Costs of illness for melanoma and nonmelanoma skin cancer in Denmark.

Incidences of melanoma and nonmelanoma skin cancer are high and increasing in many countries including Denmark. The diseases are highly preventable. We have estimated the healthcare costs of these cancers by comparing costs for cohorts of patients and matched controls in a national register-based study in Denmark. All incident patients with a diagnosis of melanoma, basal cell carcinoma, or squamous cell carcinoma in the period 2004-2008 were included. Four control individuals for each case were matched in terms of sex, age, and area of residence. Healthcare costs and productivity loss for patients and controls were estimated using Danish health and social registries 3 years before and 3 years after diagnosis. The healthcare costs of melanoma and nonmelanoma skin cancer were &OV0556;33.3 million in the 3-year period after diagnosis, with male patients inducing the highest costs for all three cancers and costs increasing with age. The diagnoses of basal cell carcinoma and melanoma had almost the same healthcare costs, but per patient average healthcare costs were higher for melanoma. The costs of melanoma and nonmelanoma skin cancers, which can be prevented by sensible sun habits, exceed the costs of the preventive measures of the Danish SunSmart campaign manifold. Costs of melanoma and nonmelanoma skin cancer are expected to increase in the future with populations aging in the western world. The analyses provide a strong argument for the societal rationale of skin cancer prevention in Denmark.

Sunburn in children and adolescents: associations with parents' behaviour and attitudes.

AIMS: Sunburn in childhood is a known risk factor for melanoma and non-melanoma skin cancer. Based on a theoretical model, we tested the hypothesis that parental attitudes and behaviour are related to the risk of sunburn in their children. METHODS: We analysed the association between behaviour in the sun and attitudes related to tanning among Danish parents and their children's risk for sunburn by logistic regression. Gender, educational level, and skin type of the responding parent were included as confounders and analyses were stratified for child age. RESULTS: In children aged 7-12 and 13-17 years, the risk of sunburn increased when parents had experienced sunburn themselves, and also for 13-17 year olds if parents had a very positive attitude towards tanned skin. We found no association between parental attitudes and behaviour and the risk of sunburn in children aged 0-6 years. CONCLUSIONS: Interventions to influence the attitudes and behaviour of parents could reduce their children's risk for excessive sun exposure and thereby their risk for melanoma and non-melanoma skin cancer. The results encourage preventive campaigns to focus on changing parental attitudes towards tanned skin and sun behaviour.

Parent training interventions for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years.

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterised by high levels of inattention, hyperactivity and impulsivity that are present before the age of seven years, seen in a range of situations, inconsistent with the child's developmental level and causing social or academic impairment. Parent training programmes are psychosocial interventions aimed at training parents in techniques to enable them to manage their children's challenging behaviour. OBJECTIVES: To determine whether parent training interventions are effective in reducing ADHD symptoms and associated problems in children aged between five and eigtheen years with a diagnosis of ADHD, compared to controls with no parent training intervention. SEARCH METHODS: We searched the following electronic databases (for all available years until September 2010): CENTRAL (2010, Issue 3), MEDLINE (1950 to 10 September 2010), EMBASE (1980 to 2010 Week 36), CINAHL (1937 to 13 September 2010), PsycINFO (1806 to September Week 1 2010), Dissertation Abstracts International (14 September 2010) and the metaRegister of Controlled Trials (14 September 2010). We contacted experts in the field to ask for details of unpublished or ongoing research. SELECTION CRITERIA: Randomised (including quasi-randomised) studies comparing parent training with no treatment, a waiting list or treatment as usual (adjunctive or otherwise). We included studies if ADHD was the main focus of the trial and participants were over five years old and had a clinical diagnosis of ADHD or hyperkinetic disorder that was made by a specialist using the operationalised diagnostic criteria of the DSM-III/DSM-IV or ICD-10. We only included trials that reported at least one child outcome. DATA COLLECTION AND ANALYSIS: Four authors were involved in screening abstracts and at least 2 authors looked independently at each one. We reviewed a total of 12,691 studies and assessed five as eligible for inclusion. We extracted data and assessed the risk of bias in the five included trials. Opportunities for meta-analysis were limited and most data that we have reported are based on single studies. MAIN RESULTS: We found five studies including 284 participants that met the inclusion criteria, all of which compared parent training with de facto treatment as usual (TAU). One study included a nondirective parent support group as a second control arm.  Four studies targeted children's behaviour problems and one assessed changes in parenting skills. Of the four studies targeting children's behaviour, two focused on behaviour at home and two focused on behaviour at school. The two studies focusing on behaviour at home had different findings: one found no difference between parent training and treatment as usual, whilst the other reported statistically significant results for parent training versus control. The two studies of behaviour at school also had different findings: one study found no difference between groups, whilst the other reported positive results for parent training when ADHD was not comorbid with oppositional defiant disorder. In this latter study, outcomes were better for girls and for children on medication.We assessed the risk of bias in most of the studies as unclear at best and often as high. Information on randomisation and allocation concealment did not appear in any study report. Inevitably, blinding of participants or personnel was impossible for this intervention; likewise, blinding of outcome assessors (who were most often the parents who had delivered the intervention) was impossible.We were only able to conduct meta-analysis for two outcomes: child 'externalising' behaviour (a measure of rulebreaking, oppositional behaviour or aggression) and child 'internalising' behaviour (for example, withdrawal and anxiety). Meta-analysis of three studies (n = 190) providing data on externalising behaviour produced results that fell short of statistical significance (SMD -0.32; 95% CI -0.83 to 0.18, I(2) = 60%). A meta-analysis of two studies (n = 142) for internalising behaviour gave significant results in the parent training groups (SMD -0.48; 95% CI -0.84 to -0.13, I(2) = 9%). Data from a third study likely to have contributed to this outcome were missing, and we have some concerns about selective outcome reporting bias.Individual study results for child behaviour outcomes were mixed. Positive results on an inventory of child behaviour problems were reported for one small study (n = 24) with the caveat that results were only positive when parent training was delivered to individuals and not groups. In another study (n = 62), positive effects (once results were adjusted for demographic and baseline data) were reported for the intervention group on a social skills measure.The study (n = 48) that assessed parenting skill changes compared parent training with a nondirective parent support group. Statistically significant improvements were reported for the parent training group. Two studies (n = 142) provided data on parent stress indices that were suitable for combining in a meta-analysis. The results were significant for the 'child' domain (MD -10.52; 95% CI -20.55 to -0.48) but not the 'parent' domain (MD -7.54; 95% CI -24.38 to 9.30). Results for this outcome from a small study (n = 24) suggested a long-term benefit for mothers who received the intervention at an individual level; in contrast, fathers benefited from short-term group treatment. A fourth study reported change data for within group measures of parental stress and found significant benefits in only one of the two active parent training group arms (P ≤ 0.01).No study reported data for academic achievement, adverse events or parental understanding of ADHD. AUTHORS' CONCLUSIONS: Parent training may have a positive effect on the behaviour of children with ADHD. It may also reduce parental stress and enhance parental confidence. However, the poor methodological quality of the included studies increases the risk of bias in the results. Data concerning ADHD-specific behaviour are ambiguous. For many important outcomes, including school achievement and adverse effects, data are lacking.Evidence from this review is not strong enough to form a basis for clinical practice guidelines. Future research should ensure better reporting of the study procedures and results.

Influential factors for sun policy implementation in Danish kindergartens.

BACKGROUND: In 2007, the Danish Cancer Society and the Tryg Fonden launched a campaign to prevent skin cancer and melanoma. As a part of this intervention programme, the Danish Cancer Society prepared a ''sun policy'', which recommends how children in Danish kindergartens can be protected from the sun. AIMS: The aim of this study was to determine the factors that influence a decision to implement the sun policy in Danish kindergartens. METHODS: We conducted a comparative qualitative study. Data were collected at semi-structured interviews with the principals of five kindergartens with a sun policy and five without. RESULTS: The key factor in making a decision is the priority given to the sun policy by the principal, which in turn depends on the principal's perception of his or her resources. Further factors are the principal's attitude toward parental responsibility and media focus on sun protection. CONCLUSIONS: Principals must be convinced of the importance of a written sun policy. A mailed reminder containing arguments about its importance to accompany the draft sun policy might reinforce the formulation and implementation of sun policies nationwide.

Vacations to sunny destinations, sunburn, and intention to tan: a cross-sectional study in Denmark, 2007-2009.

BACKGROUND: Denmark has experienced an increase in melanoma incidence since the 1960s. Exposure to ultraviolet radiation is the main preventable cause of this cancer. We examined current travel to, and sun-related behaviour of Danes at, sunny destinations in relation to their risk for sunburn. METHOD: A population-based sample of 11,158 respondents aged 15-59 years completed three questionnaires in 2007-2009 that included items on exposure to ultraviolet radiation. Using logistic regression analysis we examined the relations between sunny vacations, sun-related behaviour, demographic factors and risk for sunburn. RESULTS: During 2007-2009, 44.8-45.8% of the respondents travelled to a sunny destination at least once a year; 24% became sunburnt, and 69% tanned intentionally. The odds ratio for sunburn in general for people who went on a sunny vacation as compared with those who did not was 1.6 (1.5-1.7). Sunscreen use (1.9; 1.4-2.6) and intentional tanning (3.4; 2.8-4.1) were positively associated with sunburn on vacation. CONCLUSIONS: Taking a vacation in a sunny place is a risk factor for sunburn, especially for young people. The recommendation for sunscreen use should be re-evaluated, as intention to tan is the most important factor in sunburn on vacation and should be targeted more strategically.

Prevalence of sunburn and sun-related behaviour in the Danish population: a cross-sectional study.

BACKGROUND: In Denmark, the incidence of melanoma has been increasing since the 1960s. Intermittent exposure to ultraviolet radiation and a history of sunburn and sunbed use are known risk factors. We describe the association between use of protective measures, sun-related behaviour and experience of sunburn in the Danish population three months after the start of the campaign. METHOD: A population-based sample of 3,499 persons aged 15-59 years completed a questionnaire that included items on exposure to ultraviolet radiation. We examined the relations between sunburn and sun-related behaviour by logistic regression analysis. RESULTS: Within the previous 12 months, 35% of the study population had experienced sunburn. Sunburn became less frequent with age (odds ratio (OR) 4.44; 15-19 vs. 50-59) and skin type (OR 2.57; I vs. III). Sunburn was negatively associated with shade and clothing and positively with use of sunscreens. We found no significant difference in sunscreen use between intentional tanners who experienced sunburn and those who did not. A larger fraction of unintentional tanners with sunburn than those who were not sunburnt had used sunscreen. Sunscreen was used to prolong the time spent in the sun by 66% of sunburnt people; however, we found no association between duration of sun exposure and sunscreen use. CONCLUSIONS: Future campaigns to reduce the prevalence of sunburn in the Danish population must especially target young persons and intentional tanning, and they should emphasize that sunscreen cannot be used to extend the time spent in the sun and that shade and clothing provide the best protection against sunburn.

Sunbed use in the Danish population in 2007: a cross-sectional study.

BACKGROUND: In Denmark, the incidence of all types of skin cancer, including malignant melanoma, has been increasing since the 1960s. Exposure to ultraviolet (UV) radiation is the main preventable cause of skin cancer. We describe current sunbed use in the Danish population. METHODS: A population-based sample of 3437 persons aged 15-59 years completed a questionnaire that included items on artificial and natural exposure to UV. We examined relations between sunbed use, outdoor tanning, knowledge about associated health risks and demographic factors with logistic regression analysis. RESULTS: Within the past 12 months, 29% of all Danes aged 15-59 had used a sunbed, including 59% females aged 15-19, even though knowledge about the relation between exposure to UV and cancer was more frequent in this group. A larger proportion of persons aged 15-18 had first used a sunbed before the age of 14 than older groups. Single males, frequent outdoor sunbathers, persons who experienced sunburns and less educated persons were more likely to use sunbeds. CONCLUSIONS: Future campaigns to reduce the Danes sunbed use should target initiation by young people and the high prevalence among them. The results suggest a legislative solution, with a minimum age of 18 years for indoor tanning.

Parent training interventions for attention deficit hyperactivity disorder.

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine whether parent-training interventions are effective in reducing ADHD symptoms and associated problems (e.g. disruptive behaviour disorders or child-specific impairments such as learning difficulties) in children and young people aged 5-18 with ADHD, compared to controls with no parent-training interventions.