[S3 guideline on skin cancer prevention: evaluation and updating procedure]. / S3-Leitlinie Prävention von Hautkrebs: Evaluation und Aktualisierungsprozess.

BACKGROUND: Originally published in 2014, the S3 guideline "Prevention of skin cancer" is the first evidence-based guideline available exclusively for primary and secondary prevention, which summarizes interprofessional consented recommendations for skin cancer risk reduction and early detection. Due to the large number of new publications and expanding focus, an update was deemed necessary. METHODS: After a structured needs assessment, key questions were prioritized. The resulting systematic literature search resulted in a three-stage screening process. Recommendations formulated in working groups were approved in a formal consensus process, taking into account conflicts of interest, and finalized after a 6­week public consultation process. RESULTS: The needs assessment identified "skin cancer screening" (60.1%), "individual risk avoidance behaviors" (44.20%), and "risk factors" (43.48%) as topics of greatest interest. The prioritization phase resulted in 41 new key questions. A total of 22 key issues were re-evaluated in an evidence-based manner using 93 publications. As part of comprehensive guideline restructuring, 61 recommendations were newly developed and 43 were modified. The consultation phase resulted in no changes to recommendations and 33 changes to background material. CONCLUSION: The identified need for change resulted in extensive modification and redrafting of recommendations. As the target group "nononcology patients" cannot be identified via cancer registries or certification systems, no quality indicators can be derived from the guideline. To transfer the guideline to health care, innovative, addressee-specific concepts are required, which will be discussed and implemented during the preparation of the patient guideline.

[Shaded places for skin cancer prevention in kindergartens and schools]. / Schattenplätze zur Hautkrebsprävention in Kindertagesstätten und Schulen.

BACKGROUND: Excessive UV radiation from the sun may lead to skin cancer, the most common type of cancer in Germany. Therefore, among other things, the World Health Organization recommends seeking shade during the midday hours from a UV index of 3 (3 to 5 = "moderate"). However, this important preventive measure can only be taken if sufficient shaded areas are available. The aim of the study is to record shaded areas in kindergartens and schools nationwide. METHODS: An epidemiological cross-sectional study with two samples was carried out. Management of kindergartens and schools were surveyed using online questionnaires about the provision of shading measures at their educational institution from May to August 2020 and from April to July 2021, respectively. The primary outcome was to record the presence of various structural shading measures in the outdoor area of their educational institutions. The secondary outcome was to estimate the size of the shaded exterior area. RESULTS: From the nationwide population, 1042 kindergartens (1.9%) and 713 schools (2.3%) participated. Compared to schools, kindergartens had sun protection measures in the outdoor area significantly more often (99% vs. 82%; p < 0.001) and were able to shade a significantly larger outdoor area (43% vs. 26%; p < 0.001). Assuming a minimum required shaded outdoor area of 1 m2 per person, 45% of the schools and 10% of the kindergartens did not have sufficient shaded outdoor areas (p < 0.001). CONCLUSION: Almost every fifth school in Germany had no shaded places in the outdoor area. Against the background of climatic changes, an urgent high need for improvements seems obvious.

S3 guideline Allergy Prevention.

BACKGROUND: The persistently high prevalence of allergic diseases in Western industrial nations and the limited possibilities of causal therapy make evidence-based recommendations for primary prevention necessary. METHODS: The recommendations of the S3 guideline Allergy Prevention, published in its last version in 2014, were revised and consulted on the basis of a current systematic literature search. The evidence search was conducted for the period 06/2013 - 11/2020 in the electronic databases Cochrane and MEDLINE, as well as in the reference lists of current reviews and through references from experts. The literature found was screened in two filtering processes, first by title and abstract, and the remaining papers were screened in the full text for relevance. The studies included after this were sorted by level of evidence, and the study quality was indicated in terms of potential bias (low/high). The revised recommendations were formally agreed and consented upon with the participation of representatives of the relevant professional societies and (self-help) organizations (nominal group process). Of 5,681 hits, 286 studies were included and assessed. RESULTS: Recommendations on maternal nutrition during pregnancy and breastfeeding as well as on infant nutrition in the first months of life again play an important role in the updated guideline: Many of the previous recommendations were confirmed by the current data. It was specified that breastfeeding should be exclusive for the first 4 - 6 months after birth, if possible, and that breastfeeding should continue with the introduction of complementary foods. A new recommendation is that supplementary feeding of cow's milk-based formula should be avoided in the first days of life if the mother wishes to breastfeed. Furthermore, it was determined that the evidence for a clear recommendation for hydrolyzed infant formula in non-breastfed infants at risk is currently no longer sufficient. It is therefore currently recommended to check whether an infant formula with proven efficacy in allergy prevention studies is available until the introduction of complementary feeding. Finally, based on the EAACI guideline, recommendations were made for the prevention of chicken egg allergy by introducing and regularly giving thoroughly heated (e.g., baked or hard-boiled) but not "raw" chicken egg (also no scrambled egg) with the complementary food. The recommendation to introduce peanut in complementary feeding was formulated cautiously for the German-speaking countries: In families who usually consume peanut, the regular administration of peanut-containing foods in age-appropriate form (e.g., peanut butter) with the complementary diet can be considered for the primary prevention of peanut allergy in infants with atopic dermatitis (AD). Before introduction, a clinically relevant peanut allergy must be ruled out, especially in infants with moderate to severe AD. There is still insufficient evidence for an allergy-preventive efficacy of prebiotics or probiotics, vitamin D, or other vitamins in the form of supplements so that recommendations against their supplementation were adopted for the first time in the current guideline. Biodiversity plays an important role in the development of immunological tolerance to environmental and food allergens: there is clear evidence that growing up on a farm is associated with a lower risk of developing asthma and allergic diseases. This is associated with early non-specific immune stimulation due to, among other things, the greater microbial biodiversity of house dust in this habitat. This aspect is also reflected in the recommendations on animal husbandry, on which a differentiated statement was made: In families without a recognizable increased allergy risk, pet keeping with cats or dogs should not generally be restricted. Families with an increased allergy risk or with children with already existing AD should not acquire a new cat - in contrast, however, dog ownership should not be discouraged. Interventions to reduce exposure to dust mite allergens in the home, such as the use of mite allergen-proof mattress covers ("encasings"), should be restricted to patients with already proven specific sensitization against house dust mite allergen. Children born by caesarean section have a slightly increased risk of asthma - this should be taken into account when advising on mode of delivery outside of emergency situations. Recent work also supports the recommendations on air pollutants: Active and passive exposure to tobacco smoke increase the risk of allergies, especially asthma, and should therefore be avoided. Exposure to nitrogen oxides, ozone, and small particles (PM 2.5) is associated with an increased risk, especially for asthma. Therefore, exposure to emissions of nitrogen oxides, ozone, and small particles (PM 2.5) should be kept low. The authors of this guideline are unanimously in favor of enacting appropriate regulations to minimize these air pollutants. There is no evidence that vaccinations increase the risk of allergies, but conversely there is evidence that vaccinations can reduce the risk of allergies. All children, including children at risk, should be vaccinated according to the current recommendations of the national public health institutes, also for reasons of allergy prevention. CONCLUSION: The consensus of recommendations in this guideline is based on an extensive evidence base. The update of the guideline enables evidence-based and up-to-date recommendations for the prevention of allergic diseases including asthma and atopic dermatitis.

Validation of SEPI in German-A German Translation of the Sun Exposure and Protection Index.

The Sun Exposure and Protection Index (SEPI) is a brief instrument for scoring of sun exposure habits and propensity to increase sun protection, previously validated in English and in Swedish, as well as in two different outdoor sun intensity environments (Australia and Northern Europe). The aim of the present study was to study reliability and validity of a German translated version of the SEPI to be used in German-speaking populations. Data was collected at University of Flensburg and at Hamburg University of Applied Sciences from November 2018 to April 2019. Participants (n = 205) filled out the SEPI and also a selection of corresponding questions from the Austrian Vienna UV Questionnaire in German. After three weeks, the participants filled out the SEPI once again in order to assess test-retest stability. Of the 205 participants completing the baseline questionnaire, 135 participants completed it once again after three weeks. Internal consistency, by Cronbach's alpha, for the baseline responses was 0.70 (95% C.I: 0.63-0.76) for SEPI part 1 (sun exposure habits) and 0.72 (95% C.I: 0.66-0.78) for part 2 (propensity to increase sun protection). Test-retest stability was high, with weighted Kappa >0.6 for all items but one, and the instrument correlated well with the previously validated German-language UV Skin Risk Survey Questionnaire. In conclusion, the German version of SEPI can reliably be used for mapping of individual sun exposure patterns.