Skin examination behavior: the role of melanoma history, skin type, psychosocial factors, and region of residence in determining clinical and self-conducted skin examination.

OBJECTIVE: To examine the frequency and correlates of skin examination behaviors in an international sample of individuals at varying risk of developing melanoma. DESIGN: A cross-sectional, web-based survey. SETTING: Data were collected from the general population over a 20-month period on behalf of the Melanoma Genetics Consortium (GenoMEL). PARTICIPANTS: A total of 8178 adults from Northern (32%), Central (33%), and Southern (14%) Europe, Australia (13%), and the United States (8%). MAIN OUTCOME MEASURES: Self-reported frequency of skin self-examination (SSE) and clinical skin examination (CSE). RESULTS: After adjustment for age and sex, frequency of skin examination was higher in both Australia (odds ratio [OR]SSE=1.80 [99% CI, 1.49-2.18]; ORCSE=2.68 [99% CI, 2.23-3.23]) and the United States (ORSSE=2.28 [99% CI, 1.76-2.94]; ORCSE=3.39 [99% CI, 2.60-4.18]) than in the 3 European regions combined. Within Europe, participants from Southern Europe reported higher rates of SSE than those in Northern Europe (ORSSE=1.61 [99% CI, 1.31-1.97]), and frequency of CSE was higher in both Central (ORCSE=1.47 [99% CI, 1.22-1.78]) and Southern Europe (ORCSE=3.46 [99% CI, 2.78, 4.31]) than in Northern Europe. Skin examination behavior also varied according to melanoma history: participants with no history of melanoma reported the lowest levels of skin examination, while participants with a previous melanoma diagnosis reported the highest levels. After adjustment for region, and taking into account the role of age, sex, skin type, and mole count, engagement in SSE and CSE was associated with a range of psychosocial factors, including perceived risk of developing melanoma; perceived benefits of, and barriers to, skin examination; perceived confidence in one's ability to engage in screening; and social norms. In addition, among those with no history of melanoma, higher cancer-related worry was associated with greater frequency of SSE. CONCLUSIONS: Given the strong association between psychosocial factors and skin examination behaviors, particularly among people with no history of melanoma, we recommend that greater attempts be made to integrate psycho-education into the fabric of public health initiatives and clinical care, with clinicians, researchers, and advocacy groups playing a key role in guiding individuals to appropriate tools and resources.

[Study of depressiveness with Beck Depression Inventory in patients with cardiac arrhythmias]. / Badanie depresyjnosci skala depresji Becka u pacjentów z zaburzeniami rytmu serca.

INTRODUCTION: Atrial fibrillation belongs to the group of supraventricular arrhythmias. The episode begins with anxiety about the loss of health or life. Anxiety is accompanied by depressive disorders. The aim of this work was to study the intensity of depression in patients with atrial fibrillation. MATERIAL AND METHODS: We used Beck Depression Inventory in 52 patients with atrial fibrillation hospitalized at the Department of Internal Medicine of the Poviat Hospital in Bialogard. Correlations between the intensity of depression and age, gender, and education level were determined. RESULTS: The intensity of depression depended on age, gender, and education level. Mild depression was more common in women, moderate in men, and was very severe in 2 women. Patients between the age of 61 and 80 years and with incomplete primary and vocational education presented with all forms of depression. CONCLUSIONS: The intensity of depression correlates with episodes of atrial fibrillation and depends on such factors as age, gender, and education level (p < 0.05). Effective therapy of atrial fibrillation may help reduce the intensity of depression.

Predictors of sun protection behaviors and severe sunburn in an international online study.

BACKGROUND: The incidence of melanoma continues to increase in many countries, and primary prevention of melanoma includes avoidance of sunburn as well as adequate sun protection behavior. The aim of this study was to examine the prevalence of self-reported sun protection behaviors and sunburn in users of the Internet, and to identify the demographic, clinical, and attitudinal/motivational correlates of sun protection behaviors. METHODS: Self-report data were gathered on behalf of the GenoMEL consortium using an online survey available in 10 different languages, and 8,178 individuals successfully completed at least 80% of survey items, with 73% of respondents from Europe, 12% from Australia, 7% from the United States, 2% from Israel, and 6% from other countries. RESULTS: Half of all respondents and 27% of those with a previous melanoma reported at least one severe sunburn during the previous 12 months. The strongest factors associated with sun protection behavior were perceived barriers to protection (beta = -0.44/beta = -0.37), and respondents who reported a positive attitude toward suntans were less likely to protect (beta = -0.16/beta = -0.14). Reported use of protective clothing and shade, as well as avoidance of midday sun exposure, were more strongly related to reduced risk of sunburn than sunscreen use. CONCLUSIONS: Despite widespread dissemination of public health messages about the importance of sun protection, a substantial proportion of this international sample, including respondents with a previous melanoma, reported inadequate sun protection behaviors resulting in severe sunburn. IMPACT: Future strategies to decrease sunburn should target the practical, social, and psychological barriers associated with nonuptake of sun protection.

Melanoma risk factors, perceived threat and intentional tanning: an international online survey.

Cutaneous melanoma continues to increase in incidence in many countries, and intentional tanning is a risk factor for melanoma. The aim of this study was to understand how melanoma risk factors, perceived threat and preferences for a suntan relate to intentional tanning. Self-report data were collected on behalf of GenoMEL (www.genomel.org) from the general population using an online survey. A total of 8178 individuals completed the survey, with 72.8% of respondents being from Europe, 12.1% from Australia, 7.1% from the US, 2.5% from Israel and 5.5% from other countries. Seven percent of respondents had previously been diagnosed with melanoma and 8% had at least one first-degree relative with a previous melanoma. Overall, 70% reported some degree of intentional tanning during the past year, and 38% of respondents previously diagnosed with melanoma had intentionally tanned. The total number of risk factors was positively correlated with perceived risk of melanoma [correlation coefficient (rho) = 0.27], and negatively correlated with intentional tanning (rho = -0.16). Preference for a dark suntan was the strongest predictor of intentional tanning [regression coefficient (beta) = 0.35, P<0.001], even in those with a previous melanoma (beta = 0.33, P<0.01). A substantial proportion of participants reported having phenotypic and behavioural risk factors for melanoma. The preference regarding suntans seemed more important in the participants' decision to intentionally tan than their perceived risk of developing melanoma, and this finding was consistent among respondents from different countries. The drive to sunbathe to tan is a key factor to be moderated if melanoma incidence is to be reduced.

Identification of patients at high risk of psychological distress after BRCA1 genetic testing.

To predict which women might suffer from abnormally high levels of anxiety and depression after receiving a positive genetic BRCA1 test result, series of pregenetic testing and postgenetic testing psychological measurements were performed. Of 3524 women who returned the psychological test sheets before receiving their genetic test result, 111 women were found to carry a BRCA1 mutation. We found that overall, anxiety does not increase in women who receive a positive BRCA1 genetic test result; however, women who experience high levels of anxiety before genetic testing continue to experience high levels of anxiety up to 1 year posttesting. There were differences in cancer-related distress in affected and unaffected women. BRCA1 carriers with a previous diagnosis of cancer had significantly higher levels of cancer-related distress at 1 month posttest than those without cancer. Our findings suggest that healthcare providers should consider including a brief pretest psychological assessment before initiating genetic testing for BRCA1 and BRCA2.

[Measurement of anxiety with C.D. Spielberger's test in patients with cardiac arrhythmias]. / Badanie nasilenia leku testem C.D. Spielbergera u pacjentów z zaburzeniami rytmu serca.

INTRODUCTION: Atrial fibrillation is a common supraventrical arrhythmia. The onset of fibrillation is marked by fear of loss of health or life. Symptoms of depression occur concurrently. This study was undertaken to measure anxiety in patients with atrial fibrillation grouped according to gender, age, and education. MATERIAL AND METHODS: The test anxiety inventory of C.D. Spielberger was administered to 52 patients aged 41 to 80 years, treated for atrial fibrillation at the Internal Ward of the District Hospital in Bialogard. RESULTS: Anxiety as a state was observed more frequently in males and in patients with vocational and secondary education. Anxiety was not a trait of atrial fibrillation. Psychotherapeutic interventions used in cardiac rehabilitation are not recommended in atrial fibrillation. However, relaxation techniques could be of benefit in reducing the intensity of anxiety as a state.