Cyberbullying is an emerging problem among youngsters. Although the current body of knowledge about cyberbullying is expanding rapidly, it lacks a more in-depth research approach honoring adolescents' perspectives on the problem. Moreover, very few studies have focused on cyberbullying among elementary school children. The purpose of this study therefore, was to explore children's perspectives on the problem of cyberbullying. A participatory research design was used in which 28 children (aged 11-12 from four elementary schools) actively participated for 6 weeks in weekly scheduled group sessions. In these sessions, different aspects of cyberbullying were discussed using various enabling techniques. Between sessions, the children were given preparation assignments. The research revealed several ambiguities that should be addressed in interventions against cyberbullying. First, it appears difficult for all parties involved to distinguish cyberbullying from innocent pranks. Frequency and intention are key variables, but these are ambiguous in the context of cyberbullying. Second, cyberbullies may have very different motives, not all of which have to do with their relationship with the victim. Third, the expectations children have of the way their parents or teachers will react to incidents of cyberbullying are an obstacle for seeking help. Children are particularly afraid of overreaction and the subsequent loss of their Internet privileges. These results confirm earlier insights from research on cyberbullying, and examine the ambiguities in more detail. In addition, the research demonstrates the usefulness of participatory research to investigate cyberbullying among younger children and demonstrates that the research led to mutual learning.

Positive feedback letters are more often copied and shared integrally with personnel, compared with negative letters. Compliance with respect to underage alcohol sales can be improved, although compliance levels remain low in the Netherlands.

Purpose The purpose of the study was to identify the earliest time point where subjects realized the greatest clinical improvement after TKA, and the time when post-operative scores became superior to pre-operative scores. Post-hoc exploratory analyses were conducted to investigate predictors of early post-operative outcomes and patient satisfaction. Methods Six investigators across 4 sites in the Netherlands prospectively implanted 200 subjects with a contemporary cemented rotating platform device. Patient Reported Outcome Measurements (PROMs) KOOS-PS, PKIP, and EQ-5D were collected pre-operatively and post-operatively through 2-years. PROMs change from pre-operative baseline were summarized, along with radiographic outcomes and adverse events (AEs). Pre-operative patient characteristics were explored for correlation with patient outcomes, and patient satisfaction for correlation with KOOS-PS. Results Follow-up compliance was 99% at 6-months, and 95.5% at 2-years. The percentage with higher KOOS-PS compared to baseline was 81.3% at 6-months. KOOS-PS, PKIP, and PKIP subscore means were all better at 6-weeks versus baseline. Gender, BMI, hypertension, and pre-operative KOOS-PS were weakly correlated with 6-week KOOS-PS (multivariate R-squared = 14.1%), but only pre-operative KOOS-PS demonstrated correlation with post-operative KOOS-PS at 6-months or later (R-squared < 5% at 6-months and 2 years). Satisfaction was moderately correlated with concurrent KOOS-PS at each post-operative time point, with (R-squared = 35.3% at 6-months, and 37.5% at 2 years). Conclusion The greatest mean clinical improvement occurred within the first 6-weeks. Although some pre-operative factors were correlated with higher early post-operative KOOS-PS outcomes, these advantages disappeared by 6-months aside from weak correlation with pre-operative KOOS-PS. Post-operative KOOS-PS was moderately correlated with concurrent post-operative satisfaction. These results may be used for pre-operative counseling and management of patient’s postoperative expectations. Trial registration Clinicaltrials.gov, NCT02339610. Registered 15 January 2015.

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