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Exposure to solar ultraviolet radiation in young Dutch children: Assessment by means of a 6-week retrospective questionnaire

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Abstract

We designed a 6-week retrospective questionnaire on sunlight exposure. Estimation of the short-term exposure to sunlight is important for observational human studies concerning the effects of ultraviolet radiation (UVR) on the human immune system and related resistance to infections. This questionnaire was given to the parents of 1672 1-year-old children in the Netherlands who participated in a birth cohort study. We evaluated the questionnaire and estimated the personal 6-week cumulative exposure to solar UVR. Only 910 questionnaires (54.4%) were filled out completely and consistently. This suggests that reporting data on children's outdoor exposure, even for the recent past, is often difficult. The data from these questionnaires indicated that the crude number of reported outdoor hours was enough to obtain a relative estimate of the individual exposure to ambient UVR, but that weighting for the effect of clothing was essential for the classification of the systemic UVR dosage received. Sunny weeks in the Netherlands in 1998, as were established by independent measurements of the levels of ambient UVR, vacations abroad, and sunburn, were associated with a comparatively high mean estimated exposure. These results support the suitability of the questionnaire for classifying the participants with respect to their short-term exposure to solar UVR.
ERRATUM
Exposure to solar ultraviolet radiation in young Dutch children:
Assessment by means of a 6-week retrospective questionnaire
FABIAN TERMORSHUIZEN, ALET WIJGA, JOHAN GARSSEN, PETER N. DEN OUTER, HARRY SLAPER
AND HENK VAN LOVEREN
Journal of Exposure Analysis and Environmental Epidemiology ( 2002 ) 12, 204 213 doi:10.1038/sj.jea.7500220
Figure 2 of the above paper was published in black and white in error. The figure is reproduced below in colour.
Journal of Exposure Analysis and Environmental Epidemiology (2002) 12, 389
# 2002 Nature Publishing Group All rights reserved 1053-4245/02/$25.00
www.nature.com/jea
... ESHA Research, Salem, Oregon, USA); 2) Weight-bearing physical activity records; 3) Sunlight exposure questionnaires; 4) Health related QoL (SF-36) questionnaires (www.qualitymetric.com Liscence Number QM019185 OPTUMInsight TDM ); and 5) Adherence and acceptance surveys [34][35][36][37][38][42][43][44]. Adherence to vitamin D 3 supplementation was also assessed by pill counts of returned vitamin bottles at 3 and 6 months. ...
... Participants completed a validated questionnaire for vitamin D synthesis potential according to sun exposure behaviours [43]. This questionnaire was completed to help account for seasonal variations and the impact this may have on vitamin D synthesis. ...
... The following were standard responses to vitamin D toxicity in our population: 1) Serum and urine electrolytes, renal function, electrocardiogram, and fluid balance monitoring and maintenance [38]. 2) If necessary, additional measures may have been taken to enhance excretion/metabolism of the vitamin D including: IV administration of furosemide; corticosteroid, bisphosphonate or calcitonin therapy; hemo-or peritoneal dialysis [43]. If hypersensitivity to vitamin D 3 occurred which included anaphylaxis, then appropriate treatment with epinephrine and ventilation would have been provided as needed. ...
Article
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Background Suboptimal vitamin D status is highly prevalent in Northern communities, particularly in those patients with chronic diseases such as diabetes and chronic renal disease. Emerging literature suggests that adherence to daily vitamin D supplementation may be an important factor influencing vitamin D status and overall bone health, but compliance with therapies for bone health is a major challenge. It is unknown what level of vitamin D supplementation will ameliorate or improve suboptimal vitamin D status in patients with diabetic nephropathy or contribute to improved bone health, particularly for those living in northern climates. Methods/Design The study purpose was to examine two different strategies of vitamin D3 supplementation; daily dosing of 2000 IU per day verses monthly dosing of 40,000 IU per month on markers of vitamin D status, bone health and to examine whether adherence, quality of life and patient satisfaction with the supplementation strategy differs between the two vitamin D strategies in adults diagnosed with diabetic nephropathy. Discussion The need for RCTs assessing higher doses of vitamin D3 supplementation at varying frequencies of administration and its impact on bone health in adults with diabetes and chronic kidney disease are needed. Trial registration ClinicalTrials.gov NCT01476501.
... Although objective measurement of individually received UVR has been advocated for since the beginning of the century, currently objective UV dosimetry among children, specifically in the Netherlands, is scarce (419). Since skin cancer has a latency of at least 5-20 years after UVR-induced damage (420), we need to gain insight in the objective amounts of children's sun exposure and sunburn. ...
Thesis
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Citation for published version (APA): Thoonen, K. A. H. J. (2021). Breaking through the clouds: towards understanding sunburn, sun exposure and sun protection of children in the Netherlands. Maastricht University.
... Furthermore, although validation studies show fair to strong correlations between self-reported and observed exposure [57,59], collecting objective data about children's UVR exposure has been strongly advocated [60]. Environmental effects such as shade coverage, altitude or humidity cannot be measured in self-reported questionnaires [61]. Because detailed information on actual received UVR dosage is lacking among children, the formulation of specific policy and guidelines, weighted for specific environmental characteristics (e.g. ...
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Preventing sunburn in childhood is imperative in the light of skin cancer prevention. To provide directions for targeted interventions, a better understanding of children's sunburn and associated parental behaviours is necessary. To explore sun exposure and parent-for-child sun protection patterns and their relationship with sunburn experienced in children. An online survey was conducted among parents (n = 1,299) of children (4 to 12 years). Latent class analysis (LCA) was performed to identify parental subgroups for children's sunburn, sun exposure and several sun protection behaviours (i.e. applying sunscreen, clothing, seeking shade) in two sun exposure settings (i.e. planned versus incidental). LCA results were validated by assessing predictions of class membership through several socio-demographic characteristics. Reported sunburn in the previous year was frequent (>40%). Four latent classes of sunburn-exposure-protection were identified. Overall, the majority of parents reported fair sun protection behaviours. While a low level of protection behaviour was not strongly reflected in lower sunburn rates among the classes, a high level of planned exposure (e.g. going to the beach) seemed to correspond with higher sunburn risk. Parents of younger children and those with more sensitive skin reported sun protection measures more frequently. Older children and those with more sensitive skin experienced more sunburn. This study contributes to current insight into children's sunburn, based on parent-proxy reports. Although a clear differentiation in sunburn risk was not found, several variables, relevant for future interventions, were indicated. By further understanding the complexity of children's sunburn, further research may be directed accordingly.
... Further, although validation studies show fair to strong correlations between self-reported and observed exposure (82,86,87), collecting objective data about children's UVR-exposure has been strongly advocated (88). Environmental effects such as shade coverage, altitude or humidity cannot be measured in self-reported questionnaires (89). Because detailed information on actual received UVR-dosage is lacking among children, the formulation of specific policy and guidelines, weighted for specific environmental characteristics (e.g. ...
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To provide directions for targeted interventions, a better understanding of children’s sunburn and associated parental behaviours is necessary. We conducted Latent Class Analyses (LCA) to identify subgroups of parents in terms of children's sunburn, sun exposure and parental sun protection behaviours. Although a clear differentiation in sunburn risk was not found, several groups relevant for future interventions were indicated. Moreover, by revealing the complexity of children’s sunburn, suggestions for further research are provided.
... De hecho, son los métodos más utilizados y a los que más se hace referencia en la bibliografía existente. Los cuestionarios han demostrado su validez para medir la conducta fotoprotectora 16 y la exposición solar en períodos previos de varias semanas 17 . Los investigadores del estudio Helios 18 establecieron la fiabilidad del cuestionario utilizado en el estudio para medir las quemaduras solares en la infancia, la exposición solar a lo largo de la vida y el color de los ojos y el pelo. ...
... Vitamin K content of individual foods was determined from the manufacturer food label, where available, and/or using the USDA database. Assessment of physical activity (Adolescent Physical Recall Questionnaire and FELS Questionnaire for children aged 6-12 years) and sunlight exposure was determined using validated questionnaires at diagnosis and after 1 year (Crocker et al., 1997;Termorshuizen et al., 2002;Treuth et al., 2005). ...
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... The exposure ratio has most often been determined using a mannequin to estimate the anatomical distribution of UV (79,83,115); however, few studies have validated this technique for extrapolation to active children and adolescents. Termorshuizen et al. (59) used a model to estimate exposure for 1year-old children for a 6 week period. Questionnaire data recording self-reported time spent outdoors were adjusted for latitude and season, weighted for reported clothing use, weather conditions and ambient UV data derived from a UV transfer model and used to estimate personal exposure. ...
Article
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