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Seeking shade, the use of textile sun protection and sunscreen, and protecting one’s eyes by wearing sunglasses are recommended sun protection measures in children. We aimed to quantify the use of these measures as well as the prevalence of sunburn in children aged 1 to 10 years in Germany and to identify their determinants. Data collected via telephone interviews in a nationwide sample of 554 parents or caregivers in family were analyzed. Use of sunscreen was the most common measure applied (77.8%), while sunglasses were least frequently used (12.5%). The prevalence of sunburn during the past year was 21.8%, and it was positively associated with children’s age. The use of sun protection measures was significantly associated with the age and skin color of the child, while characteristics and tanning behaviors of the caregivers only played a minor role. The use of sun protection measures was higher when caregivers perceived themselves as a role model (Odds Ratio (OR) = 4.33, p< 0.001). Our nationwide data show that there remains a need for the improved use of sun protection measures, especially in children aged 7 to 10 years. In educational material, parents should be encouraged to become positive role models for their children regarding sun protection.
Tatiana Görig; Corinna Södel; Annette Pfahlberg; Olaf Gefeller; Eckhard Breitbart; Katharina Diehl. Sun Protection and Sunburn in Children Aged 1–10 Years in Germany: Prevalence and Determinants. Children 2021, 8, 668 .
AMA StyleTatiana Görig, Corinna Södel, Annette Pfahlberg, Olaf Gefeller, Eckhard Breitbart, Katharina Diehl. Sun Protection and Sunburn in Children Aged 1–10 Years in Germany: Prevalence and Determinants. Children. 2021; 8 (8):668.
Chicago/Turabian StyleTatiana Görig; Corinna Södel; Annette Pfahlberg; Olaf Gefeller; Eckhard Breitbart; Katharina Diehl. 2021. "Sun Protection and Sunburn in Children Aged 1–10 Years in Germany: Prevalence and Determinants." Children 8, no. 8: 668.
SARS-CoV-2 infection fatality ratios (IFR) remain controversially discussed with implications for political measures. The German county of Tirschenreuth suffered a severe SARS-CoV-2 outbreak in spring 2020, with particularly high case fatality ratio (CFR). To estimate seroprevalence, underreported infections, and IFR for the Tirschenreuth population aged ≥14 years in June/July 2020, we conducted a population-based study including home visits for the elderly, and analyzed 4203 participants for SARS-CoV-2 antibodies via three antibody tests. Latent class analysis yielded 8.6% standardized county-wide seroprevalence, a factor of underreported infections of 5.0, and 2.5% overall IFR. Seroprevalence was two-fold higher among medical workers and one third among current smokers with similar proportions of registered infections. While seroprevalence did not show an age-trend, the factor of underreported infections was 12.2 in the young versus 1.7 for ≥85-year-old. Age-specific IFRs were <0.5% below 60 years of age, 1.0% for age 60–69, and 13.2% for age 70+. Senior care homes accounted for 45% of COVID-19-related deaths, reflected by an IFR of 7.5% among individuals aged 70+ and an overall IFR of 1.4% when excluding senior care home residents from our computation. Our data underscore senior care home infections as key determinant of IFR additionally to age, insufficient targeted testing in the young, and the need for further investigations on behavioral or molecular causes of the fewer infections among current smokers.
Ralf Wagner; David Peterhoff; Stephanie Beileke; Felix Günther; Melanie Berr; Sebastian Einhauser; Anja Schütz; Hans Niller; Philipp Steininger; Antje Knöll; Matthias Tenbusch; Clara Maier; Klaus Korn; Klaus Stark; André Gessner; Ralph Burkhardt; Michael Kabesch; Holger Schedl; Helmut Küchenhoff; Annette Pfahlberg; Iris Heid; Olaf Gefeller; Klaus Überla. Estimates and Determinants of SARS-Cov-2 Seroprevalence and Infection Fatality Ratio Using Latent Class Analysis: The Population-Based Tirschenreuth Study in the Hardest-Hit German County in Spring 2020. Viruses 2021, 13, 1118 .
AMA StyleRalf Wagner, David Peterhoff, Stephanie Beileke, Felix Günther, Melanie Berr, Sebastian Einhauser, Anja Schütz, Hans Niller, Philipp Steininger, Antje Knöll, Matthias Tenbusch, Clara Maier, Klaus Korn, Klaus Stark, André Gessner, Ralph Burkhardt, Michael Kabesch, Holger Schedl, Helmut Küchenhoff, Annette Pfahlberg, Iris Heid, Olaf Gefeller, Klaus Überla. Estimates and Determinants of SARS-Cov-2 Seroprevalence and Infection Fatality Ratio Using Latent Class Analysis: The Population-Based Tirschenreuth Study in the Hardest-Hit German County in Spring 2020. Viruses. 2021; 13 (6):1118.
Chicago/Turabian StyleRalf Wagner; David Peterhoff; Stephanie Beileke; Felix Günther; Melanie Berr; Sebastian Einhauser; Anja Schütz; Hans Niller; Philipp Steininger; Antje Knöll; Matthias Tenbusch; Clara Maier; Klaus Korn; Klaus Stark; André Gessner; Ralph Burkhardt; Michael Kabesch; Holger Schedl; Helmut Küchenhoff; Annette Pfahlberg; Iris Heid; Olaf Gefeller; Klaus Überla. 2021. "Estimates and Determinants of SARS-Cov-2 Seroprevalence and Infection Fatality Ratio Using Latent Class Analysis: The Population-Based Tirschenreuth Study in the Hardest-Hit German County in Spring 2020." Viruses 13, no. 6: 1118.
(1) Background: Different sources of information are used by the population regarding skin cancer prevention. The pertinent quality of information that can be retrieved via an internet search engine needs assessment; (2) Methods: Four topical searches in common language were entered into Google™. The first 200 “hits” were stored for further use. Eligible websites were evaluated using content-based criteria based on the current German medical guideline “Skin cancer prevention” and employing generic (DISCERN, HONcode) quality criteria. (3) Results: Overlap between the four search results was between 0 and 7 of 200. The completeness of relevant content was scored with a median of 10 points (first quartile (Q1):6; Q3:14) and thus, it was much lower than the theoretical maximum of 43 points. Global quality, with a maximum of 10 points, was 3 in median (Q1:2; Q3:4). Quality and completeness, respectively, were somewhat higher in the higher ranks of search results. The generic quality was moderate. (4) Conclusions: A direct comparison with other sources of information (print, audio-visual, presentation, or personal counselling) is not possible, but important deficits concerning the quality and scope of relevant information on the internet are demonstrated.
Wolfgang Uter; Christina Eversbusch; Olaf Gefeller; Annette Pfahlberg. Quality of Information for Skin Cancer Prevention: A Quantitative Evaluation of Internet Offerings. Healthcare 2021, 9, 229 .
AMA StyleWolfgang Uter, Christina Eversbusch, Olaf Gefeller, Annette Pfahlberg. Quality of Information for Skin Cancer Prevention: A Quantitative Evaluation of Internet Offerings. Healthcare. 2021; 9 (2):229.
Chicago/Turabian StyleWolfgang Uter; Christina Eversbusch; Olaf Gefeller; Annette Pfahlberg. 2021. "Quality of Information for Skin Cancer Prevention: A Quantitative Evaluation of Internet Offerings." Healthcare 9, no. 2: 229.
Pharmacists and pharmaceutical technicians play an important role in counselling customers regarding sunscreen use and sun protection measures. A potentially helpful tool that can be used during counselling is the ultraviolet index (UVI), which informs individuals when and what sun protection measures are needed at a specific place and time. Our aim in this qualitative study was to explore awareness, knowledge, and use of the UVI during counselling in pharmacies. We used semi-structured interviews with pharmacists and pharmaceutical technicians (n = 20) to answer our research questions. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. During the interviews pharmacists and pharmaceutical technicians revealed a lot of uncertainty and lack of knowledge regarding the UVI. Eight professionals were able to give a correct definition of UVI. Amongst others, the UVI was confused with sun protection factor. Overall, the UVI was hardly used during the counselling of customers. The UVI was developed to provide guidance when which type of sun protection is required to avoid detrimental effects of ultraviolet radiation. For effective implementation, both the general population and health professionals (e.g., pharmacists) have to increase their knowledge about the UVI. This would strengthen its use during professional counselling in pharmacies and may help to reduce the incidence of skin cancer over the long term.
Katharina Diehl; Tatiana Görig; Charlotte Jansen; Maike Carola Hruby; Annette B. Pfahlberg; Olaf Gefeller. “I’ve Heard of It, Yes, but I Can’t Remember What Exactly It Was”—A Qualitative Study on Awareness, Knowledge and Use of the UV Index. International Journal of Environmental Research and Public Health 2021, 18, 1615 .
AMA StyleKatharina Diehl, Tatiana Görig, Charlotte Jansen, Maike Carola Hruby, Annette B. Pfahlberg, Olaf Gefeller. “I’ve Heard of It, Yes, but I Can’t Remember What Exactly It Was”—A Qualitative Study on Awareness, Knowledge and Use of the UV Index. International Journal of Environmental Research and Public Health. 2021; 18 (4):1615.
Chicago/Turabian StyleKatharina Diehl; Tatiana Görig; Charlotte Jansen; Maike Carola Hruby; Annette B. Pfahlberg; Olaf Gefeller. 2021. "“I’ve Heard of It, Yes, but I Can’t Remember What Exactly It Was”—A Qualitative Study on Awareness, Knowledge and Use of the UV Index." International Journal of Environmental Research and Public Health 18, no. 4: 1615.
The rising incidence of cutaneous melanoma over the past few decades has prompted substantial efforts to develop risk prediction models identifying people at high risk of developing melanoma to facilitate targeted screening programs. We review these models, regarding study characteristics, differences in risk factor selection and assessment, evaluation, and validation methods. Our systematic literature search revealed 40 studies comprising 46 different risk prediction models eligible for the review. Altogether, 35 different risk factors were part of the models with nevi being the most common one (n = 35, 78%); little consistency in other risk factors was observed. Results of an internal validation were reported for less than half of the studies (n = 18, 45%), and only 6 performed external validation. In terms of model performance, 29 studies assessed the discriminative ability of their models; other performance measures, e.g., regarding calibration or clinical usefulness, were rarely reported. Due to the substantial heterogeneity in risk factor selection and assessment as well as methodologic aspects of model development, direct comparisons between models are hardly possible. Uniform methodologic standards for the development and validation of risk prediction models for melanoma and reporting standards for the accompanying publications are necessary and need to be obligatory for that reason.
Isabelle Kaiser; Annette B. Pfahlberg; Wolfgang Uter; Markus V. Heppt; Marit B. Veierød; Olaf Gefeller. Risk Prediction Models for Melanoma: A Systematic Review on the Heterogeneity in Model Development and Validation. International Journal of Environmental Research and Public Health 2020, 17, 7919 .
AMA StyleIsabelle Kaiser, Annette B. Pfahlberg, Wolfgang Uter, Markus V. Heppt, Marit B. Veierød, Olaf Gefeller. Risk Prediction Models for Melanoma: A Systematic Review on the Heterogeneity in Model Development and Validation. International Journal of Environmental Research and Public Health. 2020; 17 (21):7919.
Chicago/Turabian StyleIsabelle Kaiser; Annette B. Pfahlberg; Wolfgang Uter; Markus V. Heppt; Marit B. Veierød; Olaf Gefeller. 2020. "Risk Prediction Models for Melanoma: A Systematic Review on the Heterogeneity in Model Development and Validation." International Journal of Environmental Research and Public Health 17, no. 21: 7919.
Introduction(Over)exposure to ultraviolet radiation is a major risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was introduced by the WHO and partner organisations in 1995 as a simple measure of the intensity of solar UV radiation, providing guidance for the population to use appropriate sun protective measures. Little is known about the impact of the UVI on actual sun protection behaviour. Our systematic review aims to assess global levels of awareness, understanding and use of the UVI as prerequisites for the preventive effectiveness of this public health tool.Methods and analysisSystematic searches will be performed in 10 electronic literature databases including Medline, Scopus and Web of Science–Core Collection, two clinical trials registries and at least two grey literature databases (OpenGrey, Bielefeld Academic Search Engine). Additional literature sources will be retrieved using hand search of reference lists of included studies and snowballing methods. We will include studies with all types of quantitative study designs and participants reporting on at least one outcome in the three main categories (i) awareness, (ii) understanding and (iii) use of the UVI. We will assess the risk of bias within studies with an abbreviated version of the AXIS tool, designed specifically for cross-sectional studies. As we expect large heterogeneity in outcomes, we will conduct a narrative synthesis of results instead of a meta-analysis.Ethics and disseminationEthical approval and patient consent are not required as this is a systematic review based on published studies. The results of this study will be published in an international peer-reviewed journal.Prospero registration numberCRD42018093693.
Maria Lehmann; Maria Heinitz; Wolfgang Uter; Annette B Pfahlberg; Olaf Gefeller. The extent of public awareness, understanding and use of the Global Solar UV index as a worldwide health promotion instrument to improve sun protection: protocol for a systematic review. BMJ Open 2019, 9, e028092 .
AMA StyleMaria Lehmann, Maria Heinitz, Wolfgang Uter, Annette B Pfahlberg, Olaf Gefeller. The extent of public awareness, understanding and use of the Global Solar UV index as a worldwide health promotion instrument to improve sun protection: protocol for a systematic review. BMJ Open. 2019; 9 (7):e028092.
Chicago/Turabian StyleMaria Lehmann; Maria Heinitz; Wolfgang Uter; Annette B Pfahlberg; Olaf Gefeller. 2019. "The extent of public awareness, understanding and use of the Global Solar UV index as a worldwide health promotion instrument to improve sun protection: protocol for a systematic review." BMJ Open 9, no. 7: e028092.
Overexposure to ultraviolet (UV) radiation is the main modifiable risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was introduced as a tool to visualize the intensity of UV radiation on a certain day, which should enable and encourage people to take appropriate protective measures. The ‘low’ exposure category of the UVI, defined by a rounded UVI value of 0, 1 or 2, was linked to the health message ‘No protection required’ by the World Health Organization and partner organizations. However, published evidence corroborating this advice is not available. To evaluate the erythemal risk of low UVI days, we analyzed 14,431 daily time series of ambient erythemal irradiance data measured at nine stations of the German solar UV monitoring network during the years 2007–2016. We analyzed the proportion of days in the sample for which ambient erythemal doses calculated for various time intervals exceed average minimal erythemal doses (MEDs) of the Fitzpatrick skin phototypes I–VI to assess the potential for erythema arising from sun exposure on days with low UVI values. Additionally, we calculated for each day the minimum exposure duration needed to receive one MED. Our results indicate that on days with a UVI value of 0, risk of erythema is indeed negligible. Conversely, the abovementioned health message appears misleading when melano-compromised individuals (skin type I and II) spend more than 1.5 hours outdoors on days with a UVI value of 2. Under rare circumstances of prolonged exposure, MEDs of the two most sensitive skin types can also be exceeded even on days with a UVI value of 1. Hence, current WHO guidance for sun protection on days with low UVI values needs reconsideration.
Maria Lehmann; Annette B. Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. Public Health Messages Associated with Low UV Index Values Need Reconsideration. International Journal of Environmental Research and Public Health 2019, 16, 2067 .
AMA StyleMaria Lehmann, Annette B. Pfahlberg, Henner Sandmann, Wolfgang Uter, Olaf Gefeller. Public Health Messages Associated with Low UV Index Values Need Reconsideration. International Journal of Environmental Research and Public Health. 2019; 16 (12):2067.
Chicago/Turabian StyleMaria Lehmann; Annette B. Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. 2019. "Public Health Messages Associated with Low UV Index Values Need Reconsideration." International Journal of Environmental Research and Public Health 16, no. 12: 2067.
According to the World Health Organization and partner organizations, no protection against ultraviolet (UV) radiation is required on days with ‘low’ values (i.e. values of less than 3) of the Global Solar Ultraviolet Index (UVI). Erythemal irradiance (Eer) data of such days were analyzed to evaluate this claim. Measurements from 9 stations of the German solar UV monitoring network from 2007 to 2016 yielded 14,431 daily Eer time series of low UVI days. Erythemal doses for certain fixed time intervals ‐ acquired from measurements on horizontal planes ‐ were compared with the average minimal erythemal dose (MED) of skin phototype II. Doses from days with rounded UVI values of 0 were insufficient to induce erythema and even on days with rounded UVI values of 1 doses exceeding 1 MED of skin type II could only be acquired under very specific circumstances of prolonged exposure. Conversely, sun exposure on days with rounded UVI values of 2 can indeed provide doses sufficient to induce erythema in skin type II after two hours around noon. In conclusion, our analyses do not support the claim of harmlessness currently associated with the entire low UVI exposure category in public guidance on interpretation of the UVI. This article is protected by copyright. All rights reserved.
Maria Lehmann; Henner Sandmann; Annette B. Pfahlberg; Wolfgang Uter; Olaf Gefeller. ErythemalUVRadiation on Days with LowUVIndex Values—an Analysis of Data from the German SolarUVMonitoring Network over a Ten‐year Period. Photochemistry and Photobiology 2019, 95, 1076 -1082.
AMA StyleMaria Lehmann, Henner Sandmann, Annette B. Pfahlberg, Wolfgang Uter, Olaf Gefeller. ErythemalUVRadiation on Days with LowUVIndex Values—an Analysis of Data from the German SolarUVMonitoring Network over a Ten‐year Period. Photochemistry and Photobiology. 2019; 95 (4):1076-1082.
Chicago/Turabian StyleMaria Lehmann; Henner Sandmann; Annette B. Pfahlberg; Wolfgang Uter; Olaf Gefeller. 2019. "ErythemalUVRadiation on Days with LowUVIndex Values—an Analysis of Data from the German SolarUVMonitoring Network over a Ten‐year Period." Photochemistry and Photobiology 95, no. 4: 1076-1082.
Overexposure to ultraviolet (UV) radiation is the main modifiable risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was introduced as a tool to visualize the intensity of UV radiation on a certain day which should enable and encourage people to take appropriate protective measures. The exposure category ‘low’ of the UVI, including values from 0 to 2, was linked to the health message ‘No protection required’ by the World Health Organization and collaborating centres. However, published evidence corroborating this advice is scarce. Therefore, we analysed ambient erythemal irradiance data of 14,431 daily UVI time series of low UVI days. Data were gathered at nine stations of the German solar UV monitoring networkcovering all major climate areas in Germanyin the years 2007–2016. We compared ambient erythemal doses calculated for various time intervals with average minimal erythemal doses (MEDs) of the Caucasian Fitzpatrick skin phototypes I-IV to assess the potential for skin damage arising from sun exposure on days with low UVI values. The most common months for the occurrence of days with low UVI values in our dataset were January and December, February and November, and March and October for UVI 0, 1 and 2, respectively. Our results indicate that on days with a UVI value of 0, risk of deterministic radiation injury (solar erythema) is negligible. Conversely, the above-mentioned health message appears misleading when melano-compromised individuals spend several hours outdoors on days with a UVI value of 2, as median doses exceed the MEDs of Fitzpatrick skin types I and II after an exposure duration of only 2 h around solar noon. Under very rare specific circumstances, MEDs of those two most sensitive skin types can also be exceeded even on days with UVI 1. Hence, two aspects of current public health messages may need reconsideration: on the one hand, the health message related to an ‘innocuous level’ of the UVI and, on the other hand, a possible adaption of UVI-related health messages to different skin types.
Maria Lehmann; Annette B. Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. Public Health Messages Associated with the Low Exposure Category of the UV Index Need Reconsideration. Proceedings 2018, 6, 6 .
AMA StyleMaria Lehmann, Annette B. Pfahlberg, Henner Sandmann, Wolfgang Uter, Olaf Gefeller. Public Health Messages Associated with the Low Exposure Category of the UV Index Need Reconsideration. Proceedings. 2018; 6 (1):6.
Chicago/Turabian StyleMaria Lehmann; Annette B. Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. 2018. "Public Health Messages Associated with the Low Exposure Category of the UV Index Need Reconsideration." Proceedings 6, no. 1: 6.
Minimizing exposure to ultraviolet radiation (UVR) is strongly recommended as the most important primary prevention measure regarding skin cancer. The responsibility for adequate sun protection of young children lies with their parents and external caregivers. Since a high proportion of 3- to 6-year-old children in Germany attend nurseries, the practice of sun protection in this setting was assessed. A survey was conducted in 246 nurseries in southern Germany during spring and summer of 2014 and 2015. Shade coverage in the outdoor area of the nursery was assessed by study team members and UVR protective behavior of staff was assessed by an interview with the directors. On average, 52% of the entire outdoor area and 65% of the children’s outdoor play area were covered by shade, with a significant difference between nurseries of different sizes, pointing to a better shade coverage in larger nurseries. The daily outdoor stay was not regularly scheduled before or after peak sun intensity hours around noon to avoid intense UVR exposure. General sun protection rules were present in the majority of the nurseries and addressed predominantly wearing sunhats and applying sunscreen. Our findings show that current sun protection recommendations for children are only partially met in nurseries and indicate a lower level of sun protection in small institutions. Especially, avoidance of excessive exposure to UVR around noon and the importance of shade provision over play structures needs to be emphasized in future information campaigns.
Cornelia Fiessler; Annette B. Pfahlberg; Wolfgang Uter; Olaf Gefeller. Shedding Light on the Shade: How Nurseries Protect Their Children from Ultraviolet Radiation. International Journal of Environmental Research and Public Health 2018, 15, 1793 .
AMA StyleCornelia Fiessler, Annette B. Pfahlberg, Wolfgang Uter, Olaf Gefeller. Shedding Light on the Shade: How Nurseries Protect Their Children from Ultraviolet Radiation. International Journal of Environmental Research and Public Health. 2018; 15 (9):1793.
Chicago/Turabian StyleCornelia Fiessler; Annette B. Pfahlberg; Wolfgang Uter; Olaf Gefeller. 2018. "Shedding Light on the Shade: How Nurseries Protect Their Children from Ultraviolet Radiation." International Journal of Environmental Research and Public Health 15, no. 9: 1793.
Die Vermittlung von Wissen zu Risikofaktoren sowie Schutzverhalten stellt eine wesentliche Grundlage der primären Hautkrebsprävention dar. Die tatsächlich von der Bevölkerung genutzten Informationskanäle sind auf diesem Gebiet weitgehend unbekannt. Deskriptive Darstellung der einschlägigen Informationsquellen, die Eltern von 3‑ bis 6‑jährigen Kindern als besonders relevante Zielgruppe nutzen, sowie Analyse von Zusammenhängen zwischen soziodemografischen Faktoren, Arten von Informationsquellen und dem Wissensstand. Querschnittsstudie mittels selbstausgefülltem Fragebogen mit Onlineoption von Oktober 2011 bis Februar 2012 mit 3129 Familien, deren Kind einen der teilnehmenden Kindergärten des Landkreises Erlangen-Höchstadt bzw. der Stadt Erlangen und der Stadt Ansbach besuchten (87,5 % Response auf Kindergartenebene, 56,5 % auf Ebene der Beobachtungseinheit [Familie]). Es bestanden relativ geringe strukturelle Unterschiede zwischen den Standorten. Das Internet wurde von nur 13,3 % der Befragten genutzt. Eine positive Assoziation zwischen Nutzung mehrerer Informationsquellen und relevantem Wissen sowie präventivem Verhalten war zu verzeichnen. Darüber hinaus konnte eine negative Assoziation zwischen Nutzung des Internets und erworbenem Wissen festgestellt werden. Demgegenüber war die Nutzung von Printmedien sowie audiovisueller bzw. persönlich vermittelter Information positiv mit Wissen assoziiert. Prävention sollte verstärkt auf Teile der Bevölkerung mit geringerer formaler Bildung zugeschnitten werden. Bei der Wissensvermittlung scheint derzeit dem Internet keine große Bedeutung zuzukommen; die negative Assoziation zwischen Internetnutzung und Wissen ist möglicherweise auf verbreitete irreführende Informationen zurückzuführen. The dissemination of knowledge on risk factors and preventive strategies is a core element of skin cancer prevention. However, little is known about the information channels utilised by the population for this purpose. Descriptive analysis of information sources used by parents of 3‑ to 6‑year-old children as a particularly relevant target group and analysis of association patterns between socio-demographic factors, types of information sources and acquired knowledge. A cross-sectional study was performed using a self-administered questionnaire with an online option between October 2011 and February 2012 with 3129 families who had at least one child visiting a kindergarten in the county of Erlangen-Höchstadt, the city of Erlangen or the city of Ansbach (Bavaria, Germany), with an 87.5% response rate on the level of kindergartens and 56.5% on the level of observational units (families). There were few structural differences between study regions. The internet was used by only 13.3% of participants. A positive association was found between the use of multiple information sources and relevant knowledge and, partly, protective behaviour. A negative association was identified between the use of the internet and knowledge. In contrast, the use of print media or audio-visual or personal channels of information was positively associated with knowledge. Preventive efforts should be increased that target parts of the population with lower formal education. The internet does not seem to play an important role and may even adversely affect knowledge, possibly due to unvalidated and misleading information.
Wolfgang Uter; Cornelia Fießler; Olaf Gefeller; Annette Pfahlberg. Kenntnisse und Wissensquellen zu Hautkrebs-Risikofaktoren bei Eltern von 3‑ bis 6‑jährigen Kindern. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2017, 60, 856 -864.
AMA StyleWolfgang Uter, Cornelia Fießler, Olaf Gefeller, Annette Pfahlberg. Kenntnisse und Wissensquellen zu Hautkrebs-Risikofaktoren bei Eltern von 3‑ bis 6‑jährigen Kindern. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2017; 60 (8):856-864.
Chicago/Turabian StyleWolfgang Uter; Cornelia Fießler; Olaf Gefeller; Annette Pfahlberg. 2017. "Kenntnisse und Wissensquellen zu Hautkrebs-Risikofaktoren bei Eltern von 3‑ bis 6‑jährigen Kindern." Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 60, no. 8: 856-864.
Olaf Gefeller; Cornelia Fiessler; Martin Radespiel-Tröger; Annette B Pfahlberg; Wolfgang Uter. Reply to: Seasonality of birth for skin melanoma deserves further investigation. International Journal of Epidemiology 2017, 46, 765 -766.
AMA StyleOlaf Gefeller, Cornelia Fiessler, Martin Radespiel-Tröger, Annette B Pfahlberg, Wolfgang Uter. Reply to: Seasonality of birth for skin melanoma deserves further investigation. International Journal of Epidemiology. 2017; 46 (2):765-766.
Chicago/Turabian StyleOlaf Gefeller; Cornelia Fiessler; Martin Radespiel-Tröger; Annette B Pfahlberg; Wolfgang Uter. 2017. "Reply to: Seasonality of birth for skin melanoma deserves further investigation." International Journal of Epidemiology 46, no. 2: 765-766.
Maria Lehmann; Annette Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. Implications of Low Levels of the UV Index for Sun Protection. Studies in health technology and informatics 2017, 243, 25 -29.
AMA StyleMaria Lehmann, Annette Pfahlberg, Henner Sandmann, Wolfgang Uter, Olaf Gefeller. Implications of Low Levels of the UV Index for Sun Protection. Studies in health technology and informatics. 2017; 243 ():25-29.
Chicago/Turabian StyleMaria Lehmann; Annette Pfahlberg; Henner Sandmann; Wolfgang Uter; Olaf Gefeller. 2017. "Implications of Low Levels of the UV Index for Sun Protection." Studies in health technology and informatics 243, no. : 25-29.
During childhood, parents play a vital role in sun protection of their children. Their guidance is essential for avoiding excessive exposure to ultraviolet (UV) radiation, a risk factor for developing skin cancer in later life. In a population-based cross-sectional study conducted between October 2011 and February 2012, we assessed how 3281 parents implemented sun protection for their three- to six-year-old children in practice. In particular, clothing, shade-seeking behavior, wearing of sunhats and sunglasses, use of sunscreens and the amount of time spent outdoors were ascertained in two settings (beach, garden/playground). The results showed that the overall level of parental sun protection for their children in the beach setting, and to a lesser extent also in the everyday outdoor setting, is relatively high. Using sunscreens with a high sun protection factor and instructing children to wear a sunhat were very common. Lesser attention was paid to sun-protective clothing, seeking the shade and wearing sunglasses. The amount of time spent outdoors during summer days was high. Therefore, the recommendation to completely avoid sun exposure during peak UV times around noon during summertime needs to be reinforced. In addition, the observed difference in the protective behavior between the beach and an everyday outdoor setting points to the necessity to encourage better sun protection for children also in outdoor activities of daily living.
Olaf Gefeller; Wolfgang Uter; Annette B. Pfahlberg. Protection from Ultraviolet Radiation during Childhood: The Parental Perspective in Bavaria. International Journal of Environmental Research and Public Health 2016, 13, 1011 .
AMA StyleOlaf Gefeller, Wolfgang Uter, Annette B. Pfahlberg. Protection from Ultraviolet Radiation during Childhood: The Parental Perspective in Bavaria. International Journal of Environmental Research and Public Health. 2016; 13 (10):1011.
Chicago/Turabian StyleOlaf Gefeller; Wolfgang Uter; Annette B. Pfahlberg. 2016. "Protection from Ultraviolet Radiation during Childhood: The Parental Perspective in Bavaria." International Journal of Environmental Research and Public Health 13, no. 10: 1011.
Evidence on the effect of ultraviolet radiation (UVR) exposure in infancy on melanoma risk in later life is scarce. Three recent studies suggest that people born in spring carry a higher melanoma risk. Our study aimed at verifying whether such a seasonal pattern of melanoma risk actually exists. Data from the population-based Cancer Registry Bavaria (CRB) on the birth months of 28 374 incident melanoma cases between 2002 and 2012 were analysed and compared with data from the Bavarian State Office for Statistics and Data Processing on the birth month distribution in the Bavarian population. Crude and adjusted analyses using negative binomial regression models were performed in the total study group and supplemented by several subgroup analyses. In the crude analysis, the birth months March-May were over-represented among melanoma cases. Negative binomial regression models adjusted only for sex and birth year revealed a seasonal association between melanoma risk and birth month with 13-21% higher relative incidence rates for March, April and May compared with the reference December. However, after additionally adjusting for the birth month distribution of the Bavarian population, these risk estimates decreased markedly and no association with the birth month was observed any more. Similar results emerged in all subgroup analyses. Our large registry-based study provides no evidence that people born in spring carry a higher risk for developing melanoma in later life and thus lends no support to the hypothesis of higher UVR susceptibility during the first months of life.
Cornelia Fiessler; Annette B. Pfahlberg; Andrea K. Keller; Martin Radespiel-Tröger; Wolfgang Uter; Olaf Gefeller. Association between month of birth and melanoma risk: fact or fiction? International Journal Of Epidemiology 2016, 46, 686 -693.
AMA StyleCornelia Fiessler, Annette B. Pfahlberg, Andrea K. Keller, Martin Radespiel-Tröger, Wolfgang Uter, Olaf Gefeller. Association between month of birth and melanoma risk: fact or fiction? International Journal Of Epidemiology. 2016; 46 (2):686-693.
Chicago/Turabian StyleCornelia Fiessler; Annette B. Pfahlberg; Andrea K. Keller; Martin Radespiel-Tröger; Wolfgang Uter; Olaf Gefeller. 2016. "Association between month of birth and melanoma risk: fact or fiction?" International Journal Of Epidemiology 46, no. 2: 686-693.
Substantial public health efforts have been undertaken throughout the last 25 years to increase awareness about skin cancer risks in the German population. An evaluation of long-term effects of these awareness campaigns and preventive activities on the population level and in specific subgroups is yet lacking. We address the temporal development of knowledge about skin cancer risk factors and agreement to the necessity of sun protection in different outdoor situations among parents of young children. We compiled data from four population-based surveys comprising data from 8184 parents of 3- to 6-year-old children in two regions of Germany performed over a nineteen-year period between 1993 and 2012. These individual cross-sectional studies used an identical methodology to recruit study subjects and to assess the principal outcome measures. Overall, parental knowledge about skin cancer risk factors and agreement to the necessity of sun protection improved significantly over the nineteen-year period. For instance, the recognition of fair skin/hair, sunburns during childhood and a high number of naevi, respectively, being risk factors for skin cancer increased by 20.0%, 19.9% and 19.2% from the first to the most recent survey. Two remaining knowledge gaps became evident: (i) the underrating of intermittent intensive sun exposure as a skin cancer risk factor and (ii) the erroneous belief that clouds provide sufficient sun protection at midday during summertime. The messages of future public health campaigns in Germany addressing skin cancer risks and informing about preventive measures for sun protection should thus be refined regarding these aspects.
Olaf Gefeller; Wolfgang Uter; Annette B. Pfahlberg. Long-term development of parental knowledge about skin cancer risks in Germany: Has it changed for the better? Preventive Medicine 2016, 89, 31 -36.
AMA StyleOlaf Gefeller, Wolfgang Uter, Annette B. Pfahlberg. Long-term development of parental knowledge about skin cancer risks in Germany: Has it changed for the better? Preventive Medicine. 2016; 89 ():31-36.
Chicago/Turabian StyleOlaf Gefeller; Wolfgang Uter; Annette B. Pfahlberg. 2016. "Long-term development of parental knowledge about skin cancer risks in Germany: Has it changed for the better?" Preventive Medicine 89, no. : 31-36.
Olaf Gefeller; Cornelia Fiessler; Martin Radespiel-Tröger; Wolfgang Uter; Annette Pfahlberg. The Effect of Exposure to Ultraviolet Radiation in Infancy on Melanoma Risk. Studies in health technology and informatics 2016, 228, 1 .
AMA StyleOlaf Gefeller, Cornelia Fiessler, Martin Radespiel-Tröger, Wolfgang Uter, Annette Pfahlberg. The Effect of Exposure to Ultraviolet Radiation in Infancy on Melanoma Risk. Studies in health technology and informatics. 2016; 228 ():1.
Chicago/Turabian StyleOlaf Gefeller; Cornelia Fiessler; Martin Radespiel-Tröger; Wolfgang Uter; Annette Pfahlberg. 2016. "The Effect of Exposure to Ultraviolet Radiation in Infancy on Melanoma Risk." Studies in health technology and informatics 228, no. : 1.
Seasonal variation in melanoma diagnoses has been observed in numerous studies that used calendar time indicators. Depending on the latitude (and altitude) of the study region, the magnitude of seasonal and year-to-year variation of ultraviolet radiation (UVR) is neglected in these studies. An alternative approach comprises the direct incorporation of UVR measurements into such analyses. The aim of this investigation is a comparative evaluation of these approaches. The population-based Bavarian cancer registry recorded 11 901 incident melanoma cases between 2003 and 2008 that were used for the analysis. UVR intensity data for the same period were available from the solar radiation station at Munich-Neuherberg. Negative binomial regression modelling yielded adjusted relative risks (RR) controlled for year of diagnosis and age in 16 subgroups defined by sex, Breslow thickness and localization. Overall, the analyses showed slightly differing yet consistent results for exposure effects in subgroups. Melanoma evolving on the extremities showed the most pronounced association with increasing level of the UV index among men [e.g. RR=1.086, 95% confidence interval (CI) 1.054-1.119, and RR=1.102, 95% CI 1.046-1.161, for thin and thick melanoma on the upper limbs, respectively] and women (e.g. RR=1.088, 95% CI 1.058-1.119, and RR=1.056, 95% CI 1.010-1.103, for thin and thick melanoma on the lower limbs, respectively). Our analysis provides a benchmark for international comparisons and synthesis of epidemiologic evidence of seasonal variability in melanoma diagnoses. Future studies should use direct UVR measures to enable pooling of risk estimates and resolve remaining inconsistencies potentially resulting from latitudinal differences in exposure between international studies.
Andrea K. Keller; Wolfgang Uter; Annette Pfahlberg; Martin Radespiel-Tröger; Ingo Mayer; Olaf Gefeller. Replacing surrogate measures by direct quantification of ultraviolet radiation exposure in registry-based analyses of seasonality of melanoma diagnoses. Melanoma Research 2015, 25, 543 -549.
AMA StyleAndrea K. Keller, Wolfgang Uter, Annette Pfahlberg, Martin Radespiel-Tröger, Ingo Mayer, Olaf Gefeller. Replacing surrogate measures by direct quantification of ultraviolet radiation exposure in registry-based analyses of seasonality of melanoma diagnoses. Melanoma Research. 2015; 25 (6):543-549.
Chicago/Turabian StyleAndrea K. Keller; Wolfgang Uter; Annette Pfahlberg; Martin Radespiel-Tröger; Ingo Mayer; Olaf Gefeller. 2015. "Replacing surrogate measures by direct quantification of ultraviolet radiation exposure in registry-based analyses of seasonality of melanoma diagnoses." Melanoma Research 25, no. 6: 543-549.
Olaf Gefeller; Annette Pfahlberg; Wolfgang Uter; Martin Radespiel-Tröger. Seasonal variation in diagnosis of invasive cutaneous melanoma. Cancer Epidemiology 2015, 40, 196 -197.
AMA StyleOlaf Gefeller, Annette Pfahlberg, Wolfgang Uter, Martin Radespiel-Tröger. Seasonal variation in diagnosis of invasive cutaneous melanoma. Cancer Epidemiology. 2015; 40 ():196-197.
Chicago/Turabian StyleOlaf Gefeller; Annette Pfahlberg; Wolfgang Uter; Martin Radespiel-Tröger. 2015. "Seasonal variation in diagnosis of invasive cutaneous melanoma." Cancer Epidemiology 40, no. : 196-197.
Instruments for the evaluation of campaigns targeting the reduction of UV exposure in the population, and thus skin cancer risk, are needed. To examine the “childhood monitoring of naevus density” approach suggested some 10 years ago in a routine setting of mandatory pre-school examinations. Data were collected between 1999 and 2005 in Göttingen, Wolfenbüttel, Northeim, Salzgitter, and Erlangen. Besides basic data, freckling, iris and hair colour, and “Fitzpatrick skin type” as well as counts of melanocytic naevi were documented. Negative binomial regression analysis quantified the association between naevus counts and above factors, and year and site of examination, respectively. Of 12,809 children examined at five different sites over a period of 6 years, 11,345 were eligible for the analysis. While differences between sites were marked and significant, only a very minute, albeit significant, decrease in risk was found between the reference group (Göttingen 1999/2000) and the last year examined in Göttingen (2005). Significant between-site variation in the analysis adjusted for constitutional factors points to problems with standardization; thus, a broad application of this instrument does not seem to be advisable.
Wolfgang Uter; Cornelia Fießler; Olaf Gefeller; Annette Pfahlberg. Monitoring of naevus density at age 6: Is it both feasible and meaningful? International Journal of Hygiene and Environmental Health 2015, 219, 118 -122.
AMA StyleWolfgang Uter, Cornelia Fießler, Olaf Gefeller, Annette Pfahlberg. Monitoring of naevus density at age 6: Is it both feasible and meaningful? International Journal of Hygiene and Environmental Health. 2015; 219 (1):118-122.
Chicago/Turabian StyleWolfgang Uter; Cornelia Fießler; Olaf Gefeller; Annette Pfahlberg. 2015. "Monitoring of naevus density at age 6: Is it both feasible and meaningful?" International Journal of Hygiene and Environmental Health 219, no. 1: 118-122.