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.

Comparison of humans versus mobile phone-powered artificial intelligence for the diagnosis and management of pigmented skin cancer in secondary care: a multicentre, prospective, diagnostic, clinical trial.

BACKGROUND: Diagnosis of skin cancer requires medical expertise, which is scarce. Mobile phone-powered artificial intelligence (AI) could aid diagnosis, but it is unclear how this technology performs in a clinical scenario. Our primary aim was to test in the clinic whether there was equivalence between AI algorithms and clinicians for the diagnosis and management of pigmented skin lesions. METHODS: In this multicentre, prospective, diagnostic, clinical trial, we included specialist and novice clinicians and patients from two tertiary referral centres in Australia and Austria. Specialists had a specialist medical qualification related to diagnosing and managing pigmented skin lesions, whereas novices were dermatology junior doctors or registrars in trainee positions who had experience in examining and managing these lesions. Eligible patients were aged 18-99 years and had a modified Fitzpatrick I-III skin type; those in the diagnostic trial were undergoing routine excision or biopsy of one or more suspicious pigmented skin lesions bigger than 3 mm in the longest diameter, and those in the management trial had baseline total-body photographs taken within 1-4 years. We used two mobile phone-powered AI instruments incorporating a simple optical attachment: a new 7-class AI algorithm and the International Skin Imaging Collaboration (ISIC) AI algorithm, which was previously tested in a large online reader study. The reference standard for excised lesions in the diagnostic trial was histopathological examination; in the management trial, the reference standard was a descending hierarchy based on histopathological examination, comparison of baseline total-body photographs, digital monitoring, and telediagnosis. The main outcome of this study was to compare the accuracy of expert and novice diagnostic and management decisions with the two AI instruments. Possible decisions in the management trial were dismissal, biopsy, or 3-month monitoring. Decisions to monitor were considered equivalent to dismissal (scenario A) or biopsy of malignant lesions (scenario B). The trial was registered at the Australian New Zealand Clinical Trials Registry ACTRN12620000695909 (Universal trial number U1111-1251-8995). FINDINGS: The diagnostic study included 172 suspicious pigmented lesions (84 malignant) from 124 patients and the management study included 5696 pigmented lesions (18 malignant) from the whole body of 66 high-risk patients. The diagnoses of the 7-class AI algorithm were equivalent to the specialists' diagnoses (absolute accuracy difference 1·2% [95% CI -6·9 to 9·2]) and significantly superior to the novices' ones (21·5% [13·1 to 30·0]). The diagnoses of the ISIC AI algorithm were significantly inferior to the specialists' diagnoses (-11·6% [-20·3 to -3·0]) but significantly superior to the novices' ones (8·7% [-0·5 to 18·0]). The best 7-class management AI was significantly inferior to specialists' management (absolute accuracy difference in correct management decision -0·5% [95% CI -0·7 to -0·2] in scenario A and -0·4% [-0·8 to -0·05] in scenario B). Compared with the novices' management, the 7-class management AI was significantly inferior (-0·4% [-0·6 to -0·2]) in scenario A but significantly superior (0·4% [0·0 to 0·9]) in scenario B. INTERPRETATION: The mobile phone-powered AI technology is simple, practical, and accurate for the diagnosis of suspicious pigmented skin cancer in patients presenting to a specialist setting, although its usage for management decisions requires more careful execution. An AI algorithm that was superior in experimental studies was significantly inferior to specialists in a real-world scenario, suggesting that caution is needed when extrapolating results of experimental studies to clinical practice. FUNDING: MetaOptima Technology.

A Retrospective Study Supporting the Importance of Individualizing the Dose of Botulinum Toxin According to the Age.

BACKGROUND: Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide with a high rate of efficacy and patient satisfaction. OBJECTIVE: This study aims to demonstrate the importance of individualization of botulinum toxin doses to treat the upper face according to the age of the patients, considering the muscles particularities and the specificities of each face area. MATERIALS AND METHODS: A retrospective study with 389 female patients treated with botulinum toxin type A in the upper third of the face (forehead, glabellar, and periorbital lines). Statistical analysis of the data was performed. RESULTS: The mean age was 47.49 years old and the median total dose of botulinum toxin type A was 53.76 units, whereas the median dose in the glabella was 26.28 U, the mean forehead dose was 12.23 U, and in the periorbital area was 14.79 U, adding both sides. It is possible to observe that the doses are negatively correlated with age, except in the periorbital area, where an increase in the dose was observed. CONCLUSION: It is important to highlight that although there is consensus on pre-established dose suggestions, the treatment should be individualized, respecting the individual characteristics of each patient.

Melanomas of the scalp: is hair coverage preventing early diagnosis?

BACKGROUND: Scalp melanomas are usually thicker and show worse prognosis than other sites and other head and neck melanomas. One hypothesis to explain this aggressive behavior could be diagnosis delay attributed to hair concealment of lesions. METHODS: Primary melanomas of the scalp diagnosed over two decades at four reference centers in Australia and Italy were included. Hair coverage and visibility of the lesions were assessed on preoperative photographic documentation by two investigators and correlated with some prognostic factors (Breslow thickness, mitotic rate, and ulceration). Patients records and pathology reports provided clinical and histological data. RESULTS: The majority of 113 melanomas included were located on easily visible areas of the scalp - hairless scalp (49%) or hairline (15%). The remaining ones (36%), considered to be hair-covered, showed more frequently thinning of hair (63%) than a dense hair coverage (37%). Melanomas of "hairy scalps" were more frequently invasive (81%) and had higher median Breslow (0.8 ± 1.3 mm) than those arising on bald scalps or areas with thinning of hair (43%; 0 ± 0.6 mm), P = 0.004. However, when considering only the invasive cases (n = 55), Breslow thickness and mitotic rate were not statistically different between concealed and easily visible areas. Melanomas detected by a doctor were thinner than those first noticed by the patient, relatives, or a hairdresser (P < 0.001). CONCLUSIONS: Most scalp melanomas arose on easily visible areas, which are more prone to ultraviolet damage. Hair-covered ones, despite rare, could be overlooked during examination. Proactive screening of the scalp area should be encouraged.

Bare Earth's Surface Spectra as a Proxy for Soil Resource Monitoring.

The Earth's surface dynamics provide essential information for guiding environmental and agricultural policies. Uncovered and unprotected surfaces experience several undesirable effects, which can affect soil ecosystem functions. We developed a technique to identify global bare surface areas and their dynamics based on multitemporal remote sensing images to aid the spatiotemporal evaluation of anthropic and natural phenomena. The bare Earth's surface and its changes were recognized by Landsat image processing over a time range of 30 years using the Google Earth Engine platform. Two additional products were obtained with a similar technique: a) Earth's bare surface frequency, which represents where and how many times a single pixel was detected as bare surface, based on Landsat series, and b) Earth's bare soil tendency, which represents the tendency of bare surface to increase or decrease. This technique enabled the retrieval of bare surfaces on 32% of Earth's total land area and on 95% of land when considering only agricultural areas. From a multitemporal perspective, the technique found a 2.8% increase in bare surfaces during the period on a global scale. However, the rate of soil exposure decreased by ~4.8% in the same period. The increase in bare surfaces shows that agricultural areas are increasing worldwide. The decreasing rate of soil exposure indicates that, unlike popular opinion, more soils have been covered due to the adoption of conservation agriculture practices, which may reduce soil degradation.

Soil class map of the Rio Jardim watershed in Central Brazil at 30 meter spatial resolution based on proximal and remote sensed data and MESMA method.

Geospatial soil information is critical for agricultural policy formulation and decision making, land-use suitability analysis, sustainable soil management, environmental assessment, and other research topics that are of vital importance to agriculture and economy. Proximal and Remote sensing technologies enables us to collect, process, and analyze spectral data and to retrieve, synthesize, visualize valuable geospatial information for multidisciplinary uses. We obtained the soil class map provided in this article by processing and analyzing proximal and remote sensed data from soil samples collected in toposequences based on pedomorphogeological relashionships. The soils were classified up to the second categorical level (suborder) of the Brazilian Soil Classification System (SiBCS), as well as in the World Reference Base (WRB) and United States Soil Taxonomy (ST) systems. The raster map has 30 m resolution and its accuracy is 73% (Kappa coefficient of 0.73). The soil legend represents a soil class followed by its topsoil color.

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.

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.

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.(AU)

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.(AU)

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.(AU)

Visão da homeopatia sob o ponto de vista de usuários de duas farmácias homeopáticas do Estado de São Paulo

A Homeopatia é uma ciência em crescimento no Brasil e no mundo. Nos últimos anos tem estado em evidencia na mídia, que tem trazido muita polêmica por meio de informações de origens diversas, além de muitos questionamentos para a população, principalmente quanto à eficácia da mesma. Diante deste cenário, buscou-se junto aos usuários desta terapia uma verificação do seu conhecimento e opinião sobre o tema.(AU)