Search

Assessing the risk of bias (ROB) of studies is an important part of the conduct of systematic reviews and meta-analyses in clinical medicine. Among the many existing ROB tools, the Prediction Model Risk of Bias Assessment Tool (PROBAST) is a rather new instrument specifically designed to assess the ROB of prediction studies. In our study we analyzed the inter-rater reliability (IRR) of PROBAST and the effect of specialized training on the IRR. Six raters independently assessed the risk of bias (ROB) of all melanoma risk prediction studies published until 2021 (n = 42) using the PROBAST instrument. The raters evaluated the ROB of the first 20 studies without any guidance other than the published PROBAST literature. The remaining 22 studies were assessed after receiving customized training and guidance. Gwet’s AC1 was used as the primary measure to quantify the pairwise and multi-rater IRR. Depending on the PROBAST domain, results before training showed a slight to moderate IRR (multi-rater AC1 ranging from 0.071 to 0.535). After training, the multi-rater AC1 ranged from 0.294 to 0.780 with a significant improvement for the overall ROB rating and two of the four domains. The largest net gain was achieved in the overall ROB rating (difference in multi-rater AC1: 0.405, 95%-CI 0.149–0.630). In conclusion, without targeted guidance, the IRR of PROBAST is low, questioning its use as an appropriate ROB instrument for prediction studies. Intensive training and guidance manuals with context-specific decision rules are needed to correctly apply and interpret the PROBAST instrument and to ensure consistency of ROB ratings.

More than twenty-five years ago, the Global Solar UV index (UVI) was introduced as a simple means of visualizing the intensity of ultraviolet radiation and to alert people to the need for sun protection. In our survey, among directors of 436 kindergartens in southern Germany we investigated the level of awareness and knowledge about the UVI as well as the practical consequences for sun protection in kindergartens. Less than half of the directors (n = 208, 47.7%) had ever heard of the UVI, and only a small minority of them (n = 34, 8.7%) used the daily UVI information to adapt sun protective measures in their kindergartens. Detailed knowledge about the UVI was a rarity among the respondents. The proportion of respondents with self-perceived detailed UVI knowledge was five times higher than the actual knowledge assessed by an in-depth structured interview using open-ended questions about the UVI (14.2% vs. 2.8%). No clear relationship between UVI awareness, knowledge, and use and directors’ age and gender was found. The UVI-related variables also showed no association with directors’ knowledge of risk factors for skin cancer and their attitudes towards tanned skin. Overall, the results paint a sobering picture regarding the penetration of the UVI into sun protection policies of German kindergartens. Future public health campaigns should aim to increase the awareness and understanding of the UVI as well as its relevance for sun protection of children.

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.

SARS-CoV-2 infection fatality ratios (IFR) remain controversially discussed with implications for political measures, but the number of registered infections depends on testing strategies and deduced case fatality ratios (CFR) are poor proxies for IFR. The German county of Tirschenreuth suffered a severe SARS-CoV-2 outbreak in spring 2020 with particularly high CFR.To estimate seroprevalence, dark figure, and IFR for the Tirschenreuth population aged ≥14 years in June/July 2020 with misclassification error control, we conducted a population-based study, including home visits for elderly, and analyzed 4203 participants for SARS-CoV-2 antibodies via three antibody tests (64% of our random sample). Latent class analysis yielded 8.6% standardized county-wide seroprevalence, dark figure factor 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 dark figure was 12.2 in the young versus 1.7 for ≥85-year-old. Age-specific IFRs were 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.

(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.

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.

Die Vermittlung von Wissen zu Risikofaktoren sowie Schutzverhalten stellt eine wesentliche Grundlage der primaren Hautkrebspravention dar. Die tatsachlich von der Bevolkerung genutzten Informationskanale sind auf diesem Gebiet weitgehend unbekannt. Deskriptive Darstellung der einschlagigen Informationsquellen, die Eltern von 3‑ bis 6‑jahrigen Kindern als besonders relevante Zielgruppe nutzen, sowie Analyse von Zusammenhangen zwischen soziodemografischen Faktoren, Arten von Informationsquellen und dem Wissensstand. Querschnittsstudie mittels selbstausgefulltem Fragebogen mit Onlineoption von Oktober 2011 bis Februar 2012 mit 3129 Familien, deren Kind einen der teilnehmenden Kindergarten des Landkreises Erlangen-Hochstadt 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 praventivem Verhalten war zu verzeichnen. Daruber hinaus konnte eine negative Assoziation zwischen Nutzung des Internets und erworbenem Wissen festgestellt werden. Demgegenuber war die Nutzung von Printmedien sowie audiovisueller bzw. personlich vermittelter Information positiv mit Wissen assoziiert. Pravention sollte verstarkt auf Teile der Bevolkerung mit geringerer formaler Bildung zugeschnitten werden. Bei der Wissensvermittlung scheint derzeit dem Internet keine grose Bedeutung zuzukommen; die negative Assoziation zwischen Internetnutzung und Wissen ist moglicherweise auf verbreitete irrefuhrende Informationen zuruckzufuhren.

Substantial public health efforts have been undertaken throughout the last 25years 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.

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

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 network – covering all major climate areas in Germany – in 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 2h 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.

Measurement errors of medico-technical devices can be separated into systematic bias and random error. We propose a new method to address both simultaneously via generalized additive models for location, scale and shape (GAMLSS) in combination with permutation tests. More precisely, we extend a recently proposed boosting algorithm for GAMLSS to provide a test procedure to analyse potential device effects on the measurements. We carried out a large-scale simulation study to provide empirical evidence that our method is able to identify possible sources of systematic bias as well as random error under different conditions. Finally, we apply our approach to compare measurements of skin pigmentation from two different devices in an epidemiological study.

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.

Background 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. Methods 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. Results 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. Conclusions 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.

Summary Background No observed event is a special, but not uncommon, result in patch test studies. The interpretation of such findings depends critically on the sample size (n) of the investigation, and is statistically addressed by the use of confidence intervals (CIs). Objective To define the statistically correct method of calculating a CI with a confidence level of 1 − α, where α denotes the tolerated statistical error probability, for an observed prevalence of 0%. Methods A literature survey and evaluation of the statistical methods was conducted. The popular statistical software packages spss™ and sas™ were examined with regard to the methods implemented, and the results obtained, for estimating such CIs in this special case. Results The evaluation identified [0; 1 − α1/n], which is well approximated by [0; 3/n] for α = 0.05, as an appropriate method to compute a CI with a confidence level of 1 − α. The resulting CI is an exact one, and more efficient than standard solutions. Popular statistical software such as spss™ and sas™ offers only various inefficient or even invalid procedures, but does not include this method. Conclusions It is easy to calculate a CI for an observed prevalence of 0% obtained in some studies. Such a CI facilitates the interpretation of such a finding, as it puts the observed zero result into adequate statistical perspective.

Summary Background Reducing exposure to ultraviolet (UV) radiation is the main effective measure for preventing skin cancer. Educational campaigns targeting sun protection have been focused either on behaviour on the beach during the summer holiday alone, or during everyday outdoor activities of the children. Little is known about the comparison between these different settings. Objectives To analyse whether parents apply similar protective measures to reduce UV exposure for their young children in different outdoor environments. Methods Families (n = 2619) with children aged 3–6 years (response: 64·7%) were enrolled in a population-based survey in the German city of Erlangen and its surrounding rural county. Using a self-administered standardized questionnaire parents gave information about demographic and photosensitivity data of their children, their knowledge about risk factors for skin cancer and their typical instructions given to their children when these played outside on a summer day in different outdoor environments. Results Significant discrepancies regarding the four UV protective measures (clothes, shade, sunhat, sunscreen) for children between an everyday outdoor setting and a holiday setting on the beach were observed. A high level of parental risk factor knowledge was significantly associated with a better protection for children in all four measures only on the beach. Photosensitivity and demographic characteristics had some impact on protective behaviour, too. Measures of sun protection were reduced with children’s increasing age. Conclusions Skin cancer prevention campaigns should target the encouragement of sun protection for children also in outdoor activities of daily living, not only during a summer holiday on the beach.

Background: Exposure to ultraviolet (UV) radiation is the most important modifiable risk factor for skin cancer. Parents are responsible for sun protection of their young children and thus their knowledge and attitudes should be assessed. Methods: A survey that included 2619 children aged 3–6 years (response: 64.7%) was performed in Erlangen during 2001/2002. Parents' attitude, knowledge and behavior regarding sun protection were ascertained by using a self-administered questionnaire. Demographic and photosensitivity data of the children were recorded, along with the UV radiation-related outcomes. Results: Most parents correctly recognized the risk factors of skin cancer, except the intermittent and intensive sun exposure. Nevertheless, most parents also agreed with statements regarding sun- and tanning related beauty and well-being. The overwhelming majority of parents stressed the necessity of sun protection for their children; however, 50% of the children experienced some form of solar radiation injury during the preceding summer. Children eagerly pursued outdoor activities, especially boys compared with girls (P

Purpose To analyse the association between occupation (represented by job title) and contact allergy to thiuram vulcanising agents based on data of a clinical registry (IVDK, www.ivdk.org). Methods Clinical, demographic and allergy patch test data of all patients tested between 1992 and 2006 with the thiuram mix (1% in petrolatum) as part of the baseline series was analysed (n = 121,051). Poisson regression analysis was used to quantify the association between different occupations (and other relevant factors) and a positive patch test reaction to the thiuram mix. Furthermore, the time trend of sensitisation prevalence was analysed in high-risk occupational subgroups identified. Results In comparison to a largely unexposed reference group (office workers and teachers), rubber manufacturers had a significantly elevated risk (prevalence ratio (PR): 5.1, 95% confidence interval (CI) 2.0–10.5). However, health care workers such as physicians and dentists (PR: 3.8, 95% CI: 3.0–4.8) or nursing staff (PR: 3.0, 95% CI: 2.5–3.6) as well as meat and fish processors (PR 3.5, 95% CI: 2.2–5.3) and cleaners (PR 3.1, 95% CI: 2.5–3.8) were found to have a high sensitisation risk as well. In case of health care workers, a significant downward trend during the study period was observed; while in food processors and cleaners, sensitisation prevalence remained largely stable. Conclusion The adjusted multifactorial analysis identified occupations yet unknown to be associated with elevated thiuram contact allergy risk, e.g., food processors and cleaners. Thus, (i) further in-depth research can be targeted and (ii) efforts to prevent sensitisation to thiurams focussed, e.g., by limiting thiuram concentrations in products to a residual level which is technically inevitable.

Boosting is one of the most important methods for fitting regression models and building prediction rules. A notable feature of boosting is that the technique can be modified such that it includes a built-in mechanism for shrinking coefficient estimates and variable selection. This regularization mechanism makes boosting a suitable method for analyzing data characterized by small sample sizes and large numbers of predictors. We extend the existing methodology by developing a boosting method for prediction functions with multiple components. Such multidimensional functions occur in many types of statistical models, for example in count data models and in models involving outcome variables with a mixture distribution. As will be demonstrated, the new algorithm is suitable for both the estimation of the prediction function and regularization of the estimates. In addition, nuisance parameters can be estimated simultaneously with the prediction function.

Summary Background We recently found a very low adherence to a generally recommended skin protection regimen in a sample of 1355 metalworkers. Objectives The present study assessed the effectiveness of skin protection as presently recommended, especially the differential contribution of skin care and skin protection, to the prevention of occupational hand eczema. Methods Of 1355 metalworkers screened, 1020 male volunteers, all fit for work, were recruited for a prospective intervention study with four arms (skin care, skin protection, both combined, and control group, i.e. no recommendation). The study was performed from winter 2006/2007 to spring 2008, following each subject for up for 12 months. Both hands were examined using a quantitative skin score, and a standardized personal interview was performed three times. The change of the objective skin score from baseline to 12 months was used as primary outcome measure. Results After 12 months 800 subjects were included (78·4% of those recruited). The compliance to follow the randomized measure depended on the recommended measure and ranged from 73·7% to 88·7%. While in the control group a significant deterioration was found, the largest and significant improvement was noted in the group following the generally recommended skin protection programme (skin care + skin protection) followed by skin protection alone as second best. Conclusions The generally recommended skin protection regimen seems to provide effective prevention of occupational skin disease. Therefore, the compliance to follow the skin protection regimen, especially the use of skin protection, should be enhanced.

Summary Background Patch test (PT) guidelines recommend classifying PT reactions based on morphological criteria only, i.e. irrespective of context information such as substance, concentration and vehicle. Objectives To analyse reclassification of PT reactions after revelation of context information subsequent to an initial blinded reading. Methods One hundred and twenty-two participants (experienced dermatologists and researchers) rated 20 digital images of different PT reactions twice, first blinded, then unblinded regarding substance, concentration and vehicle. Agreement between both ratings was quantified with Cohen’s kappa, and systematic differences statistically examined with tests for marginal homogeneity. Results Mostly, ratings remained stable, e.g. in > 90% of cases of images showing typical strong or extreme positive PT reactions. Reclassification was comparatively often observed in images depicting irritant reactions. Conversely, 16 of 122 participants re-rated doubtful reactions to thiuram mix and dichromate, respectively, as ‘allergic’ (weak or strong positive) after knowing the substance. Conclusions The considerable proportion of participants who choose an ‘allergic’ rating, despite a morphological presentation definitely not justifying this, points to a conceptual problem of the PT reading scale: the mixing up of morphological classification and interpretation. We therefore suggest amending the scale. Moreover, standardization of PT reading can be improved by continual PT training sessions.

A higher mortality risk for women with acute ST-elevation myocardial infarction (STEMI) has been a common finding in the past, even after acute percutaneous coronary intervention (PCI). We set out to analyze whether there are gender differences in real-world contemporary treatment and outcomes of STEMI.A retrospective analysis of all consecutive patients with STEMI and acute coronary angiography with the intention of performing a PCI at our center 6/1999-6/2006 was carried out (n = 566). Data were examined for gender-specific differences regarding patients' characteristics, referral patterns, timing of acute symptoms, angiographic findings, procedural details, and adverse events at 30 days after PCI.Women (n = 161) were on average 8 years older than men (n = 405), had higher co-morbidity, were more often transported to the hospital by ambulance and presented less often to the emergency room on their own (4.2% vs. 12.6% in men, P = 0.02). The pre-hospital delay from symptom onset to admission was significantly longer for women (median 185 vs. 135 min, P0.02). There was no gender difference in time from admission to PCI (median 46 min vs. 48 min, P = 0.42). Both genders received PCI with similar frequency (88.8% vs. 92.4%, P = 0.19), with similar success rates (83.2% vs. 85.3%, P = 0.68). Thirty-day overall mortality for women was not significantly higher than for men (8.7% vs. 7.2%, P = 0.6). Re-infarction or stroke within 30 days were rare for both genders without gender-specific differences whereas bleeding necessitating blood replacement was significantly more frequent in women (16.8% vs. 5.9%, P0.001). In multivariate analysis, female gender was not independently associated with a higher risk of 30-day mortality (OR 0.964, P = 0.93).Women underwent PCI therapy for STEMI with the same frequency and the same angiographic success as men. Despite their more advanced age and the higher prevalence of co-morbidities, they did not have a significantly higher 30-day mortality rate than men. Female gender was not an independent risk factor of 30-day mortality. Longer pre-hospital delays before hospital admission in women indicate that awareness of risk from coronary artery disease should be further raised in women.

BACKGROUND: Contact allergies (CA) against active agents of topical ophthalmological therapeutics, causing inflammation of the conjunctiva and/or the lid, are usually not life-threatening, but occur not infrequently. As yet, the assessment of the CA-eliciting risk has been based on clinical data alone, while a valid epidemiological risk assessment is lacking. MATERIALS AND METHODS: The Information Network of Departments of Dermatology supplied information on diagnostic results obtained in 4,102 patients patch-tested for suspected CA to ophthalmic drugs between 1995 and 2004. Clinical prevalences were extrapolated to incidences at the German population level. These estimates served as numerator for a relative incidence (RI), which included the nationwide frequency of prescriptions collected by the WIdO, Bonn, in terms of a standardised defined daily dose (DDD) as denominator. RESULTS: The estimated annual incidence of CA ranges from 155 (atropine sulphate) to 2077 (gentamicin sulphate) and can thus be regarded as moderate. If incidence estimates are related to prescription frequencies, the highest risk was found for kanamycin and neomycin sulphate (RI > 8 / 100,000 DDD). In contrast, the RI of pilocarpine-HCl (0.3) was virtually negligible. CONCLUSIONS: The substance-specific risk of CA has been evaluated for the first time and found to differ between therapeutics (with a similar spectrum of application). CA risk should be considered in differential therapeutic decision-making.

Summary Background: Contact allergy (CA) to topical corticosteroids (CS) is relatively rare; however, current data from Germany are not available. Furthermore, valid risk assessment needs to take into account of the actual exposure to CS in the population. Patients and Methods: The reaction profile of 9 CS included in a “CS test battery” of the German Contact Dermatitis Research Group (DKG) in patients seen in German clinics belonging to the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org) between 01/1995 and 12/2004 was analyzed. Applying the “Clinical Epidemiology/Drug Utilization Research” approach, annual incidences of CA to CS in Germany were extrapolated. These estimates were used as numerator for a relative incidence (RI) estimate which used exposure in terms of “defined daily doses” (DDD) to the respective CS as denominator, the latter information collected by the AOK Research Institute (WIdO). Results: On average, 7.4% of all patients were patch tested with the CS series, mostly yielding < 1% positive reactions. Exceptions included hydrocortisone 17-butyrate (1.5%), amcinonide (1.6%) and budesonide (2.6%). With a RI of 10.7, 23.6 and 4.9 per 100 000 DDD, respectively, the three CS mentioned classify as moderate topical drug allergens. Clobetasol 17-propionate and triamcinolone acetonide both yielded a RI of 1.4/100 000 DDD, indicating low sensitization risk. For hydrocortisone, betamethasone, prednisolone and dexamethasone (RI < 1/100 000 DDD) the risk of sensitization appears minute. Conclusions: The results support and extend previous evidence on the CA risk of CS, adding to a therapeutic index and risk assessment.

To analyse the association between occupational ultraviolet (UV) light exposure and skin cancer (basal cell carcinoma, BCC; squamous cell carcinoma, SCC; cutaneous malignant melanoma, CMM) based on data from the Bavarian population-based cancer registry. The population-based cancer registry of Bavaria (Germany) provided data on incident cases of BCC, SCC, and CMM, respectively, during the period 2001 until 2005. Eleven Bavarian districts with complete skin cancer registration were included in this analysis based on 2,156,336 person years. Cases were assigned to “indoor”, “mixed indoor/outdoor”, and “outdoor” exposure categories according to their job title. We computed age-specific and age-adjusted incidence rates of BCC (n = 1,641), SCC (n = 499), and CMM (n = 454) by work type, and the relative risk (RR) of skin cancer occurrence for “outdoor” and “mixed indoor/outdoor” workers, respectively, compared to “indoor” workers. The risk of BCC was substantially elevated in male (RR, 2.9; 95% CI, 2.2–3.9) and female (RR, 2.7; 95% CI, 1.8–4.1) outdoor workers compared to male and female indoor workers, respectively. We also found an elevated risk of similar magnitude for SCC in male (RR, 2.5; 95% CI, 1.4–4.7) and female (RR, 3.6; 95% CI, 1.6–8.1) outdoor workers compared to male and female indoor workers, respectively. CMM risk was not significantly associated with outdoor work. Our study confirms previous reports on the increased risk of BCC and SCC in outdoor workers compared to indoor workers.

Summary Background Fluctuating irritability of the skin induced by low ambient temperature and humidity may compromise the reproducibility of patch testing. Objectives To assess the impact of temperature and absolute humidity at the time of patch testing on the occurrence of irritant or doubtful (IR/?), weak positive (+) and (strong) positive (++/+++) reactions, respectively, among 12 allergens included in the German Standard Series. Methods Analysis of clinical data collected in the surveillance network IVDK (http://www.ivdk.org) between January 1993 and December 2001 (n = 73 691 patients) combined with meteorological data obtained by the national services in Germany and Austria. Multinomial logistic regression analysis was used to estimate the risk associated with temperature, absolute humidity and vapour pressure, respectively, adjusted for sex, age, atopic dermatitis and duration of patch test application. Results For low temperature and humidity, a relevant increase of IR/? reaction frequency was observed in the cases of paraben mix and (chloro-) methylisothiazolinone. Both IR/? and + reactions were significantly increased with respect to the allergens fragrance mix, oil of turpentine, methyldibromo glutaronitrile + phenoxyethanol and particularly formaldehyde, while ++/+++ reactions were hardly affected by weather conditions. Conclusions The observed increase of IR/? reactions may be due to epidermal barrier function impairment. The impact of dry/cold weather on + reactions in terms of possibly false-positive reactions is restricted to few allergens. In the case of + reactions of unknown relevance, a re-test under warm conditions or verification tests such as the repeated open application test or the provocative use test may be recommendable.

Background— Arterial hypertension is a prime cause of morbidity and mortality in the general population. Pharmacological treatment has limitations resulting from drug side effects, costs, and patient compliance. Thus, we investigated whether traditional Chinese medicine acupuncture is able to lower blood pressure. Methods and Results— We randomized 160 outpatients (age, 58±8 years; 78 men) with uncomplicated arterial hypertension in a single-blind fashion to a 6-week course of active acupuncture or sham acupuncture (22 sessions of 30 minutes’ duration). Seventy-eight percent were receiving antihypertensive medication, which remained unchanged. Primary outcome parameters were mean 24-hour ambulatory blood pressure levels after the treatment course and 3 and 6 months later. One hundred forty patients finished the treatment course (72 with active treatment, 68 with sham treatment). There was a significant ( P Conclusions— Acupuncture according to traditional Chinese medicine, but not sham acupuncture, after 6 weeks of treatment significantly lowered mean 24-hour ambulatory blood pressures; the effect disappeared after cessation of acupuncture treatment.

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.

To evaluate an adequate strategy for biological monitoring of aluminium (Al), a group of 62 Al welders (age in 1999: 23-51 years, median 35 years) was surveyed annually from 1999 to 2003 by determination of pre- and post-shift Al in urine and plasma. Biomonitoring was supplemented by personal air measurements of the total dust concentration. The welders' internal exposure was compared to the exposure of 60 non-exposed assembly workers (age in 1999: 21-51 years, median: 36 years) who were surveyed in 1999, 2001 and 2003. Having a nearly constant dust exposure, median concentrations of Al in urine (Al in plasma) of the welders decreased from 40.1 microg/g to 19.8 microg/g creatinine (8.7 to 4.6 microg/l). For the control group the median levels of Al in urine (plasma) ranged from 4.8 microg/g to 5.2 microg/g creatinine (2.4-4.3 microg/l) indicating a higher sensitivity for the marker Al in urine. No systematic differences have been found between pre- and post-shift internal exposure. This might be caused by the slow elimination kinetics and low systemic bioavailability of Al. A correlation analysis did not yield close relationships between dust exposure, Al in plasma and Al in urine underlining the importance of biomonitoring for assessment of Al exposure.

Summary Aim: This study investigates whether interactive rigid fusion of routine PET and CT data improves localization, detection and characterization of lesions compared to separate reading. For this purpose, routine PET and CT scans of patients with metastases from malignant melanoma were used. Patients, methods: In 34 patients with histologically confirmed malignant melanoma, FDG-PET and spiral CT were performed using clinical standard protocols. For all of these patients, gold standard was available. Clinical and radiological follow-up identified 82 lesions as definitely pathological. Two board-certified nuclear medicine physicians and two board-certified radiologists analyzed PET and CT images independently from each other. For each patient up to 32 anatomical regions (24 lymph node regions, 8 extranodular regions) were systematically classified. Discordant areas were interactively analyzed in manually and rigidly registered images using a commercially available fusion tool. No side-by-side reading was performed. Results: Image fusion disclosed that the evaluation of the PET images alone led to a mislocalization in 26 of 91 focally FDG enhancing lesions. The overall sensitivities of PET, CT, and image fusion were 85, 88, and 94%, respectively; the overall specificities of PET, CT and image fusion were 98, 95 and 100%, respectively. Image fusion exhibited statistically significant higher specificity values as compared with CT. Ten definitely malignant sites were false-negative in CT, but could be detected by PET. On the other hand, twelve metastases were false-negative in PET, but could be detected by CT. These included two lesions, which had a clear correlate on the PET image when the fused images were evaluated. On the whole, registration of the PET and CT images yielded additional diagnostic information in 44% of the definitely malignant lesions. Conclusion: Retrospective image fusion of independently obtained PET and CT data is particularly valuable in exactly localizing foci of abnormal FDG uptake and improves the detection of metastases of malignant melanoma.

Purpose: To investigate the incidence of fat necrosis, breast tissue fibrosis and breast pain after conserving surgery and accelerated partial-breast irradiation (APBI, group A), whole-breast external-beam irradiation (EBRT, group B), or EBRT combined with an interstitial boost (EBIB, group C) in women with breast cancer. Patients and Methods: 85 patients who received breast-conserving therapy from 02/2000 to 03/2002 were analyzed. 30 patients received EBRT, 33 patients APBI, and 22 patients EBIB. Median follow-up was 35.5, 35.0, and 37.5 months, respectively. Fat necrosis was detected and rated by mammograms, fibrosis and pain were clinically rated with the LENT-SOMA scores. Results: The incidence of fat necrosis was 15.3% for all patients; and 15.2%, 20.0%, and 9.0% for groups A, B, and C, respectively. The 3-year fat necrosis-free survival probability was 83%, 76%, and 95% (difference not significant). The mean time to first diagnosis of fat necrosis was 25.6, 26.2, and 26.0 months. No patient needed surgical intervention because of fat necrosis-related pain. Fibrosis was present in 27.3%, 63.3%, and 77.3% (p < 0.001), breast pain in 9.0%, 33.4%, and 18.1% (p < 0.05). Conclusion: Asymptomatic fat necrosis is a common finding after both percutaneous and interstitial irradiation after breast-conserving surgery. This analysis did not support the hypothesis that APBI with multicatheter implants leads to higher rates of fat necrosis, fibrosis, or pain.

While there is extensive methodological literature analysing the effects of misclassification on the relative risk under various misclassification scenarios, for the attributable risk only the effects of non-differential misclassification either of exposure or disease, and the effects of non-differential independent misclassification of exposure and disease have been discussed for the 2 × 2-situation. The paper investigates the effects of non-differential correlated misclassification of exposure and disease on the attributable risk taking possible correlations of both types of misclassification into account. Furthermore, a comparison with the corresponding effects on the relative risk is drawn. We propose a matrix-based approach to describe the underlying structure of non-differential misclassification. The bias arising from non-differential misclassification in the attributable risk and relative risk is evaluated in four examples assuming under- or overreporting of exposure and disease. In each of the four examples we found scenarios where pronounced differences in degree and, more importantly, in direction of bias occurred. Our results clearly demonstrate the danger lying in the stereotype transfer of findings regarding misclassification effects on the relative risk to other epidemiologic risk measures and underline the necessity of specific analyses of the effects of misclassification on the attributable risk. Copyright © 2005 John Wiley & Sons, Ltd.

Purpose To perform a comprehensive, multifactorial analysis of potential risk factors (demographic and clinical) for contact allergy to neomycin sulfate, a common adverse reaction resulting from the topical use of this drug; especially in some subgroups of the population. Methods Retrospective analysis of allergy test data of the Information Network of Departments of Dermatology (IVDK, www.ivdk.org) between 1998 and 2003, including all patients patch tested with a standard screening series because of suspected allergic contact dermatitis (ACD). As one outcome, a positive (allergic) test reaction to neomycin sulfate was considered. An alternative outcome included only those patients with a positive test to neomycin sulfate and a final diagnosis of ACD. The association between outcome and potential risk factors was analyzed with Poisson regression analysis, deriving prevalence ratios (PR) as risk estimates. Results Of the 47 559 patients tested, 2.5% had positive reactions to neomycin sulfate, while in 1.1% ACD was additionally diagnosed. The results of the multifactorial analysis indicated that the risk of both outcomes decreased slightly during the period covered; was higher among patients with leg dermatitis; varied significantly with age and increased progressively with the number of additional positive reactions to other standard series allergens. Cross-reactivity to other, selectively tested, aminoglycoside antibiotics was substantial (κ = 0.67; 95%CI: 0.63–0.71) for framycetin sulfate, to low (κ = 0.33; 95%CI: 0.27–0.37) for gentamicin sulfate. Conclusions The prevalence of contact sensitization to neomycin sulfate was noteworthy among patients patch tested in the IVDK centers. Supplementing clinical epidemiology, neomycin contact allergy has been estimated to be relatively common even on the level of the unselected population (prevalence approx. 1%). Hence, the topical use of neomycin sulfate by patients should be carefully monitored, considering its potential to induce ACD, with emphasis on subgroups at risk. Copyright © 2005 John Wiley & Sons, Ltd.

Objectives To describe lung function in correlation with information on exposure to dust and fibers in soft tissue paper-producing factories in Germany. Methods Ambient monitoring was performed for inhalable, respirable dust and fibers in nine soft tissue paper-producing factories. In a study group of 1,047 workers (189 control subjects, 240 workers with moderate exposure, and 618 workers with high exposure), spirometry (FVC, FEV 1 ) was performed. Information on occupational history, duration of exposure, workshop within the company, former occupational exposures, and smoking habits were collected. By employing multiple linear regression modeling, the potentially confounding effects of age, sex, body mass index, smoking habits, and factory were incorporated into the analysis of FVC, FEV 1 , and FEV 1 in percent of FVC (FEV 1 %FVC). By employing a logistic regression model, odds ratios were calculated for FVC Results The mean concentrations for inhalable, respirable, and fibrous dusts were 12.4 mg/m 3 , 0.28 mg/m 3 , and 420,000 fibers per cubic meter. With relation to cumulative dust and fiber exposure, a decrease of FVC from 105.4% predicted to 96.9% predicted (dust) and 97.1% predicted (fibers) in the subgroup with highest cumulative exposure was observed. For FEV 1 , a decrease from 107.3% predicted to 103.0% predicted (dust) and 102.8% predicted (fibers) was found. The parameter estimates show dose-response relationships that are more pronounced for FVC compared to FEV 1 . FEV 1 %FVC did not change significantly with increasing cumulative exposure, indicating a restrictive pattern of the findings. Conclusions Due to high ambient dust concentrations and the observed adverse effects on lung function, a reduction of dust exposure and secondary preventive measures is advised.

Background/Purpose: Sensitivity to ultraviolet (UV) light is associated with phenotypic variables like iris or hair colour or freckling, which are all strongly inter-related. We assessed the pattern of association among these factors to construct a summary measure reflecting constitutional UV sensitivity in a simple one-dimensional score with sufficient discriminating power. Methods: Information on iris and hair colour (3 and 4 categories, respectively), freckling (none vs. any) and the reaction to mid-day summer sunlight as an outcome (dichotomized into ‘burn’ and ‘tan’) was collected in a cross-sectional study among children at school enrolment in 1999 and 2000 in Gottingen, Germany (n=3765 with complete data). Chi-squared automatic interaction detector (CHAID) analysis and log-linear modelling was used to assess the pattern of mutual inter-relations. Results: Hair colour turned out to be the factor most strongly associated with UV sensitivity. In case of blonde or brown hair (the most common phenotypes in our sample), the consideration of freckling further refined the classification system, whereas iris colour did not contribute additional information. The results of the CHAID and log-linear analyses suggest a simple five-point score capturing constitutional UV sensitivity. The discriminating power of this score was high in our sample, with the proportion of persons who burned ranging from 7.7 (lowest category) to 73% (highest category). Conclusion: The new scoring system summarized efficiently relevant information on individual constitutional UV sensitivity in our sample. Its further validation in independent studies comprising Caucasian children or adults is necessary to assess objectively its properties for future applications.

To support the decision as to whether erythematous patch test reactions to allergens are irritant or allergic, sodium lauryl sulfate (SLS, 0.5% in water) has been added to the standard patch tests since July 1996 in the Dortmund Department of Dermatology. Data on 1600 patients patch tested up until June 2001, as well as standardized data on ambient temperature and humidity obtained by the German Meteorological Service, were included in a logistic regression analysis taking age, sex and atopy as potential confounders into account. The pattern of association was heterogeneous: while doubtful reactions to nickel sulfate were significantly associated with dry/ cold weather conditions, but not with SLS reactivity, the opposite was observed for lanolin alcohol, benzocaine and Myroxylon pereirae resin (balsam of Peru). Doubtful reactions to other allergens, namely formaldehyde, fragrance mix or p-phenylenediamine, were associated with both factors. For several other allergens of the standard series, no distinct, significant pattern could be discerned. In conclusion, meteorological conditions and SLS reactivity independently contribute information on individual irritability at the time of patch testing, and both should be considered.

Background: This study assessed the hypothesis that a decreased exposure to childhood infectious diseases is associated with signs and symptoms of ‘atopic’ hypersensitivity diseases. Methods: A cross-sectional survey was performed among 1368 Spanish and German first-year university students between 1997 and 1999, including self-administered questionnaire data and serological tests. Results: No association between the disease outcomes and hepatitis A, Helicobacter pylori infection and herpes simplex infection was observed in logistic regression analyses, adjusting for potential confounders (centre, sex, smoking, parental education). In contrast, vaccination against hepatitis B was associated with a decreased risk for the outcomes allergic rhinitis (OR 0.63, 95% CI: 0.42–0.95) and total serum IgE above 100 U/ml (OR 0.56, 95% CI: 0.39–0.81). Conversely, seropositivity to HBc antigen was significantly associated with high total serum IgE (OR 2.04, 95% CI: 1.34–3.06). Conclusions: Our study partly confirmed and partly contradicted previous evidence and hypotheses, respectively, concerning the role of the infections considered. The observation of a decreased risk in persons vaccinated against hepatitis B warrants further, prospective investigation.

To quantify the independent impact of potential risk factors for nickel contact allergy (NCA), a multifactorial Poisson regression analysis of standardized anamnestic and patch test data (with nickel sulfate, 5% in petrolatum) was performed, comprising 74 940 patients assessed in the 33 German and Austrian contact dermatitis units of the Information Network of Departments of Dermatology (IVDK) between 1992 and 2000. NCA was observed in 15.5% patients. Female sex was the strongest risk factor (prevalence ratio 3.74, 95% CI: 3.51-3.98). Risk increased monotonically and significantly with decreasing age. Atopic dermatitis was not a risk factor. The year of patch test had no influence on NCA risk. Significant variation of risk between occupations was observed. In conclusion, our multifactorial analysis was able to quantify the impact of established risk factors and additionally address other, e.g. occupational, factors yet unidentified.

Aims: To correlate the prevalence of respiratory tract symptoms and diseases with dust and fibre exposure in the soft tissue industry in Germany. Methods: Ambient monitoring was performed for inhalable, respirable dust and fibres in seven soft tissue producing factories. In 441 workers (72 controls, 90 moderate, 279 high exposure) a standardised questionnaire on respiratory symptoms, diseases, occupational history, and smoking habits was used. Crude differences in the prevalence of respiratory symptoms and diseases were assessed. Logistic regression analysis was used to determine the relation between the respiratory symptoms/diseases and the cumulative dust and fibre exposure, respectively, while adjusting for age, gender, smoking habits, and factory. The effects of exposure intensity and duration were differentiated by categorising dust/fibre concentrations and years of exposure separately and setting up logistic regression models. Results: The mean concentrations for inhalable, respirable, and fibrous dusts were 10.3 mg/m 3 , 0.22 mg/m 3 , and 415 000 fibres/m 3 . Adjusted odds ratios (OR) with relation to cumulative dust exposure intensity were significantly raised for blocked nose (18.2), mucosal irritation (6.5), dry nose (8.9), cough (3.5), phlegm (7.5), exercise induced dyspnoea (2.6), hoarseness (11.3), and sneezing attacks (7.9) (ORs for highest exposure categories). Cumulative dust or fibre exposure had no significant effects on the prevalence of respiratory diseases. For all symptoms with significantly raised ORs, combined effects of intensity and duration of exposure were found. Conclusions: Because of the high prevalence of respiratory symptoms a reduction of dust exposures is recommended. Chronic exposure effects could not be found in this study, however, a healthy worker effect has to be considered.

Objective: Naevus density in children depends both on constitutional factors (see below) and on previous (solar) UV exposure, which is a well-known risk factor for malignant melanoma. Secular trends of childhood UV exposure - e.g., due to intervention programmes - can be monitored by repeated, standardised cross-sectional studies assessing naevus density in children. Methods: The 'CMONDE-Study (childhood monitoring of naevus density)' appears as a suitable instrument, introduced into the process of school enrolment for children of the years 1999 and 2000 in Gottingen. Results: Analyses are based on 3883 children. Median age was 6.25 years, the proportion of girls 47 %. Median naevus density was 5.8/m 2 , with an increase of density from Fitzpatrick skin type' IV to II, but marked decrease in type I. Similarly, naevus density increased with increasing lightness of hair colour, but was very low in red-haired individuals. While the number of freckles was also strongly associated with naevus density, the association between iris colour and skin darkness, respectively, was weak. Conclusion: To meet the objective of continual monitoring, further comparative cross-sectional studies are needed.

The development of the mammalian heart is characterized by substantial changes in myocardial performance. We studied the ontogeny of myocardial function with and without various inotropic interventions in the developing isolated, antegrade-perfused rabbit heart (2d, 8d, 14d, 28d, n = 96). Myocardial function was related to the protein expression of the sarcolemmal Na(+)-Ca2+ exchanger and to the sarcoplasmic Ca(2+)-ATPase. In neonatal hearts an age-dependent increase in maximal developed pressure velocity (dP/dtmax) by 45% and peak negative pressure velocity (dP/ dtmin) by 75% within days 2 to 8 were observed. In response to inotropic intervention with isoproterenol, ouabain, calcium and the Na(+)-channel modulator BDF 9148, dP/dtmax and dP/dtmin increased in a concentration dependent manner. Significant differences between neonatal, juvenile and adult hearts could be demonstrated in a repeated measurement ANOVA model on the concentration-response curves for BDF 9148 (dP/dtmax and dP/dtmin), ouabain (dP/dtmin) and calcium (dP/dtmin), but not for isoproterenol. At the maximum isoproterenol concentration of 1 micromol/l, the increase in dP/dtmax and dP/dtmin was significantly higher in adult compared to neonatal hearts (t-test, p0.01). The significant decline of the Na(+)-Ca2+ exchanger protein expression from neonatal (1822 +/- 171) to adult hearts (411 +/- 96 S.E.M. [units per 20 microg protein], p0.01) was related to an increase in myocardial function (dP/dtmax r = 0.63, p0.01, dP/dtmin r = 0.62, p0.01). Contractility, relaxation and the observed positive inotropic effects were in general significantly lower in neonatal compared to adult hearts. In the individual heart an increase in contractility and relaxation was related to a decrease in Na(+)-Ca2+ exchanger expression.

Background Malignant melanoma is a very rare paediatric tumour. This study was performed in order to understand clinical features and prognosis of malignant melanoma in children and adolescents. Methods 443 patients ⩽18 years of age with malignant melanoma were prospectively registered with the German Central Malignant Melanoma Registry between 1983 and 2011. Cases were collected from 58 participating centres. 276 paediatric cases with a follow-up >3 months were evaluated for survival probabilities and prognostic factors by Kaplan–Meier method. Results Age of diagnosis ranged from 3 months to 18 years (median age 16 years). The male to female ratio was 0.8 (202 male, 240 female). Most melanoma were located at the trunk ( n = 195) and the lower extremity ( n = 114). Patients with >3 months of follow-up (median 55 months) showed an overall survival (OS) of 94.8% in 5 years. Survival according to tumour stage was 98.5% for stage I ( n = 190), 91.1% for stage II ( n = 39) and 53.0% for stage III/IV tumours ( n = 11). Worse outcome was seen in patients with nodular melanoma (OS 77.9%, n = 42) compared to superficial spread histotype (OS 100%, n = 138) or other histotype (OS 96.9%, n = 88) ( p n = 84) compared to thinner tumours (Clark level I, II, III, OS 99.1%, n = 164) ( p = 0.0008) and in case of ulceration (OS 65.6%, n = 17) compared to no ulceration (OS 99.2%, n = 182). Conclusion Patient and tumour characteristics in paediatric melanoma patients show no evident differences to adult melanoma cases. The same clinical approach as in adults should be used.

A high number of melanocytic naevi is one of the major risk factors for cutaneous melanoma. Therefore, counting the number of acquired naevi could be a useful strategy to identify individuals at an increased risk for targeted skin cancer screening. The aim of this study was to assess agreement between naevus self-counts and counts of trained examiners as well as to analyse potential determinants of the magnitude of agreement. In a large cross-sectional survey (n=1772), university students counted their naevi on both arms and were additionally examined by specifically trained examiners in a mutually blinded manner. Further data on other melanoma risk factors such as skin phototype, hair colour or freckling were collected by a questionnaire. The relative difference between the two naevus counts and the ratio of the counts were calculated to quantify agreement. Regression modelling was performed to identify independent determinants of agreement. The overall agreement was moderate, with participants counting on average 14% more naevi than the examiners. In terms of the potential determinants associated with agreement, skin type and medical education showed a strong effect. The difference in naevus counts was significantly larger for individuals with lighter skin types compared with those with a dark skin (Fitzpatrick type IV), and medical students yielded a naevus count more similar to the examiner's count than nonmedical students. Naevus self-counts can only provide a rough estimate of the number of naevi, but may not be accurate enough to reliably identify a high-risk group for melanoma screening, especially in individuals with light skin types.

OBJECTIVES—To assess the role of potential (occupational) risk factors for fragrance contact allergy (FCA). Most studies assessing the range of contact sensitisation in various clinical populations found the fragrance mix, a good screening tool for the detection of FCA in general, to be one of the leading allergens. The role of occupational exposure to fragrances is, however, yet unclear. METHODS—Firstly, crude analyses of the prevalence of FCA in various occupational fields including all 57 779 patients patch tested in the participating centres of the Information Network of Departments of Dermatology (IVDK) between January 1992 and December 1998. Secondly, a multifactorial Poisson regression analysis of these patients, including several potential risk factors. RESULTS—(a) The proportion of patients with FCA varied greatly between different occupational groups from 2.5% to 17.4%, (b) the highest occupational risk of FCA was associated with work as a masseur or physiotherapist, metal furnace operator, potter or glass maker etc, or geriatric nurse, (c) non-occupational factors that influenced risk of FCA included atopy, female sex, several sites, in particular the axillae, and increasing age. CONCLUSIONS—Occupations with a high risk of FCA were identified as targets of preventive action—that is, the substitution of scented products with fragrance free materials with which to work (skin disinfectants, cleaning solutions, personal care products) wherever possible. Keywords: contact allergy; occupational risk factors; fragrances