Sun Exposure and Sun Protection at Primary Schools in The Netherlands: A Cross-Sectional Study.

BACKGROUND: In The Netherlands, skin cancer incidence rates have dramatically increased during the last decades. Exposure to ultraviolet radiation is the most important environmental risk factor for developing skin cancer. AIMS: The present study aimed to determine the level of sun exposure and sun protection of children at Dutch primary schools. MATERIALS AND METHODS: Registered members of an Internet panel of a private research company with a child 6 to 12 years of age completed a standardized questionnaire on sun exposure, sun protection and sunburn for their child on school days during the spring and summer. RESULTS: A total of 1103 parents completed the questionnaire. Most parents reported that their child spent 31 minutes to 1 hour (39.7%) or 1 hour to 1.5 hours (26.1%) outside at school during the spring and summer, 29.3% reported that sunscreen is always or often applied to the skin of their child in the morning on school days, 37% reported that they always or often paid attention to sun protection when selecting their child's outfit, 19.3% of the parents stated that their child could not play in the shade outside at school, and 19.9% of the parents reported that their child had ever had a sunburn at school. DISCUSSION: With most children, this consistent and repetitive pattern of sun exposure at school will probably lead to damage of exposed skin, because sun protection is insufficiently achieved among children during school days in the spring and summer. CONCLUSIONS: Future school-based interventions are necessary to alert and change behavior of parents, children, and primary school teachers.

Prognostic factors for outcome after median, ulnar, and combined median-ulnar nerve injuries: a prospective study.

BACKGROUND: A major problem in the surgical treatment of peripheral nerve injuries of the upper extremities is the unpredictable final outcome. More insight and understanding of the prognostic factors is necessary to improve functional outcome after repair of the peripheral nerves. The objective of this study was to identify prognostic factors for the functional recovery of peripheral nerve injury of the forearm and their independent contribution in the outcome in the first year after reconstruction. METHODS: A multicentered prospective study in the Netherlands resulted in the inclusion of 61 patients with a median, ulnar, or combined median-ulnar nerve injury. The age, level of injury, type of nerve injury, number of damaged structures, number of damaged arteries, education, smoking, and posttraumatic stress were analyzed as prognostic factors for functional outcome after repair of the peripheral nerves. The outcome parameters were sensory recovery (Semmes-Weinstein monofilament test) and motor recovery (Medical Research Council (MRC) score, power grip, and pinch grip) and the ability to perform daily activities. RESULTS: Gender, age, level of education, number of injured arteries and structures, damaged nerve, location of the injury, type of the nerve injury, and posttraumatic stress at 1 and 3 months after repair of the peripheral nerve injury were found to be predictors of functional recovery. CONCLUSIONS: Our prospective analysis of prognostic factors shows several factors to be predictive for the functional recovery after peripheral nerve injuries of the median and/or ulnar nerve of the forearm. Sensibility of the hand, power grip, and DASH score (DASH, Disabilities of Arm, Shoulder and Hand) have proven to be the three best prognostic factors in this study. Of these prognostic factors, only posttraumatic stress can be influenced to optimize functional outcome.

Early posttraumatic psychological stress following peripheral nerve injury: a prospective study.

BACKGROUND: Psychological symptoms frequently accompany severe injuries of the upper extremities and are described to influence functional outcome. As yet, little knowledge is available about the occurrence of posttraumatic psychological stress and the predictive characteristics of peripheral nerve injuries of the upper extremity for such psychological symptoms. In this prospective study, the incidence of different aspects of early posttraumatic stress in patients with peripheral nerve injury of the forearm is studied as well as the risk factors for the occurrence of early psychological stress. METHODS: In a prospective study design, patients with a median, ulnar or combined median-ulnar nerve injury were monitored for posttraumatic psychological stress symptoms with the Impact of Event Scale (IES) questionnaire up to 3 months postoperatively. RESULTS: Psychological stress within the first month after surgery occurred in 91.8% of the population (IES mean=22.0, standard deviation (SD)=17.3). Three months postoperatively, 83.3% (IES mean=13.3, SD=14.1) experienced psychological stress. One month postoperatively 24.6% and 3 months postoperatively 13.3% of the patients had IES scores indicating for the need for psychological treatment. Female gender, adult age and combined nerve injuries were related to the occurrence of psychological stress symptoms 1 month postoperatively. CONCLUSIONS: In the majority of these patients, peripheral nerve injury of the forearm is accompanied by early posttraumatic psychological stress, especially in female adults who suffered from combined nerve injuries.

Difficulties in conducting a prospective outcome study.

The success of an outcome study depends largely on the number of recruited patients, the loss of followup, and the response rate to postal questionnaires. In this article, different strategies were proposed to increase the aforementioned items. Most presented strategies were developed because of failure of measures used earlier. In the authors' study concerning hand surgery, this resulted in missed inclusions and loss of followup. It is hoped that by reading and using the strategies discussed, future researchers will start at the end of the learning curve and will shed a bright light on the obscurity of recovery after hand injury.