What dermatologists do not know about smallpox vaccination: results from a worldwide electronic survey.

The risk of a bioterrorist attack with smallpox has increased owing to breakthroughs in the de novo synthesis of long-chain DNA molecules. Although the leading roles of dermatologists in diagnosing recent outbreaks of cutaneous anthrax and monkeypox demonstrate the importance of dermatologist preparedness for bioterrorism, dermatologist knowledge regarding smallpox vaccination has not been extensively examined. We conducted a cross-sectional worldwide electronic survey of all members of the American Academy of Dermatology with available e-mail addresses. The response rate was 23% (1,303/5,723): 34% of respondents were women, 52% were age 50 or older, 85% practiced in the US, and 90% reported English as their primary language. Less than 37% indicated the Centers for Disease Control and Prevention estimated rate of death owing to smallpox vaccination (1 in 1,000,000), and many failed to identify vaccination contraindications: previous myocardial infarction (83%), angina (83%), congestive heart failure (78%), steroid eye drop use (65%), and the non-emergency vaccination of those younger than age 18 (95%). Widespread dermatologist smallpox vaccination knowledge deficits pinpoint opportunities for educational efforts.

Indoor tanning attitudes and practices of US dermatologists compared with other medical specialists.

OBJECTIVE: To compare the indoor tanning attitudes and practices of dermatologists with physicians in other medical specialties (internal medicine, pediatrics, and family medicine) commonly providing sun safety counseling to patients. DESIGN: Cross-sectional study. SETTING: Questionnaire mailed to randomly selected US dermatologists, internists, family practitioners, and pediatricians. RESULTS: The overall response rate was 38% (364/949): 71% indicated that patients had asked their opinions about indoor UV tanning, 80% believed that UV tanning was unsafe, and 90% agreed they would counsel patients against nonmedical indoor UV tanning. Many supported increased UV tanning legislation, including minimum age restrictions (91%) and parental consent requirements (90%). Dermatologists were significantly more likely than other physicians to respond to the survey (52% vs 31%, P<.001), speak with patients about indoor UV tanning (odds ratio [OR], 26.5; 95% confidence interval [CI], 9.5-74.1]), believe that indoor UV tanning is unsafe (OR, 14.0; 95% CI, 5.0-39.4), and support increased regulation (OR, 11.7; 95% CI, 1.5-88.5). Women discouraged indoor UV tanning more than men (OR, 5.2; 95% CI, 1.8-15.2). Physicians who had used indoor UV tanning (19%) more often agreed that non-UV tanning lotion (OR, 2.0; 95% CI, 1.1-3.8) and airbrush tanning (OR, 1.9; 95% CI, 1.1-3.4) were safe but did not differ in attitudes regarding UV tanning safety. Physicians practicing in the Northeast and Midwest were more likely to support UV tanning to improve mood (OR, 2.0; 95% CI, 1.1-3.5) and more commonly believed that UV tanning could help treat depression (OR, 2.6; 95% CI, 1.5-4.6) or prevent vitamin D deficiency (OR, 1.7; 95% CI, 1.0-2.8). CONCLUSIONS: Physicians, especially dermatologists, are frequently asked about and generally discourage indoor UV tanning. Dermatologists regard indoor UV tanning more negatively compared with other physicians. Physician sex and geographic location were associated with specific indoor UV tanning attitudes.

Compliance with youth access regulations for indoor UV tanning.

OBJECTIVES: To describe youth access to indoor UV tanning and youth discount pricing incentives in 4 states with different age restrictions: Colorado (no age restrictions), Texas (age 13 years), Illinois (age 14 years), and Wisconsin (age 16 years). DESIGN: Cross-sectional telephone survey conducted in October 2003 using a standardized script to assess the practices of randomly selected UV tanning operators. PARTICIPANTS: Randomly selected licensed indoor UV tanning facility operators in Colorado, Texas, Illinois, and Wisconsin. MAIN OUTCOME MEASURES: Number of facilities (1) complying with indoor UV tanning minimum age regulations for a 12-year-old potential patron and a 15-year-old potential patron and (2) offering youth discounts. RESULTS: For a 12-year-old potential patron, 62% of facilities in states with minimum age restrictions prohibiting 12-year-olds had an operator report that they would not permit indoor tanning (Texas, 23%; Illinois, 74%; and Wisconsin, 89%) compared with 18% in Colorado, a state without youth access regulations. For a 15-year-old patron, most facilities in Wisconsin, the only state with a minimum age restriction for 15-year-olds, prohibited access (77%). Overall, 15% of operators offered youth discounts: Texas, 23%; Illinois, 14%; Wisconsin, 11%; and Colorado, 11%. CONCLUSIONS: Tanning facilities in 4 states offered price incentives directed at youths. State youth access regulations were associated with decreased youth access to indoor tanning. High compliance levels in states with long-standing youth access regulations (Illinois and Wisconsin) demonstrate the potential for successful tanning industry youth access regulation.

Assessing evidence-based dermatology and evidence-based internal medicine curricula in US residency training programs: a national survey.

OBJECTIVES: To examine attitudes toward evidence-based medicine and evidence-based dermatology and to assess evidence-based training in US internal medicine and dermatology residency programs. METHODS: A 1-page self-administered questionnaire was mailed to residency training directors and chief residents at 104 dermatology and 103 internal medicine residency programs from the same or affiliated medical centers. RESULTS: Questionnaires were returned by respondents from 70 (68%) of 103 internal medicine programs and 86 (83%) of 104 dermatology programs. Most respondents (91% internal medicine and 70% dermatology) strongly agreed or agreed that evidence-based internal medicine/dermatology is valuable and should be included in residency training (93% internal medicine and 70% dermatology). Respondents from internal medicine programs agreed more strongly with both statements than respondents from dermatology programs (P =.001). Dedicated evidence-based curricula were in place at significantly more internal medicine programs (50 [71%] of 70) than dermatology programs (20 [23%] of 86) (P<.001). Curricula at internal medicine programs offered significantly more evidence-based medicine training sessions (24 vs 6; P<.001) and biostatistics sessions (10 vs 2.3; P =.03), and internal medicine programs more frequently evaluated the curricula using clinical question applications (56% vs 30%; P =.04). CONCLUSION: Despite favorable attitudes toward evidence-based dermatology, compared with internal medicine programs, dedicated evidence-based training is underdeveloped in dermatology programs.

Is high mole count a marker of more than melanoma risk? Eczema diagnosis is associated with melanocytic nevi in children.

BACKGROUND: The number of melanocytic nevi is the best single marker of increased melanoma risk. In a previous study, adults with severe eczema were reported to have significantly fewer nevi than adults without eczema. OBSERVATIONS: In a nested case-control design within a randomized, controlled interventional trial of additional sun protection vs standard care in 269 children, a history of eczema was reported by the parents of 44 (16%) of the children. More nevi were found in children with a parental report of previous eczema diagnosis than in children without reported eczema (median, 7.5 nevi vs 5.0 nevi; P =.01). Eczema diagnosis was most significantly associated with more melanocytic nevi in children with lightly pigmented skin (8.5 nevi vs 6.0 nevi; P <.001). In multivariate logistical regression analysis, including assessment of hair color, sun protection practices, and study assignment (intervention vs standard care), eczema status remained significantly predictive of nevi number in children (P <.001). CONCLUSIONS: In contrast to a previous study that associated severe eczema with fewer nevi in adults, in the present study children with a reported history of eczema had more nevi than children without a reported history of eczema.

Youth access laws: in the dark at the tanning parlor?

OBJECTIVE: To compare laws governing youth access to UV irradiation at indoor tanning facilities with laws governing youth access to tobacco. DESIGN: Tobacco and UV irradiation youth access laws were assessed via correspondence with public health offices and computerized legal searches of 6 industrialized nations with widely differing skin cancer incidence rates. SETTING: National, provincial, and state legal systems in Australia, Canada, France, New Zealand, the United Kingdom, and the United States. PARTICIPANTS: Public health, legal, information science, and medical professionals and government and tanning industry representatives. MAIN OUTCOME MEASURES: Statutes specifying age restrictions for the purchase of indoor tanning services or tobacco products. RESULTS: The 5 English-speaking countries with common law-based legal systems unilaterally prohibit youth access to tobacco but rarely limit youth access to UV irradiation from tanning salons. Only very limited regions in the United States and Canada prohibit youth access to indoor tanning facilities: Texas, Illinois, Wisconsin, and New Brunswick prohibit tanning salon use by minors younger than 13, 14, 16, and 18 years, respectively. In contrast, French law allows minors to purchase tobacco but prohibits those younger than 18 years from patronizing tanning salons. CONCLUSIONS: Youth access laws governing indoor tanning display remarkable variety. Uniform indoor tanning youth access laws modeled on the example of tobacco youth access laws merit consideration.

Indoor UV tanning operator opinion regarding youth access: an electronic survey.

BACKGROUND: Adolescents frequently use indoor tanning facilities, but little is known about tanning facility operator opinions regarding this use. Objective To assess indoor tanning operator attitudes and stated practices regarding youth access. METHODS: We electronically surveyed 89 indoor tanning facilities and 130 spas with active e-mail addresses. RESULTS: The survey response rate was 21% for both indoor tanning facilities (19/89) and spas (27/130). Most tanning operators (92%) felt that a client can be too young to receive indoor tanning, and most felt that written parental permission should be required (80%). Most facilities required adult accompaniment (92%), and most operators had discouraged a customer from receiving indoor tanning based on age (77%). The reported age of the youngest patron receiving indoor tanning ranged from 5 to 21 years. CONCLUSION: Our sample of indoor tanning facility operators believed that minimum age and parental consent regulations for indoor tanning should be required.

A case for informed consent? Indoor UV tanning facility operator's provision of health risks information (United States).

OBJECTIVE: Indoor UV tanning is associated with skin cancer. This study describes consumer health risks information provided by indoor UV tanning facility operators in four states (Colorado, Illinois, Texas, and Wisconsin) with varying operator training, regulations, enforcement and penalties. METHODS: Using a cross-sectional survey study design, 100 randomly selected licensed indoor UV tanning facilities from each state were surveyed anonymously by telephone. Facility operators were questioned regarding the provision of information on potential adverse effects of indoor UV exposure. RESULTS: Of 628 licensed indoor UV tanning facilities contacted, 400 facilities were surveyed. Most (87%) advised patrons of the potential risk of sunburn from indoor tanning. Less than half of facility operators in Colorado, Texas and Wisconsin informed patrons about the risk of skin cancer (42, 43 and 48%, respectively) compared with 81% of Illinois operators. Likewise, more operators in Illinois reported the risk of premature aging (79%) compared with other states (41% Colorado, 43% Texas and 51% Wisconsin). CONCLUSIONS: Tanning facility operators frequently misinformed patrons of indoor UV exposure risks. The provision of informed consent by indoor tanning facility operators needs improved adaptation by the tanning industry as a standard for customer service.

Clinical diagnosis of actinic keratosis identifies an elderly population at high risk of developing skin cancer.

BACKGROUND: Development of actinic keratoses (AK) involves some of the same processes as nonmelanoma skin cancer and may serve as a marker for overall increased risk of skin cancer. OBJECTIVE: The objective of this study was to examine the risk of developing skin cancer in an elderly population with and without AK. METHODS: This was a retrospective observational study. Data from the 1992-1998 Medicare Current Beneficiary Study were used in the analyses. RESULTS: Multivariate analysis showed that the risk (odds ratio [OR]) of developing nonmelanoma or melanoma was increased more than sixfold (p < or = .0001) in patients with AK. An increased risk of skin cancer was found in whites (OR 4.3; p < or = .01) and increased age by year (OR 1.04; p < or = .01). Women were less likely to develop skin cancer (OR 0.58; p < or = .01). CONCLUSION: Using data from a nationally representive sample of the Medicare population, this study demonstrates that elders with AK are a population at high risk of developing cutaneous cancer.

Demand outstrips supply of US pediatric dermatologists: results from a national survey.

BACKGROUND: The US pediatric dermatology workforce was last examined in 1986 when limited employment opportunity was found. OBJECTIVE: We sought to re-examine pediatric dermatology workforce issues. METHODS: US dermatology chairpersons and residency program directors were surveyed for: (1) agreement with pediatric dermatology workforce statements; and (2) pediatric dermatology faculty and fellow numbers. RESULTS: Respondents agreed that having a pediatric dermatologist or dermatologists on faculty is important, and that a shortage of pediatric dermatologists exists, but did not agree that increasing pediatric dermatology training requirements will increase this shortage. Almost half of the programs (45/94) employed a full-time pediatric dermatologist, and 24 programs had currently been recruiting a pediatric dermatologist for more than 1 year. Only 6 pediatric dermatology fellows were in training. CONCLUSION: Given that open pediatric dermatology faculty positions greatly exceed the number of fellows in training and that formal training requirements will be increasing, the shortage of pediatric dermatologists will likely continue.

Information science. Going, going, gone: lost Internet references.

The use of Internet references in academic literature is common, and Internet references are frequently inaccessible. The extent of Internet referencing and Internet reference activity in medical or scientific publications was systematically examined in more than 1000 articles published between 2000 and 2003 in the New England Journal of Medicine, The Journal of the American Medical Association, and Science. Internet references accounted for 2.6% of all references (672/25548) and in articles 27 months old, 13% of Internet references were inactive. Publishers, librarians, and readers need to reassess policies, archiving systems, and other resources for addressing Internet reference attrition to prevent further information loss.