Happiness across the borders-A cross-sectional study among patients with psoriasis and atopic dermatitis in Europe.

BACKGROUND: Dermatological research has traditionally concentrated on evaluating mental comorbidities, neglecting positive concepts like happiness. Initial studies indicate that psoriasis and atopic dermatitis (AD) impair the happiness of those affected. Considering global happiness variations, this study aimed to explore the disease- and country-specific differences in disease-related quality of life and happiness, and potential influential factors on heuristic happiness among psoriasis and AD patients in Europe. METHODS: A cross-sectional multicentre study was conducted in dermatology departments of university-affiliated hospitals in eight European countries (Austria, Germany, Italy, Malta, Poland, Portugal, Romania and Ukraine) between October 2021 and February 2023. Adult psoriasis and AD patients completed a standardized questionnaire in their native languages, providing data on demographics, disease-related characteristics, disease-related quality of life (Dermatology Life Quality Index, DLQI), heuristic happiness, positive affect (PA), negative affect (NA) and satisfaction with life (SWL). Descriptive analysis and quantile regression were performed. RESULTS: Between psoriasis (n = 723) and AD (n = 316) patients almost no differences were observed in happiness, SWL and NA, except for DLQI and small differences in PA, with AD patients reporting greater impact than psoriasis patients. Country-wise variation emerged in DLQI, heuristic happiness, PA, NA and SWL with Austrian patients displaying the highest levels of happiness, satisfaction and positivity, coupled with higher treatment care and lower disease severity. Quantile regression revealed varying coefficients for predictor variables across quantiles, indicating, for example positive effects on heuristic happiness associated with current or previous receipt of systemic therapies at different quantiles. CONCLUSION: This study shows notable happiness differences across European countries and significant disease-related variations, particularly with AD patients being more impaired than psoriasis patients. The findings highlight the need for equality in treatment access and support the development of targeted positive psychological interventions to enhance happiness considering country-specific distinctions in future research and health policies for psoriasis and AD patients.

Prevalence of scabies worldwide-An updated systematic literature review in 2022.

Scabies is a World Health Organization-defined neglected tropical disease, with continuously rising incidence worldwide in recent years. The aim of this study was to provide an update of the worldwide prevalence and new treatment approaches of scabies in population-based settings. MEDLINE (PubMed), Embase and LILACS databases were reviewed for English and German language population-based studies from October 2014 to March 2022. Two authors independently screened the records for eligibility, extracted all data and one critically appraised the quality of the studies and risk of bias. Systematic review registration: PROSPERO CRD42021247140. Overall, 1273 records were identified through database searching, of which 43 studies were included for the systematic review. Most of the studies (n = 31) examined the scabies prevalence in medium or low human development index countries. The highest prevalence of scabies reported in the general population (children and adults) was recorded in five randomly selected communities in Ghana (71.0%), whereas the highest scabies prevalence in studies, which only examined children (76.9%), was recorded in an Indonesian boarding school. The lowest prevalence was recorded in Uganda (0.18%). The systematic review highlights the prevalence of scabies worldwide, showing that scabies is still a serious, increasing disease that occurs globally and is clustered in developing countries. More transparent data on scabies prevalence are needed to identify risk factors to find new prevention measures.

Requirements and expectations of high-quality biomarkers for atopic dermatitis and psoriasis in 2021-a two-round Delphi survey among international experts.

BACKGROUND: Chronic inflammatory skin diseases such as atopic dermatitis (AD) and psoriasis (PSO) present major challenges in health care. Thus, biomarkers to identify disease trajectories and response to treatments to improve the lives of affected individuals warrant great research consideration. The requirements that these biomarkers must fulfil for use as practical clinical tools have not yet been adequately investigated. AIM: To identify the core elements of high-quality AD and PSO biomarkers to prepare recommendations for current biomarker research. METHOD: A cross-sectional two-round Delphi survey was conducted from August to October 2019 and October to November 2020. All participants were members of the BIOMAP project, an EU-funded consortium of clinicians, researchers, patient organizations and pharmaceutical industry partners. The first round consisted of three open-ended questions. Responses were qualitatively analysed, and 26 closed statements were developed. For the second round, 'agreement' was assumed when the responses of ≥70% of the participants were ≥5 points on a 7-point Likert scale for each statement. Priority classification was based on mean scores (<20th percentile = low, 20th to 60th percentile = medium, >60th percentile = high). RESULTS: Twenty-one and twenty-six individuals participated in rounds one and two, respectively. From 26 statements that were included in round 2, 18 achieved agreement (8 concerning the performance, 8 for the purpose and 2 on current obstacles). Seven statements were classified as high priority, e.g. those concerning reliability, clinical validity, a high positive predictive value, prediction of the therapeutic response and disease progression. Another seven statements were assigned medium priority, e.g. those about analytical validity, prediction of comorbidities and therapeutic algorithm. Low priority included four statements, like those concerning cost effectiveness and prediction of disease flares. CONCLUSION: The core requirements that experts agreed on being essential for high-quality AD and PSO biomarkers require rapid validation. Biomarkers can therefore be assessed based on these prioritized requirements.

[Web search data as health data? : Geographic differences, temporal trends, and topics of interest from internet search engine analyses in Germany]. / Websearch-Daten als Gesundheitsdaten? : Geografische Unterschiede, zeitliche Trends und Interessenschwerpunkte von Internetsuchmaschinenanfragen in Deutschland.

BACKGROUND: Limited timely, cost-effective, and regional availability of healthcare data is considered one of the limiting factors for timely analyses in the field of health services research and thus for healthcare delivery to the general population. Thus, Internet search engine analyses are coming into focus in this context. OBJECTIVES: What contribution can data on the volume of Internet searches for various diseases make to the health care of the German population? Where is the potential and where are the limitations? METHODS: A review of the current literature and a selective overview of Internet search engine analyses of dermatological, allergological, and infectious diseases published in the last 4 years in Germany were performed. RESULTS: By analyzing web search data, temporal developments such as seasonality, months with the highest interest, and geographical differences can be mapped at the national, state (Bundesländer), and city level and major points of interest (e.g., skin cancer of the eye or anal itching) regarding a certain health topic can be identified. In addition, some studies were able to show correlations between search volume and external factors (e.g., temperature, care structure) and to registered cases (e.g., skin cancer, Lyme disease). CONCLUSION: Web search data, given the limitations noted, are able to directly provide spatiotemporal mapping regarding the needs of the Internet-using population. They are particularly useful in situations where traditional health data are limited or unavailable.

Can crowdsourced data help to optimize atopic dermatitis treatment? Comparing web search data and environmental data in Germany.

BACKGROUND: Atopic dermatitis (AD) is one of the most common chronic skin diseases worldwide, showing various manifestations and having a severe impact on quality of life. As previous studies demonstrated, internet search analysis can help identify public interest in diseases and possible influencing factors on search behavior. OBJECTIVE: To identify AD-related topics of interest in Germany using internet search volume. METHODS: Google Ads Keyword Planner was used to identify AD-related search terms including their search volume in Germany on a national level as well as in 16 selected cities from January 2016 to December 2019. Identified keywords were qualitatively analyzed, and temporal trends as well as the influence of seasonal and environmental factors on search volume were assessed. RESULTS: Overall, 1222 AD-related search terms with a search volume of 8 842 360 searches were identified. An increase from 2016 to 2019 and seasonal peaks from January to April of each year were observed. Nationwide, the search volume correlated with mean monthly temperature and sun duration. With increasing temperature and sun duration, a significant decrease in search queries was observed. The most populated cities showed the lowest number of searches per 100 000 inhabitants (Berlin, Hamburg, and Munich). In the eight categories formed (comorbidities, general, influential factors, localization, stage of life, symptoms/severity, therapy/information, and questions on AD), the highest proportion of search queries were assigned to the category "therapy/information" in most cities. In this category, a focus on the topics of "alternative medicine" and "home remedies" could be observed. CONCLUSION: The overall high and increasing search volume indicates a high interest in AD-related topics, especially regarding treatment and disease education. Information provided by internet search volume analyses can optimize AD therapy and patient-centered care by providing insight into patient needs and predicting potential climatic trigger factors.

Sun Protection and Public Information.

There is enough evidence that skin cancer can be prevented by an adequate usage of primary prevention measures. However, when examining people's real-life sun protection behaviour, it was often found to be insufficient. On the one hand, some people seem unaware about their risk to develop skin cancer as they might not sufficiently inform themselves. On the other hand, a lot of people know about the risk to develop skin cancer; however, they do not adequately protect themselves. Reasons for that are individual barriers such as the usage is too time-consuming or structural barriers such as unfavourable working conditions. In addition, a lot of people use sunscreen incorrectly as they tend to use only 20%-50% of the amount needed or do not reapply it.Studies have shown that there are several prevention campaigns demonstrating the successful increase in public awareness, but still more educational effort is needed to promote a better sun protection behaviour. On the basis of the effectiveness of previous intervention campaigns, future ones should use personal interventions or multi-component media such as the Internet. For promoting health-related information via the Internet, it is important to offer comprehensive, reliable, evidence-based information and to ban misleading or false information regarding sun protection.

Perception and Transformation.

Exposure to ultraviolet radiation increases the risk of adverse health effects, predominantly skin cancer, which is the most common cancer among Caucasians. A large number of studies have shown that most of the people are aware of this risk and that sun protection behavior is a preventative measure. Nevertheless, despite the numerous public efforts made during the last decades, a large number of people still do not comply with sun protection practices recommended for sun safety. Public discussion about sunscreen safety and the idealization of a healthy tan are existing barriers for adequate protection. Research studies should continue to examine individual sun protection behavior for the development of target-orientated interventions. This will enable individuals to formulate a correct judgment of their own susceptibility and to handle perceived barriers for sun protection with a supportive environment.

Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers.

BACKGROUND: Keratinocyte carcinoma (KC) is an increasingly important public health problem with an especially high prevalence in outdoor workers. In contrast to other occupations, foresters spend most of their outdoor time under the shade of trees. OBJECTIVES: We aimed to compare the unique sun exposure patterns and sun protection behaviour of foresters with those of other outdoor workers and their relation to the KC risk. METHODS: In July 2018, a cross-sectional study was conducted at an international forestry fair using a questionnaire about health awareness and skin cancer screening by dermatologists to assess the prevalence of KC. RESULTS: A total of 591 participants (78.7% male; mean age 46.8 ± 16.2 years) including 193 foresters were enrolled. Of all foresters, 72% experienced sunburns (solar erythema) within the past year and 50% of them experienced the worst sunburn during work. Foresters were most likely to often/always wear protective clothes (29.0%) but were least likely to often/always avoid midday sun (23.8%) and stay in the shade (31.1%). Having an outdoor profession or spending hours outside for leisure was negatively associated with sun protection. Skin examination revealed an overall KC prevalence of 16.7%, with 16.5% of foresters being affected. CONCLUSION: Despite being protected by trees, the risk of KC for foresters is comparable to that of other professional groups. Shade alone may not provide sufficient protection. Additional sun protection measures are necessary.

[Health care of chronic inflammatory skin diseases : Do affected individuals seek dermatological care?] / Versorgung von chronisch entzündlichen Hauterkrankungen : Gehen Betroffene zum niedergelassenen Dermatologen?

BACKGROUND: Psoriasis, atopic eczema and urticaria are chronic inflammatory skin diseases that are often associated with an impairment of affected individuals and their families. Despite constant progress in therapy of these diseases, affected people often do not consult an office-based dermatologist. OBJECTIVES: The aim of this study was to estimate which proportion of affected individuals with severe forms of these diseases receive treatment by an office-based dermatologist in Bavaria. MATERIALS AND METHODS: All dermatologists listed in the database of the Bavarian Association of Panel Doctors (KVB; Kassenärztliche Vereinigung Bayern; n = 499) were invited to participate in a paper-based cross-sectional study. The stated number of patients by each dermatologist were set in relation with the literature-based 1­year prevalence, as well as data on population and data of the KVB. Estimations were based on three approaches (conservative, medium, and progressive estimation method). RESULTS: Overall, 137 dermatologists participated (38.7% women; mean age: 53.2 ± 8.5 years). Conservative estimation indicated that 56.5% of individuals with moderate to severe psoriasis, 57.3% of individuals with moderate to severe atopic eczema and 71.9% of those suffering from chronic spontaneous urticaria are not seen by an office-based dermatologist. CONCLUSION: Many affected individuals seem not to seek an office-based dermatologist when affected by a severe skin condition. Thus, further and more precise studies to identify, address and minimize barriers to optimal patient care are needed.

Skin diseases are more common than we think: screening results of an unreferred population at the Munich Oktoberfest.

BACKGROUND: Skin diseases are ranked as the fourth most common cause of human illness, resulting in an enormous non-fatal burden. Despite this, many affected people do not consult a physician. Accordingly, the actual skin disease burden might be even higher since reported prevalence rates are typically based on secondary data that exclude individuals who do not seek medical care. OBJECTIVE: The aim of the study was to investigate the prevalence of skin diseases in an unreferred population in a real-life setting. METHODS: A cross-sectional study of 9 days duration was performed in 2016 at the 'Bavarian Central Agricultural Festival', which is part of the Munich Oktoberfest. As part of a public health check-up, screening examinations were performed randomly on participating visitors. All participants were 18 years or older and provided written informed consent. RESULTS: A total of 2701 individuals (53.5% women, 46.2% men; mean age 51.9 ± 15.3 years) participated in the study. At least one skin abnormality was observed in 1662 of the participants (64.5%). The most common diagnoses were actinic keratosis (26.6%), rosacea (25.5%) and eczema (11.7%). Skin diseases increased with age and were more frequent in men (72.3%) than in women (58.0%). Clinical examinations showed that nearly two-thirds of the affected participants were unaware of their abnormal skin findings. CONCLUSION: Skin diseases might be more common than previously estimated based on the secondary data of some sub-populations. Further information and awareness campaigns are needed to improve people's knowledge and reduce the global burden associated with skin diseases.

Different outdoor professions have different risks - a cross-sectional study comparing non-melanoma skin cancer risk among farmers, gardeners and mountain guides.

BACKGROUND: One of the main risk factors for non-melanoma skin cancer (NMSC), the most common cancer worldwide, is solar ultraviolet radiation (UVR). This has led to the recognition of NMSC as occupational disease for outdoor workers in several countries. However, outdoor professions are a very heterogeneous group with diverse daily activities and associated UVR exposure. OBJECTIVE: To compare the prevalence of NMSC and associated risk behaviour in different outdoor professions. METHODS: Cross-sectional study among outdoor workers (farmers, gardeners, mountain guides) and indoor workers (office employees) as control group using a paper-based questionnaire on UVR exposure and protective behaviour followed by a skin examination by a dermatologist. RESULTS: A total of 563 participants (46.9% women, 46.9 ± 13.8 years) consisting of 348 outdoor workers (38.8% farmer, 35.3% gardener, 25.9% mountain guides) and 215 indoor workers were included in the study between March and September 2017. NMSC incl. actinic keratosis was diagnosed in 33.3% of mountain guides, 27.4% of farmers, 19.5% of gardeners and in 5.6% of indoor workers. Significant differences were seen between the outdoor professions with mountain guides at highest risk compared to farmers (OR = 2.6, 95% CI = 1.2-5.7). Substantial differences between the professions were also seen in skin cancer screening attendance rates (indoor worker 61.4%, mountain guides 57.8%, farmers 31.9%, gardeners 27.6%), daily UVR exposure during work and protective behaviour such as sunscreen use during work. CONCLUSION: Different outdoor professions have significant different risks for NMSC and show different risk behaviour. Tailoring prevention efforts to different professions based on their individual needs could be the key to lower the global burden of (occupational) NMSC.

Primary and secondary prevention of skin cancer in mountain guides: attitude and motivation for or against participation.

BACKGROUND: Outdoor professionals such as mountain guides are at a substantial risk of developing non-melanoma skin cancer (NMSC) due to solar ultraviolet radiation (UVR) exposure. Despite major recent primary prevention efforts, studies on secondary skin cancer prevention efforts are limited and corresponding data on outdoor workers scarce. OBJECTIVE: To assess the sun protective behaviour and individual motivations for or against skin cancer screening examinations in the German mountain guide population to aid in the development of effective awareness and prevention strategies. METHODS: A cross-sectional study among all registered mountain guides in Germany was conducted using a 35-item online questionnaire on primary and secondary prevention of NMSC as well as perceived barriers for prevention. RESULTS: A total of 145 mountain guides participated in the study in January 2017. Of these, 86.2% reported using sunscreen often or always, 62.1% with a sun protection factor (SPF) of 30-50% and 60.7% had undergone dermatological examination by a medical professional. The most common reasons for using secondary prevention efforts were hope of an early diagnosis (77.3%), fear of skin cancer (73.9%) and the intention to be aware of one's own health (70.5%). The main reasons for not doing so were absence of conspicuous skin conditions (63.2%) and feeling healthy (59.6%). CONCLUSION: Awareness of prevention strategies recommended by the scientific community is low among affected occupationally high-risk mountain guide populations. Understanding the specific needs of this high-risk group is essential for the development of sustainable awareness and prevention strategies.

Guideline-compliant prescription of biologicals and possible barriers in dermatological practices in Bavaria.

INTRODUCTION: Psoriasis and urticaria are chronic inflammatory skin diseases, which account for a substantial socioeconomic burden and severely affect patients' quality of life. According to the respective German guidelines, biologicals can be used for the treatment of severe forms of these diseases. However, only a minority of patients receive this advised treatment. OBJECTIVE: To analyse the prescription of biologicals according to the German national guidelines for psoriasis and chronic spontaneous urticaria and to assess possible barriers to prescription. MATERIALS AND METHODS: Cross-sectional, questionnaire-based study including all Bavarian dermatologists based in private practices. Linear and logistic regression models were used to identify significant influencing factors on the perception of possible barriers. RESULTS: Between January 2017 and February 2017, a total of 137 (of 499) dermatologists participated. Of all patients with moderate to severe psoriasis and chronic spontaneous urticaria, participating dermatologists indicated treating 14.2% and 6.9% with biologicals, respectively. The most prevalent barriers to prescription were the high cost of the therapy, the low reimbursement and the fear of recourse. Analysis showed that age, years spent working in a dermatological hospital and the number of patients treated with moderate to severe psoriasis affect the perception of many barriers. Furthermore, age and barriers related to physician factors and external factors were identified as modifiers to the prescription scheme of dermatologists. CONCLUSIONS: The role of clinical education and the importance of external and economic barriers in comparison with medical barriers have to be emphasised. Guideline-compliant use of biologicals has to be optimised. Further research is needed to ascertain not only a barrier pattern for Bavaria but also for wider settings. Actions based on this for psoriasis are needed to achieve the goal of the WHO Global Psoriasis Report to strengthen the role of patient-centred care and improve the quality of life of affected patients. Analogue, this applies also for urticaria.

Satisfaction of mountain guides with high sun protection as a tool to prevent non-melanoma skin cancer.

BACKGROUND: Non-melanoma skin cancer (NMSC) is an occupational disease for outdoor workers in Germany since 2015. Sustainable prevention is demanded and sunscreen promoted as an effective tool. However, studies on the satisfaction of sunscreen users are rare. OBJECTIVE: To evaluate the satisfaction of mountain guides using a high SPF sunscreen product as an appropriate prevention tool for mountain guides. METHODS: Motivating mountain and ski guides in Germany to use very high protection sunscreen (SPF50+, Actinica Lotion) during a 4- to 8-h workday followed by the completion of a self-filled paper-based questionnaire about their experience and satisfaction with the product. RESULTS: Of 88 mountain and ski guides (61 men, 27 women) included in the study, 61.4% reported regular sunscreen use with the application of very high protection (SPF50+) in 18.6% of all cases. At the end of the workday, 78.6% found the product convenient and easy to include into their daily work and 79.3% felt sufficiently protected against the sun. CONCLUSION: Overall satisfaction with the use of high SPF products during work is high in mountain and ski guides and could be an effective tool in prevention campaigns.