Adherence to melanoma screening and surveillance skin check schedules tailored to personal risk.

Population-wide skin cancer screening is not currently recommended in most countries. Instead, most clinical guidelines incorporate risk-based recommendations for skin checks, despite limited evidence around implementation and adherence to recommendations in practice. We aimed to determine adherence to personal risk-tailored melanoma skin check schedules and explore reasons influencing adherence. Patients (with/without a previous melanoma) attending tertiary dermatology clinics at the Melanoma Institute Australia, Sydney, Australia, were invited to complete a melanoma risk assessment questionnaire via iPad and provided with personal risk information alongside a risk-tailored skin check schedule. Data were collected from the risk tool, clinician-recorded data on schedule deviations, and appointment booking system. Post-consultation, we conducted semi-structured interviews with patients and clinic staff. We used a convergent segregated mixed methods approach for analysis. Interviews were audio recorded, transcribed and data were analysed thematically. Participant data were analysed from clinic records (n = 247) and interviews (n = 29 patients, 11 staff). Overall, there was 62% adherence to risk-tailored skin check schedules. In cases of non-adherence, skin checks tended to occur more frequently than recommended. Decisions to deviate were similarly influenced by patients (44%) and clinicians (56%). Themes driving non-adherence among patients included anxiety and wanting autonomy around decision-making, and among clinicians included concerns around specific lesions and risk estimate accuracy. There was moderate adherence to a clinical service program of personal risk-tailored skin check recommendations. Further adherence may be gained by incorporating strategies to identify and assist patients with high levels of anxiety and supporting clinicians to communicate risk-based recommendations with patients.

Patient demographic characteristics and risk factors associated with sun protection behaviours in specialist melanoma clinics.

OBJECTIVE: We investigated the association between sun protection behaviours and demographic and melanoma risk characteristics of patients attending Australian melanoma specialist clinics. This may assist in targeting and tailoring melanoma prevention patient education for people at high-risk and specific population subgroups. METHODS: A cross-sectional analysis of questionnaire data collected from participants attending the dermatology clinics at two major melanoma centres in Sydney, Australia between February 2021 and September 2023. The primary outcome was Sun Protection Habits (SPH) index (a summary score measured as habitual past month use of sunscreen, hats, sunglasses, a shirt with sleeves that covers the shoulders, limiting midday sun exposure and seeking shade, using a Likert scale). The primary analysis considered the SPH index and its component items scored as continuous. RESULTS: Data from 883 people were analysed. Factors associated with less frequent sun protection behaviours overall included male gender, no personal history of melanoma, lower perceived risk, lower calculated 10-year risk of developing melanoma, and no private health insurance. People aged >61 years reported lower use of sunscreen but higher use of hats and sleeved-shirts compared with people in the younger age group. There was no difference in overall sun protection behaviours according to family history of melanoma, country of birth or by lifetime melanoma risk among people without a personal history of melanoma. CONCLUSIONS: These findings highlight the potential for targeting high-risk individuals with less frequent use of sun protection for patient education, public health messaging and ultimately improving sun protection behaviours.

Haptoglobin gene polymorphisms and interleukin-6 and -8 levels in patients with sickle cell anemia

BACKGROUND: Haptoglobin genotypes, and interleukin-6 and -8 participate in the pathophysiology of sickle cell anemia. The expression of cytokines is regulated by genetic mechanisms however the effect of haptoglobin polymorphisms on these cytokines is not fully understood. This study aimed to compare the frequency of haptoglobin genotypes and the interleukin-6 and -8 concentrations in sickle cell anemia patients and controls to investigate the association between haptoglobin genotypes and cytokine levels.METHODS: Sixty sickle cell anemia patients and 74 healthy individuals were analyzed. Haptoglobin genotypes were determined by multiplex polymerase chain reaction, and the interleukin-6 and -8 levels by enzyme linked immunosorbent assay. The association between haptoglobin genotypes and cytokines was investigated by statistical tests.RESULTS:Hp2-1 was the most common genotype in both the cases and controls while Hp1-1 was less frequent among sickle cell anemia patients. Interleukin-6 and -8 levels were higher in patients than controls (p-value <0.0001). There was no significant difference in interleukin-6 and -8 concentrations between the genotypes (p-value >0.05). A similar trend was observed among the controls.CONCLUSION: Although, levels of interleukin-6 and -8 were higher in the sickle cell anemia patients, they appeared not to be related to the haptoglobin genotypes. Further investigations are necessary to identify factors responsible for increased secretion of the interleukin-6 and -8 pro-inflammatory cytokines in patients with sickle cell anemia.

Qualidade na educação infantil pública: concepções de famílias usuárias / Quality of public early childhood settings: conceptions of user families / Calidad de la educación infantil pública: concepciones de las familias usuarias

A qualidade da educação é um conceito construído histórica e socialmente, assim como seus instrumentos de avaliação. Algumas propostas, como as que defendem que a qualidade é dependente de um processo de negociação, preveem a participação de diferentes atores da comunidade na avaliação da instituição, incluindo as famílias. O artigo relata uma pesquisa realizada com foco na participação das famílias na avaliação da qualidade de uma instituição pública de educação infantil, com o objetivo de investigar quais as concepções de qualidade da educação infantil que as famílias constroem no processo de avaliação e quais parâmetros são utilizados nessa construção. Guiada pela perspectiva teórico-metodológica Rede de Significações, a construção dos dados foi realizada com 64 famílias por meio de um questionário e um colóquio em grupo. Os resultados revelam que as famílias apresentam referências de qualidade que vão ao encontro daqueles apontados por especialistas da área. Também chamam atenção para a complexidade da abertura à participação da família na avaliação da qualidade da instituição.

La calidad de la educación es un concepto históricamente y socialmente construido, así como sus herramientas de evaluación. Algunos conceptos argumentan que la calidad de educación depende de un proceso de negociación, considerando la participación de las diferentes comunidades en la evaluación de la educación, e incluyendo a las familias. Este artículo presenta un estudio enfocado en la participación de las familias en la evaluación de la calidad de la educación pública infantil, con el fin de investigar los conceptos de educación preescolar de calidad que las familias construyen en el proceso de evaluación y los parámetros que se utilizan en su construcción. Basados en los conceptos teóricos-metodológicos de Rede de Significações, la construcción de la base de datos se realizó con información de 64 familias a través de un cuestionario y un grupo de conversación. Los resultados revelan que las familias tienen referencias de calidad que cumplan con los señalados por los especialistas. También llamar la atención sobre la complejidad de la apertura de la participación de la familia en la evaluación de la calidad de la institución.

The quality of education along with its evaluation instruments is a concept developed historically and socially. Some concepts understand quality of education as a process of negotiation, significantly evaluated by different members of the educational community, amongst them the families. This article presents a research focused in family's perspective of quality of a public early childhood education setting, aiming to understand what quality of education for those families is and which parameters are selected by them to develop this concept. Based on the theoric-methodologic perspective Rede de Significações, the data was built with 64 families through a questionnaire and a group discussion. Our data reveal that the families show education quality references similar to the Early Childhood experts. It also shows how complex is the family participation in the evaluation of the early childhood education setting quality.