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SUN PROTECTION: AN EDUCATIONAL PROGRAM IN SCHOOL-AGE CHILDREN

SUN PROTECTION: AN EDUCATIONAL PROGRAM IN SCHOOL-AGE CHILDREN. Maria Cecilia Cercato, MD “Department of Epidemiology” Pier Giorgio Natali, MD “Molecular Pathology”. “Regina Elena” National Cancer Institute ROME - ITALY. Splitz, March 2008. Cutaneous Melanoma.

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SUN PROTECTION: AN EDUCATIONAL PROGRAM IN SCHOOL-AGE CHILDREN

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  1. SUN PROTECTION: AN EDUCATIONAL PROGRAM IN SCHOOL-AGE CHILDREN Maria Cecilia Cercato, MD“Department of Epidemiology” Pier Giorgio Natali, MD“Molecular Pathology” “Regina Elena” National Cancer Institute ROME - ITALY Splitz, March 2008

  2. Cutaneous Melanoma • Incidence rates are increasing in most countries (3-7% yearly in fair-skinned populations) • Genetic alterations and enviromental stresses are key players in its development • Highly aggressive with propensity to early metastatization and resistant to current therapies • Educational programs designed to improve the early detection have led to an increasing proportion of thin melanoma at diagnosis resulting in improved outcomes

  3. MELANOMA RISK FACTORS CONSTITUTIVE-HEREDITARY ENVIROMENTAL • Acute sun light exposure particularly in childhood • Skin colour • Number of naevi in fair-skinned individual • Tendency to freckles • Propensity to tan • Family history (p14 INK, Braf …) A: UV at 3.5 days and 6 wks B: UV at 6 wks C: UV at 3.5 days (erythemogenic) D: no UV

  4. STRATEGY PREVENTION: PRIMARY= reduction of exposure to risk factors POPULATION: CHILDREN= aged between 2 and 14 years TOOL: PUBLIC HEALTH PROGRAM= personal reccomandation campaign based on selected risk profiles assessed by questionnaire

  5. QUESTIONNAIRE ON SUN SENSITIVITY FACTORS AND PROTECTION PRACTICES 1. What colour are your eyes?○ CHESTNUT ○ BLACK ○ BLUE or GREEN 2. What colour is your hair?○ RED ○ FAIR/LIGHT BROWN ○ DARK BROWN/BLACK 3. What colour is your complexion?○ FAIR ○ MEDIUM ○ SWARTHY 4. Count the number of “moles or nevi” you have on your left arm○ NONE ○ 0-5 ○ MORE THAN 5 5. Do you have you freckles?○ YES ○ NO 6. Do you easily get sunburnt?○ YES ○ NO 7. Have you already had sunburns?○ YES ○ NO 8. When you stay too long in the sun, do watery blisters appear on your face and body?○ YES ○ NO 9. Are you suntanned at the end of your holiday?○ YES ○ NO 10. Do you put on a protective body and face cream before you go out in the sun?○ YES ○ NO 11.When you are out in the sun you wear:a T-shirt ○ YES ○ NO a hat or a cap ○ YES ○ NO sunglasses ○ YES ○ NO

  6. Univ ersité du Sud Faculté de Médecine de Sfax Le Doyen ENFANTS: 3.625 National Centre of Hygiene Medical Ecology and Nutrition Russian Academy of Medical Sciences CHILDREN: 2.210 The T omsk Cancer Research Institute CHILDREN: 300 STUDY NETWORK ITALY SPAIN Ajuntament de Granollers Servei de Salut Pùblica Fundacion Istituto Valenciano de Oncologia Seven Regions NIÑOS : 7.120 BAMBINI: 161.504 BELGIUM TUNISIA Centre Hospitalier Universitaire du Sart Tilmar Service de Dermatophatologie de Liège ENFANTS: 5.430 RUSSIA BULGARY HUNGARY Dept. Public Health Univ. Pécs Humgary CHILDREN: 2.365

  7. CLASSIFICATION OF "FOTOR"ITEM FOTOR+ Skin Eyes Hair fair blue/green red-fair/light brown fair blue/green other fair other red-fair/light brown FOTOR- Skin Eyes Hair all the other combinations

  8. DISTRIBUTION OF FOTOR AMONG CHILDREN IN SELECTED EUROPEAN AREAS ITALY SPAIN 33% 28% 72% 67% FOTOR+ = 1174 FOTOR- = 2975 FOTOR+ = 7775 FOTOR- = 15549 BULGARY BELGIUM 44% 40% 56% 60% FOTOR+ = 983 FOTOR- = 1228 FOTOR+ = 2112 FOTOR- = 3132

  9. SPAIN 5% 95% YES = 3957 N0 = 210 BELGIUM BULGARY 16% 47% 53% 84% YES = 4359 N0 = 847 YES = 1035 N0 =1176 USE OF SUNSCREENS AMONG CHILDREN IN SELECTED EUROPEAN AREAS ITALY 8% 92% YES = 21523 NO = 1942

  10. SPAIN 4% 96% YES=157 NO=157 BELGIUM 11% 89% YES = 566 NO = 4606 BLISTERS FREQUENCY AMONG CHILDREN IN SELECTED EUROPEAN AREAS ITALY 8% 92% YES = 1783 NO = 21546 BULGARY 13% 87% YES = 281 NO = 1930

  11. CONCLUSIONS According to the distribution of three main phenotyic features (skin, eyes, hair), the questionaire could classify the study population in two risk levels: FOTOR+ (fair complexion subjects) and FOTOR- (all the other subjects). Risk factors (high number of moles, freackles, etc.) segregated in FOTOR+ group. Through this simple and low-cost educational program individuals of the study population could be given sun protection ad hoc advices

  12. M.C. Cercato, E. Nagore, V. Ramazzotti, C. Guillén, I. Terrenato,J. Villena, M. Lomuscio, P.G. Natali, and H.J. SchünemannPreventive Medicine, in press SELF AND PARENT-ASSESSED SKIN CANCER RISKFACTORS IN SCHOOL-AGE CHILDREN

  13. PILOT STUDYSUN PROTECTION AND SCHOOL-AGE CHILDREN:IMPROVING PARENTS’ KNOWLEDGE AND BEHAVIOUR Principal Investigator: Maria Cecilia Cercato, MD “Department of Epidemiology” Italian National Cancer Institute “Regina Elena”, Rome, ITALY. (cercato@ifo.it ) Co-Investigator: Eduardo Nagore, MD “Department of Dermatology” Fundación Istituto Valenciano de Oncología, Valencia, SPAIN.

  14. PILOT STUDYSUN PROTECTION AND SCHOOL-AGE CHILDREN: IMPROVING PARENTS’ KNOWLEDGE AND BEHAVIOUR OBJECTIVE: a) To improve knowledge, attitude and sun protection behaviours in parents of primary school children; b) To evaluate the effectiveness of the health educational program; c) To identify determinants which influence parental behaviour in sun protection practices METHOD Study duration: May- October 2008. Population: 100 parents of children attending primary schools in Valencia, Spain. Pre-intervention questionnaire: will assess pre-intervention parents’ knowledge of the risks related to sun exposure, their attitude and behaviour towards sun protection practices. Educational programme: dermatologists will inform the parents using “ad hoc” training aids (slides, videos, booklets, etc…). Written recommendations to be adopted during children sun exposure will be also provided. Post-intervention questionnaire: (after summer holidays)will assess the effectiveness of the intervention in terms of improvement of parents’ knowledge, attitude and sun protection behaviour.

  15. Development of the project and future directions • From the pilot study, an educational sun protection programme suitable for selected populations could be defined to be adopted in Spanish primary schools. • In cooperation with dermatologists the educational programme will be tested in different populations to optimize its effectiveness by taking into account environmental, phenotypical, socio-educational and cultural factors. • Future efforts could be made in exploring children’s perceptions, attitude and knowledge about the risks related to sun overexposure in order to develop successfull sun protection messages.

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