 25(OH)D e fatores relacionados ao estilo de vida em uma amostra de mulheres brasileiras que vivem na latitude 21º 80' S. Analisar a associação entre verde residencial em áreas urbanas e concentrações séricas de 25(OH)D em moradoras de uma cidade brasileira interiorana de médio porte e de clima tropical. Analisar a associação entre verde residencial, estilo de vida e concentrações séricas de 25(OH)D em moradoras de cidades de clima temperado ao sul da Inglaterra. Método: Foram realizados dois estudos epidemiológicos que analisaram a influência da dieta e exposição à luz solar no status de vitamina D. Idade, variáveis antropométricas, cor da pele e estado pós-menopausa foram medidos como potenciais fatores de confusão. O estudo transversal foi realizado com 101 mulheres com 35 anos ou mais que avaliou a associação entre a concentração sérica de 25(OH)D e a exposição à radiação ultravioleta, estilo de vida e depressão. O estudo longitudinal de 1 ano avaliou o status de vitamina D em 365 mulheres caucasianas e asiáticas, na pré-menopausa e pós-menopausa, residentes na região sul do Reino Unido. Como indicador da variável áreas verdes, foi calculado o Índice de Vegetação por Diferença Normalizada. Foram usados modelos de regressão múltipla e logística para analisar a associação entre as variáveis, além de testes não paramétricos. Os estudos resultaram em três artigos que estão na presente tese. Resultados: No primeiro artigo, no estudo transversal, mulheres mais velhas tiveram uma concentração significativamente maior de 25(OH)D do que as mulheres mais jovens (p = 0,013), bem como maior exposição à RUV (p = 0,01) e menor IMC (p = 0,005). Esses achados são independentes de outros fatores de confusão medidos. No segundo artigo, observou-se uma associacao positiva estatisticamente significativa entre a exposicao ao indice de vegetacao circundante residencial abaixo da mediana e a prevalencia de niveis insuficientes de 25(HO)D (P=0,03).No terceiro artigo, no estudo de coorte, as participantes que viviam em áreas mais verdes eram mais propensas a ter status de vitamina D melhorado (RR: 1,51, IC 95%: 1,13- 2,02), assim como, as que eram mais expostas à radiação ultravioleta (RR: 2,05, IC 95%: 1,44 - 2,92). Contudo, no modelo totalmente ajustado, as variáveis etnia e hormônio paratireóideo permaneceram significantes, p < 0,001 e p = 0,003. Conclusão: Foram encontradas associações entre vitamina D, estilo de vida, saúde mental e áreas verdes importantes para um panejamento urbano e social de incentivo a atividades ao ar livre. Contudo, uma análise de mediação que elucide como as áreas verdes contribuem para maiores níveis de vitamina D através do tempo de exposição à luz solar é necessário.

Introduction: Associated with a considerable amount of chronic and acute diseases and more recently, Covid 19, vitamin D deficiency has become increasingly prevalent even in low latitude regions. General objective: To identify and characterize the association between climate, lifestyle and green areas with vitamin D status in women. Specific objectives: To evaluate the association between serum concentrations of 25(OH)D and factors related to lifestyle in a sample of Brazilian women living at latitude 21º 80' S. To analyze the association between residential green in urban areas and serum concentrations of 25(OH)D in residents of a medium-sized country town in Brazil with a tropical climate. To analyze the association between residential greenery, lifestyle and serum concentrations of 25(OH)D in residents of temperate cities in the south of England. Method: Two epidemiological studies were performed that analyzed the influence of diet and sunlight exposure on vitamin D status. Age, anthropometric variables, skin color and postmenopausal status were measured as potential confounders. A cross-sectional study was carried out with 101 women aged 35 years or older that evaluated the association between serum 25(OH)D concentration and exposure to ultraviolet radiation, lifestyle and depression. The 1-year longitudinal study assessed the vitamin D status of 365 premenopausal and postmenopausal Caucasian and Asian women residing in the southern part of the UK. As an indicator of the green areas variable, the Vegetation Index by Normalized Difference was calculated. Multiple and logistic regression models were used to analyze the association between variables, in addition to non-parametric tests. The studies resulted in three articles that are in this thesis. Results: In the first article, in the cross-sectional study, older women had a significantly higher concentration of 25(OH)D than younger women (p = 0.013), as well as greater exposure to UVR (p = 0.01) and lower BMI (p = 0.005). These findings are independent of other measured confounders. In the second article, a statistically significant positive association was observed between exposure to the surrounding residential vegetation index below the median and the prevalence of insufficient levels of 25(HO)D (P=0.03). cohort, participants who lived in greener areas were more likely to have improved vitamin D status (RR: 1.51, 95% CI: 1.13-2.02), as were those who were more exposed to ultraviolet radiation (RR: 2.05, 95% CI: 1.44 - 2.92). However, in the fully adjusted model, the variables ethnicity and parathyroid hormone remained significant, p < 0.001 and p = 0.003. Conclusion: Association was found between vitamin D, lifestyle, mental health and important green areas for urban and social planning to encourage outdoor activities. However, a mediation analysis that elucidates how green areas contribute to higher levels of vitamin D through exposure time to sunlight is needed.

Ultra-low Ultraviolet Radiation in Office Lighting Can Moderate Seasonal Vitamin D Cycle: A Pilot Study.

BACKGROUND/AIM: Ultraviolet-B (UV-B) radiation initiates vitamin D synthesis in the skin, making sun exposure a major source of vitamin D. We aimed to determine whether office lighting containing ultra-low levels of UV-B radiation could modify the winter decline in vitamin D status in the UK, while being safe and well tolerated. PATIENTS AND METHODS: Twenty commercial office desk lamps were modified with the addition of UV-B LEDs. Ten hospital office administrative staff received UV-modified lamps with UV-on, and 10 staff received identical placebo lamps with UV switched off, in a double-blind, cross-over pilot study during the winter of 2021/22. Circulating 25-hydroxyvitamin D [25(OH)D] was measured every 4 weeks for 20 weeks: at baseline and during an 8-week trial period, 4-week washout, and a cross-over 8-week trial period. RESULTS: The linear regression combining the complete datasets for phase 1 and 2 of the trial showed that an 8-week UV light intervention significantly increased 25OHD by 7.13 nmol/l with a p-Value=0.02, compared to the placebo group. Similar results were confirmed by cross-over analyses using the datasets of those completing both phases of the trial both with and without using the inverse probability weighing method to handle dropouts. CONCLUSION: The UV-B-modified lighting was well-tolerated and safe with weekly doses of UV-B of 0.5 - 0.9 Standard Erythema Dose [SED=100 Jm-2 erythema weighted UV radiation] measured at chest level. This ultra-low dosing was effective in reducing the winter decline in vitamin D status.

[Progress in health effects and measurement standards of ultraviolet radiation in the workplace].

Ultraviolet radiation affects human health. On the one hand, moderate amounts of UV radiation can promote human health and have the effect of promoting vitamin D production; but on the other hand, excessive UV radiation can also cause adverse effects on human skin and eyes, such as causing skin photoaging, skin cancer, electrophthalmia and cataracts to occur. Therefore, the measurement of ultraviolet radiation is extremely important. This paper mainly reviews the health effects of ultraviolet radiation and the progress of measurement standards in the workplace, and puts forward suggestions on the revision of the existing standards from five aspects including use new measuring instruments and methods, improve the existing measuring instruments, specify the number of measurements, expand the scope of application of the standards and consider the influence of the sun on the measurement of artificial ultraviolet radiation, so as to provide reference for the revision of new standards.

Air pollutants are negatively associated with vitamin D-synthesizing UVB radiation intensity on the ground.

Atmospheric levels of pollutants may reduce the UVB intensity at the earth's surface, with a subsequent reduction in cutaneous vitamin D synthesis. We investigated the association of various pollutants with UVB intensity on the ground. Four-year data obtained from four weather stations from across Kuwait were analyzed by median regression. Pollutants that were negatively associated with UVB were [ß (95% CI)]: benzene [- 2.61 (- 4.13, - 1.09)], ethyl-benzene [- 2.20 (- 3.15, - 1.25)], ozone [- 0.23 (- 0.28, - 0.17)], nitric oxide [- 0.11 (- 0.15, - 0.06)], sulfur dioxide [- 0.10 (- 0.17, - 0.04)] and particulate matter PM10 [- 0.002 (- 0.003, - 0.002)]. Pollutants that were negatively associated with the UVB/UVA ratio were [ß (95% CI)]: benzene [- 15.57 (- 24.94, - 6.20)], nitric oxide [- 0.53 (- 0.81, - 0.25)], ozone [- 0.38 (- 0.70, - 0.06)], and total hydrocarbon [- 0.02 (- 0.04, - 0.01)]. Furthermore, benzene and nitric oxide levels were higher in the morning and evening hours, which are the times of most solar exposure in this region due to high temperature during midday. In addition to other known factors, attenuation of UVB by these pollutants may contribute to lower vitamin D levels in populations. In addition to direct public health hazard, these pollutants may contribute to the very high prevalence of VDD in this region.

Sun-induced production of vitamin D3 throughout 1 year in tropical and subtropical regions: relationship with latitude, cloudiness, UV-B exposure and solar zenith angle.

This study evaluated the differences in vitamin D3 synthesis in two different latitudes throughout 1 year using an in vitro model, which simulates cutaneous vitamin D photoproduction. Borosilicate ampoules containing 7-dehydrocholesterol (7-DHC) were exposed to sunlight hourly throughout the daylight hours, 1 day per month for a year, in Fortaleza (latitude 03° 43' 01" S-LAT3° S) and Sao Paulo (latitude 23° 32' 53" S-LAT23° S). Later, vitamin D3 and photoisomers of 7-DHC (tachysterol and lumisterol) were measured by a high-performance liquid chromatography system (HPLC). Vitamin D synthesis weighted UV radiation (UVBVitD) and solar zenith angle (SZA) were calculated during the same periods for both latitudes. Vitamin D3 synthesis occurred throughout the year in both locations, as expected in latitudes lower than 35°. Median of photoconversion to vitamin D3 through the year was higher in LAT3°S [median (IQR): LAT 3°S 4.1% (6.0); LAT 23°S 2.9% (4.5); p value = 0.020]. Vitamin D3 production strongly correlated with UV-B (LAT3° S, r = 0.917; p < 0.0001 and at LAT23° S, r = 0.879; p < 0.0001) and SZA (LAT3° S, r = - 0.924; p < 0.0001 and in LAT23°S, r = - 0.808; p < 0.0001). Vitamin D3 production starts later in LAT23° S, especially in winter. Lowest percentages were observed in June in both cities, although, compared to LAT3° S, in LAT 23° S the conversion was over 50% lower in the winter period. Cloudiness impaired photoproduction of Vitamin D3 even in summer months in both latitudes. Our results provide data to help guide medical recommendations for sensible sun exposure to promote the cutaneous production of vitamin D3 at different latitudes, seasonality, time of day and cloudiness status in Brazil.

Vitamin D status is seasonally stable in northern European dogs.

BACKGROUND: Numerous studies in veterinary species have recently linked vitamin D status with nonskeletal health disorders. Previous studies have indicated that dogs cannot produce endogenous vitamin D via cutaneous production and rely solely on dietary intake of vitamin D. The seasonal variation of vitamin D seen in humans due to changes in ultraviolet (UV) exposure, therefore, is unlikely to be replicated in these animals. OBJECTIVES: The objective of this study was to investigate the natural variation in 25-hydroxyvitamin-D concentrations in dogs subject to seasonal UV exposure. METHODS: This longitudinal study followed 18 healthy dogs fed a standardized diet over 1 year, with blood samples obtained monthly. Two key vitamin D metabolites, 25-hydroxyvitamin-D2 and 25-hydroxyvitamin-D3 , were assessed by liquid chromatography-tandem mass spectrometry in serum samples. Various other biochemical parameters were also measured. Seasonality was assessed using cosinor statistical analysis. RESULTS: Although the dogs were subject to seasonally varying UV radiation, 25-hydroxyvitamin-D and related biomarkers (including calcium and parathyroid hormone) remained stable over time and did not follow a seasonal pattern. 25-hydroxyvitamin-D was not positively correlated with exposure to UV radiation. Nonetheless, variation in 25-hydroxyvitamin-D concentrations between individual dogs was detected. CONCLUSIONS: Given the standardization of diet, we concluded that the seasonal stability of 25-hydroxyvitamin-D concentration (vitamin D status) was likely a direct result of lack of cutaneous vitamin D production in this species and highlights the importance of dietary intake. The variation in 25-hydroxyvitamin-D concentration between animals warrants further investigation.

Idiopathic Myocardial Fibrosis in Captive Chimpanzees (Pan troglodytes).

Cardiovascular disorders and predominantly idiopathic myocardial fibrosis are frequently associated with mortality among zoo-housed chimpanzees (Pan troglodytes). Formalin-fixed whole hearts of deceased chimpanzees housed in zoos (n = 33) and an African sanctuary (n = 2) underwent detailed macroscopic and histopathologic examination using a standardized protocol. Archived histological slides from the hearts of 23 additional African sanctuary-housed chimpanzees were also examined. Myocardial fibrosis (MF) was identified in 30 of 33 (91%) of the zoo-housed chimpanzees but none of the 25 sanctuary-housed chimpanzees. MF was shown to be characterized by both interstitial and replacement fibrosis. Immunophenotyping demonstrated that the fibrotic lesions were accompanied by the increased presence of macrophages, alpha smooth muscle actin-positive myofibroblasts, and a minimal to mild T-cell-dominant leukocyte infiltration. There was no convincing evidence of cardiotropic viral infection or suggestion that diabetes mellitus or vitamin E or selenium deficiency were associated with the presence of the lesion. However, serum vitamin D concentrations among zoo-housed chimpanzees were found to be lower in seasons of low ultraviolet light levels.

Overview on vitamin D and sunbed use.

Vitamin D seems to be associated with a protective effect in a vast range of diseases, including cardiovascular, autoimmune and oncologic conditions. Since ultraviolet (UV) B light is the most important prerequisite for the cutaneous synthesis of vitamin D, sunbeds are able to increase serum vitamin D levels, although only transiently in most cases. In this scenario, the artificial tanning industry relentlessly tries to promote the use of sunbeds as a 'safe' therapeutic measure to achieve an adequate serum vitamin D status. The World Health Organization classified UV-emitting tanning devices, as well as the whole UV spectrum, as group-1 carcinogens, as they significantly increase the risk of melanoma and non-melanoma skin cancer. In case of vitamin D deficiency or insufficiency, the current risk-benefit ratio is therefore in favour of vitamin D supplementation instead of sunbed use. Artificial tanning devices should never be considered as an option to achieve an appropriate vitamin D status. Their supposedly beneficial effects, vastly publicised by the artificial tanning industry, are not worth the carcinogenic risk associated with sunbed use.

Fractional Sunburn Threshold UVR Doses Generate Equivalent Vitamin D and DNA Damage in Skin Types I-VI but with Epidermal DNA Damage Gradient Correlated to Skin Darkness.

Public health guidance recommends limiting sun exposure to sub-sunburn levels, but it is unknown whether these can gain vitamin D (for musculoskeletal health) while avoiding epidermal DNA damage (initiates skin cancer). Well-characterized healthy humans of all skin types (I-VI, lightest to darkest skin) were exposed to a low-dose series of solar simulated UVR of 20%-80% their individual sunburn threshold dose (minimal erythema dose). Significant UVR dose responses were seen for serum 25-hydroxyvitamin D and whole epidermal cyclobutane pyrimidine dimers (CPDs), with as little as 0.2 minimal erythema dose concurrently producing 25-hydroxyvitamin D and CPD. Fractional MEDs generated equivalent levels of whole epidermal CPD and 25-hydroxyvitamin D across all skin types. Crucially, we showed an epidermal gradient of CPD formation strongly correlated with skin darkness (r = 0.74, P < 0.0001), which reflected melanin content and showed increasing protection across the skin types, ranging from darkest skin, where high CPD levels occurred superficially, with none in the germinative basal layer, to lightest skin, where CPD levels were induced evenly across the epidermal depth. People with darker skin can be encouraged to use sub-sunburn UVR-exposure to enhance their vitamin D. In people with lighter skin, basal cell damage occurs concurrent with vitamin D synthesis at exquisitely low UVR levels, providing an explanation for their high skin cancer incidence; greater caution is required.

Effect of narrow-band ultraviolet B on the serum of 25-hydroxyvitamin D in vitiligo patients.

BACKGROUND: Narrow-band ultraviolet B (NB-UVB) is the gold standard in the treatment of vitiligo. 25-hydroxyvitamin D (25-OH- vitamin D) might play a physiological role in photo-induced melanogenesis in human skin so the association between vitamin D levels and vitiligo still needs to be investigated more thoroughly. OBJECTIVE: we aim to investigate the influence of cumulative doses of NB-UVB phototherapy on vitamin D in patients with vitiligo and their correlation with NB-UVB-induced pigmentation. METHODS: Eighty patients of vitiligo and twenty number of age and sex matched controls were recruited in a case-control study. Patients with vitiligo were treated with NB-UVB twice weekly for 24 weeks. 25-hydroxy vitamin D levels were measured at 0, 12, and 24 weeks in the cases and at 0 only in control by enzyme-linked immunosorbent assay (ELISA) and Vitiligo Area Severity Index (VASI) were calculated at 0 (baseline) and 24 weeks. RESULTS: The mean baseline level of 25-hydroxyvitamin D (at 0 week) was significantly lower in patients than the control group. Levels of 25(OH) vitamin D at 12 and 24 weeks showed significant improvement and Patients show significant reduction in VASI score after 24 weeks of therapy. CONCLUSIONS: Cumulative doses of NB-UVB therapy improve low vitamin D levels in patients with vitiligo, which might have a significant role in NB-UVB-induced repigmentation and may contribute to its therapeutic efficacy but further studies with larger sample size are needed to prove the complete mechanisms of NB-UVB-induced pigmentations and vitamin D in vitiligo.

Ultraviolet B Radiation: The Vitamin D Connection.

Vitamin D is known as the sunshine vitamin. During exposure to sunlight the skin transforms 7-dehydrocholesterol into vitamin D3. Throughout evolution vitamin D3 has played a pivotal role in the evolution of vertebrates. Vitamin D is not only critically important for bone health but has a multitude of other biologic functions to help reduce chronic illnesses. This Chapter reviews how vitamin D is produced in the skin, factors that affect its production and a prospective on how to obtain vitamin D from sensible sun exposure.

Role of Vitamin D in Rheumatoid Arthritis.

Vitamin D is a fat soluble hormone, with a well described role in bone health and calcium/phosphate metabolism. Recent evidences have related vitamin D to other physiological functions and pathological conditions. Specifically, vitamin D has widely proven activities on immune system and evidences suggest that it may be implicated in the pathogenesis of rheumatoid arthritis (RA). The relationship between vitamin D and RA is complex, also because a deficitary vitamin D status, which is very common in RA patients, can contribute to the increased risk of osteoporosis typical of RA. In this chapter, will be described and discussed the main aspects of the relationship between RA and vitamin D.

Endocrine actions of vitamin D in skin: Relevance for photocarcinogenesis of non-melanoma skin cancer, and beyond.

The skin represents a pivotal organ for the human body's vitamin D endocrine system, being both the site of ultraviolet (UV)-B-induced vitamin D synthesis and a target tissue for the pluripotent effects of 1,25(OH)2D3 and other biologically active vitamin D metabolites. As many other steroid hormones, 1,25(OH)2D3 exerts its effects via two independent signal transduction pathways: the classical genomic and the non-genomic pathway. While non-genomic effects of 1,25(OH)2D3 are in part exerted via effects on intracellular calcium, genomic effects are mediated by the vitamin D receptor (VDR). Recent findings convincingly support the concept of a new function of the VDR as a tumor suppressor in skin, with key components of the vitamin D endocrine system, including VDR, CYP24A1, CYP27A1, and CYP27B1 being strongly expressed in non-melanoma skin cancer (NMSC). It has now been shown that anti-tumor effects of VDR, that include some of its ligand-induced growth-regulatory effects, are at least in part mediated by interacting in a highly coordinated manner with the p53 family (p53/p63/p73) in response to a large number of alterations in cell homeostasis, including UV-induced DNA damage, a hallmark for skin photocarcinogenesis. Considering the relevance of the vitamin D endocrine system for carcinogenesis of skin cancer, it is not surprising that low 25(OH)D serum concentrations and genetic variants (SNPs) of the vitamin D endocrine system have been identified as potential risk factors for occurrence and prognosis of skin malignancies. In conclusion, an increasing body of evidence now convincingly supports the concept that the vitamin D endocrine system is of relevance for photocarcinogenesis and progression of NMSC and that its pharmacologic modulation by vitamin D, 1,25(OH)2D3, and analogs represents a promising new strategy for prevention and/or treatment of these malignancies.

The role of UV radiation and vitamin D in the seasonality and outcomes of infectious disease.

The seasonality of infectious disease outbreaks suggests that environmental conditions have a significant effect on disease risk. One of the major environmental factors that can affect this is solar radiation, primarily acting through ultraviolet radiation (UVR), and its subsequent control of vitamin D production. Here we show how UVR and vitamin D, which are modified by latitude and season, can affect host and pathogen fitness and relate them to the outcomes of bacterial, viral and vector-borne infections. We conducted a thorough comparison of the molecular and cellular mechanisms of action of UVR and vitamin D on pathogen fitness and host immunity and related these to the effects observed in animal models and clinical trials to understand their independent and complementary effects on infectious disease outcome. UVR and vitamin D share common pathways of innate immune activation primarily via antimicrobial peptide production, and adaptive immune suppression. Whilst UVR can induce vitamin D-independent effects in the skin, such as the generation of photoproducts activating interferon signaling, vitamin D has a larger systemic effect due to its autocrine and paracrine modulation of cellular responses in a range of tissues. However, the seasonal patterns in infectious disease prevalence are not solely driven by variation in UVR and vitamin D levels across latitudes. Vector-borne pathogens show a strong seasonality of infection correlated to climatic conditions favoring their replication. Conversely, pathogens, such as influenza A virus, Mycobacterium tuberculosis and human immunodeficiency virus type 1, have strong evidence to support their interaction with vitamin D. Thus, UVR has both vitamin D-dependent and independent effects on infectious diseases; these effects vary depending on the pathogen of interest and the effects can be complementary or antagonistic.

Beneficial Effects of UV-Radiation: Vitamin D and beyond.

Aside from its well-known effects on bone and mineral metabolism, vitamin D may also play an important role in extra-skeletal processes like immunologic diseases, cancer, or cardiovascular diseases. Even though meta-analyses showed that vitamin D supplementation reduces fractures, falls, and overall mortality, its potential benefits did not find universal acclaim. Several health care authorities published Recommended Dietary Allowances (RDAs) for vitamin D, most of them ranging from 600 to 800 international units (IU) per day, corresponding to a serum level of 25-hydroxyvitamin D of at least 20 ng/mL (50 nmol/L). However, studies conducted in the general population revealed a much lower overall intake of vitamin D than the proposed RDAs. Thus, strategies to increase the vitamin D intake in the general population, e.g., food fortification or vitamin D supplementation, are needed to match the existing evidence and recommendations. Therefore, several currently ongoing projects aim to investigate the effect of vitamin D supplementation in the general population and try to establish food-based solutions to improve vitamin D status.

Phototherapy and vitamin D.

The skin is the site for the photosynthesis of vitamin D and is a target tissue for the active metabolite of vitamin D. An increasing body of evidence indicates that vitamin D produced during phototherapy may be responsible for the positive effects observed during treatment of some skin diseases. Topical or oral application of vitamin D derivatives are used alone or with phototherapy. This paper reviews what is known about the use of phototherapy to enhance vitamin D levels, the use of vitamin D analogues with phototherapy, the efficacy of combination therapies, and controversies regarding some of the outcomes. Vitamin D can play a beneficial role in treating psoriasis, even though the exact role of vitamin D in the pathogenesis and severity of psoriasis remains unclear. The role of vitamin D in vitiligo, atopic dermatitis, polymorphic light eruption, and mycosis fungoides must be further investigated.

Tanning beds: Impact on health, and recent regulations.

As the use of indoor tanning beds gained popularity in the decades after their appearance in the market in the early 1970s, concerns arose regarding their use. Clinical research has revealed an association between indoor tanning and several health risks, including the subsequent occurrence of melanoma and nonmelanoma skin cancers, the development of psychologic dependence, and a tendency toward other high-risk health behaviors. In the face of mounting evidence, legislation has been passed, which includes the restriction of access to tanning beds by minors in 42 states and the District of Columbia, and the recent reclassification by the Food and Drug Administration, which now categorizes tanning beds as class II devices and worthy of restrictions and oversight. Early evidence suggests that these labors are resulting in cultural change, although continued efforts are necessary to limit further exposure and better inform the public of the dangers associated with indoor tanning use.

Vitamin D and Vitamin D from Ultraviolet-Irradiated Mushrooms (Review).

Vitamin D may have an important role in many aspects of human health, from bone fractures to prostate cancer, cardiovascular disease, neuromuscular problems, and diabetes. Vitamin D is produced in the human body by the skin after sunlight absorption, but as human lifestyles change, so does the time of exposure to sunlight, necessitating dietary supplementation of vitamin D. Mushrooms have the advantages that they are the only source of vitamin D in the produce aisle and they are one of the few nonfortified food sources. Here, we review the current literature on enhancement of the vitamin D content in mushrooms and literature evidence on the bioavailability of vitamin D in humans and animals after ingesting ultraviolet (UV)-irradiated mushrooms. We also present available literature on health safety after UV irradiation of mushrooms, and we discuss issues arising in the attempt to incorporate UV irradiation into the mushroom production line.

Promoting UV Exposure Awareness with Persuasive, Wearable Technologies.

Current methods to promote awareness of the sun's ultraviolet (UV) radiation have focussed on delivering population level information and some location-based reporting of UV Index (UVI). However, diseases related to excessive (e.g. sunburn, skin cancer) or insufficient (e.g. vitamin D deficiency) exposure to sunlight still remain a global burden. The emergence of wearable sensors and the application of persuasive technology in health domains raise the possibility for technology to influence awareness of sufficient sun intake for vitamin D production, as well as preventing risk of skin damage. This paper presents a personalised solution to promote healthy, safe sun exposure using wearable devices and persuasive techniques.