Happiness Behind the Scenes: Associations between Heuristic Happiness and Related Dimensions in Skin Diseases.

Positive health approaches, such as happiness, are largely unexplored in medicine, including dermatology. Taking into consideration the various happiness measures, the aims of this cross-sectional study were to assess this concept using a 1-item heuristic happiness question and its related dimensions (Satisfaction with Life, Positive and Negative Affect, Quality of Life, and Compound Psychological Capital) in outpatients with different skin diseases between December 2019 and June 2020, and to examine the link between these dimensions. Overall, 414 dermatological patients were included: 67 with psoriasis, 84 atopic eczema, 10 mastocytosis, 19 nummular eczema, 84 malignant melanoma and 150 keratinocyte carcinoma. Comparing the skin diseases, differences were observed for heuristic happiness, Positive Affect, and some domains of Quality of Life and Compound Psychological Capital. Analysing the relationship between heuristic happiness and other happiness measures, the data revealed moderate to strong correlations (r = 0.30-0.46, p< 0.001) and variations in the understanding of happiness between the skin diseases. Overall, the most important facet of happiness was Hope as a domain of Compound Psychological Capital. This study emphasizes the individual definition of heuristic happiness in patients with skin diseases. A 1-item heuristic approach may be a simple and practical method to assess the complexity and individuality of happiness.

Out-of-Pocket Costs in Alopecia Areata: A Cross-Sectional Study in German-speaking Countries.

Alopecia areata is a common skin disease which is associated with psychosocial and financial burden. No curative therapy exists and, hence, affected persons resort to self-financed cosmetic solutions. However, studies on the economic impact of alopecia areata on individuals are limited. To estimate annual individual out-of-pocket costs in persons with alopecia areata, a cross-sectional study using a standardized online questionnaire was performed in Germany, Austria and Switzerland. A total of 346 individuals (95.1% women, mean age: 38.5 ± 11.6 years) with alopecia areata participated between April and August 2020. Mean additional spending on everyday necessities was 1,248€ per person per year, which was significantly influenced by the duration of the illness, the treatment provider, and disease severity. Hair replacement products and cosmetics accounted for the highest monthly costs, followed by costs for physician visits, hospital treatments, and medication. Most participants (n = 255, 73.7%) were currently not undergoing treatment, due to lack of efficacy, side-effects, costs and acceptance of the disease. Sex differences in expenses were observed, with women having higher expenditures. Alopecia areata-related out-of-pocket costs place a considerable financial burden on affected individuals, are higher compared with those of other chronic diseases, and should be considered in economic assessments of the impact of this disease.

Analyzing web searches for axial spondyloarthritis in Germany: a novel approach to exploring interests and unmet needs.

Axial spondyloarthritis (axSpA) is an underdiagnosed condition with a high disease burden. Due to delayed diagnosis and limited access to specialist care, conventional health data might not sufficiently capture the perspective of affected individuals. The aim of this study was to assess public interest, unmet needs, and disease burden of axSpA in Germany through the analysis of thematic, geographic, and temporal patterns in national web search data. Google Ads Keyword Planner was used to identify axSpA-related keywords and their monthly search volume in Germany between January 2017 and December 2020. Identified keywords were qualitatively categorized into six categories. Overall, 265 axSpA-related keywords with a search volume of 3,881,490 queries were identified. Nearly 81% of the total search volume was assigned to the category terms and definition, while 19% referred to either outcomes, symptoms, diagnosis, management, or causes. In the category outcomes, prognostic outcomes like "life expectancy" generated more searches than physical manifestations like "pain". Less populated cities showed significantly more searches per 100,000 inhabitants than larger cities. Searches were seasonally stable with a Germany-wide peak in July 2017. This study provides an overview of public interest in axSpA based on web search data in Germany. The identified search patterns could be used to guide public health campaigns and optimize axSpA management in Germany.

Evaluating public interest in herpes zoster in Germany by leveraging the internet: a retrospective search data analysis.

BACKGROUND: Herpes zoster (HZ) and its complication postherpetic neuralgia (PHN), whose incidence are both expected to increase with an ageing population, have demonstrated high costs on healthcare systems and burden on individual quality of life. Previous studies have shown the possibility of assessing public interest in a disease and factors that influence search behaviour using internet search data. The aim of this study was to analyze internet search data for HZ in Germany to evaluate public interest in the disease and relevant influential temporal and geographic factors that modify search behavior. METHODS: Google Ads Keyword Planner was used to generate a list of HZ-related keywords including their search volume for Germany as a whole and its sixteen federal states from October 2016 to September 2020. All keywords were qualitatively categorized, and changes over time and correlations with population density, physician density, and vaccination rates were assessed using Welch's ANOVA, Bonferroni correction for post-hoc analyses, and Pearson's correlation. RESULTS: A total of 1,651 relevant keywords with a search volume of 20,816,210 searches were identified. Overall, national search volume increased each year of the study period with a peak in August 2020. More than half of the total search volume related to general queries (55.1%). The highest average monthly search volumes were observed in the states of Hamburg, Saarland, and Bremen. Average monthly search volume showed strong positive correlations with population density (r = .512, p = .043) and a strong negative correlation with the number of inhabitants per working physician (r = -.689, p = .003). CONCLUSIONS: The study demonstrated that evaluating internet search data is a viable method for assessing public interest in HZ, thereby identifying areas of unmet need to support targeted public health campaigns.

The national burden of scabies in Germany: a population-based approach using Internet search engine data.

PURPOSE: Scabies is a World Health Organization-defined neglected tropical disease and a growing public health issue worldwide. It is difficult to obtain reliable data on prevalence due to the lack of standardized tests. The aim of this study was to assess scabies online search behavior in Germany to identify local differences using Google search volume. METHODS: Google Ads Keyword Planner was used to investigate the scabies-related search volume for Germany as a whole, its 16 federal states, and 15 large cities for the period from January 2016 to December 2019. The identified search terms were qualitatively categorized and critically analyzed. RESULTS: A total of 572 keywords with an overall search volume of 11,414,180 searches regarding scabies were identified in Germany. The number of searches was higher in winter than in summer, with a national peak in March 2018. Around 30.6% of the searches regarding scabies therapy (n = 978,420) were related to home remedies. Regarding body localization, most searches focused on the whole body (n = 109,050), followed by head (n = 89,360) and the genital area (n = 28,640). CONCLUSIONS: The analysis of Google search data provides an overview of the populations' interest regarding scabies. The analysis can detect local peaks and assess the relevance of scabies at individual localizations of the body. The study highlighted current possible shortcomings in the therapy of scabies. It also underlined the importance of improving awareness regarding scabies so that affected individuals can consult a doctor earlier for treatment.

Happiness and depression in psoriasis: a cross-sectional study in Germany.

PURPOSE: Prior research on the psychological consequences of skin diseases has focused on assessing mental comorbidities. The aim of this study was to investigate subjective well-being in a large sample of individuals affected by psoriasis, a chronic inflammatory skin disease, and to explore the associations with depression and disease-related parameters such as disease severity. METHODS: A cross-sectional online survey was conducted from March to June 2019. The link to the questionnaire was shared on websites and Facebook pages of psoriasis patient organizations and campaigns. Participants filled in validated scales measuring subjective well-being-operationalized as positive affect (PA), negative affect (NA) and satisfaction with life (SWL); and depression. RESULTS: The data of 722 participants were analyzed. Exploratory factor analysis supported the differentiation of PA, NA, SWL, and depression as four different constructs. The respondents reported lower levels of PA than healthy individuals and judged themselves to be less happy and were less satisfied with their lives than the general population (except age group 65 + years). 40.3% of respondents were screened positive for depression. More severe psoriasis was associated with lower affective well-being and a higher risk for depression. CONCLUSION: The results of this study empirically supported the differentiation of subjective well-being and depression as different constructs in individuals with psoriasis, and underline the large mental burden of the disease which goes beyond a higher risk for depression. Measures of well-being should thus be incorporated in both research and clinical practice in patients with psoriasis in order to achieve a more comprehensive picture of the mental burden of this disease.

Eczema-related Web Search Data in Sweden: Investigating Search Patterns and the Influence of Weather.

As atopic eczema is triggered by environmental factors, such as temperature, differences in disease burden between and within countries are possible. One method to study this phenomenon is to perform web-search analysis, since the internet is commonly used to retrieve health-related information. This study, investigating the Google search volume regarding eczema in Swedish counties between April 2017 and March 2021, revealed a continuous increase in number of searches and that the search volume was higher in Northern than Southern Sweden. Gotland had the most searches per 100,000 inhabitants. In general, there was a negative correlation between search volume and temperature (r=-0.315, p < 0.001) and hours of sunshine (r=-0.213, p < 0.001), whereas there was a positive association between search volume and wind (r=0.229, p < 0.001). Search engine analysis is a rapid and cost-effective method of examining search behaviour regarding disease among the general population within a country and, thus, can enable the identification of regions with specific interests and needs.

Tick bites in different professions and regions: pooled cross-sectional study in the focus area Bavaria, Germany.

BACKGROUND: As the vector-borne diseases tick-borne encephalitis (TBE) and Lyme borreliosis (LB) are common in Germany and transmitted by tick bites, the aim of this study was to assess differences in the number of tick bites in various professions and regions across southern Germany to evaluate the differences in tick-associated risk. MATERIALS AND METHODS: The analysis is based on three cross-sectional studies that were conducted in 2016 and 2017 in two real-life settings and in one medical setting in Bavaria. All participants filled in a paper-based questionnaire about their history with tick bites. Only adult participants (≥ 18 years) were included in this study. RESULTS: Overall, 3503 individuals (mean age 50.8 ± 15.2 years, median age 53.0 ± 12.2 years, 54.0% female) were included. Of these, 50% worked in an outdoor profession and 56% lived in environs. Around 70% of participants reported at least one previous tick bite. In comparison to indoor workers, forestry workers (OR = 2.50; 95% CI: 1.10-5.68) had the highest risk for a tick bite followed by farmers (OR = 1.22; 95% CI: 1.01-1.47). Furthermore, people living in rural areas (OR = 1.97, 95% CI:1.49-2.59) and environs (OR = 1.98, 95% CI: 1.54-2.55) were twice as likely to have a previous tick bite than people living in urban areas. In general, slightly more tick bites were reported by people living in eastern Bavaria. CONCLUSION: Rising numbers of TBE and LB indicate the need for further prevention strategies, which should focus on outdoor professions with a higher risk and people living in environs and rural areas.

[Atopic dermatitis-identifying needs in the German population by internet search queries]. / Atopische Dermatitis ­ Identifikation von Bedürfnissen der deutschen Bevölkerung mittels Internetsuchanfragen.

BACKGROUND: The internet is one of the most important sources for health-related information for the general population. Therefore, the analysis of internet search engines can help to capture the social interests and needs regarding diseases. OBJECTIVES: The aim of this study was to investigate the search queries related to atopic dermatitis (AD) regarding frequency, focus of interest and temporal occurrence in the German federal states in order to identify possible regional differences. MATERIAL AND METHODS: Using the Google Ads Keyword Planner, AD relevant keywords including the monthly search volume between January 2017 and December 2020 were identified, which were then assigned to different categories. RESULTS: Overall, 1419 keywords were found that had a search volume of 14,817,610 queries. The category 'general' had the highest search volume (n = 5,970,840), but most keywords were assigned to the category 'location' (n = 348). About 60% of the keywords assigned to 'location' were related to AD on the face. On a national level, Bremen and Hamburg had the highest search volume per 100,000 inhabitants. With more than 70%, an enormous increase in search volume could be observed, which was especially high in 2020. DISCUSSION: With this internet search analysis, it was possible to clarify which aspects of AD were of particular importance for the German population, which can help to adapt information campaigns to the target population. In addition, the study underlines the increasing relevance of the internet as a source of information regarding health-related topics.

Molecular diagnostics in dermatology: An online survey to study usage, obstacles and requirements in Germany.

BACKGROUND AND OBJECTIVES: Molecular diagnostics (MDx) increasingly gains importance in dermatology and its application is a prerequisite for personalized medicine. The goal of this cross-sectional study was to determine how MDx is implemented in dermatologists' offices in the three fields of oncology, inflammation and infectiology and which hurdles office-based dermatologists face in terms of MDx. METHODS: Physician members of the Association of the German Dermatologists (Berufsverband der Deutschen Dermatologen e. V.; BVDD) were surveyed via an online questionnaire on MDx. RESULTS: 39.6 % of the 192 participants reported using MDx. Of these, the vast majority used MDx for diagnosing infectious diseases (86.5 % and 44.3 % of users perform MDx for detection of funghi and sexually transmitted diseases, respectively). Only a small minority applied MDx to answer oncological or immunological questions. The major obstacles for non-users as compared to users were difficulties in implementation, lack of expertise as well as time, personnel, and technical availability. Reimbursement was a main issue in both groups. CONCLUSIONS: Despite availability of specific therapies requiring precision medicine, MDx has not yet been broadly implemented in office-based dermatology. To advance MDx, more needs to be done in terms of continuous education, availability of reliable and valid tests, and reimbursability.

Prescription Behaviour and Barriers to Prescription of Biologicals for Treatment of Chronic Inflammatory Skin Diseases in Dermatological Practice in Two German Federal States.

The globally increasing prevalence of chronic inflammatory skin diseases has substantial costs. Biologicals have become available as therapeutic options, but are encumbered with barriers to prescription. The aim of this study was to evaluate the barriers to prescription of biologicals in the treatment of chronic dermatological diseases. Dermatologists working in private practices in the German federal states of Bavaria and Lower Saxony participated in a cross-sectional study. Economic and legal aspects, including "high therapy costs", "low reimbursements", and "fear of regress claims", were identified as the most prevalent barriers. Significant differences between dermatologists from Bavaria and Lower Saxony were found only regarding the treatment of atopic dermatitis. This study demonstrates the prevalence of barriers to the prescription of biologicals in the treatment of chronic dermatological diseases. Overcoming these barriers could improve the usage of modern therapies and thereby expand patient-centred care for chronic skin diseases.

[Is the Bavarian Population Open for Teledermatology? A Cross-Sectional Study in Rural and Urban Regions of Bavaria, Germany]. / Wie offen ist die bayerische Bevölkerung für Teledermatologie? Eine Querschnittsstudie in ländlichen und städtischen Regionen Bayerns.

AIM: Teledermatology has a great potential to improve dermatologic care in rural regions. The aim of this study was to assess the willingness to use teledermatology in the rural population of Bavaria, Southern Germany, and to explore major concerns regarding teledermatology. METHODS: The data of this cross-sectional study were collected both as part of a health survey conducted in the Bavarian forest region in Q1/2017 and as part of a follow-up survey (Q1/2018) of a running cohort study recruited at a Bavarian agricultural festival. Study participants were asked in a standardized questionnaire whether they would send pictures of skin rashes or other skin changes to their dermatologist via the internet, and if "no", why not. RESULTS: Data on 1,116 participants living in Bavaria were analysed (mean age 50.2 years, 57.3% female, 80.4% living in rural regions). Of the whole sample, 36.6% were willing to use teledermatology. Women, older participants and participants living in rural regions were less open to the use of teledermatology. Major concerns regarding teledermatology were impersonality, doubts about the quality of the service and data safety and privacy concerns. DISCUSSION: The willingness to use teledermatology in the rural population of Bavaria is still rather low. Before teledermatology can realise its full potential for improving health care in rural regions, the population needs to be educated about the functioning and the advantages of teledermatology, and data safety concerns need to be addressed.

Retracing the COVID-19 Pandemic in Germany from a Public Perspective using Google Search Queries Related to "coronavirus".

AIM OF THE STUDY: During pandemics, the whole population is simultaneously confronted with the same health threat, resulting in enormous public interest. The current COVID-19 pandemic has left the world in a unique state of crisis. The aim of this analysis was to explore whether Google searches can be used to retrospectively retrace the COVID-19 pandemic in Germany and to detect local outbreaks by reflecting public interest in the virus. METHODS: Google Trends was used to explore the relative search volume (RSV) related to "coronavirus" from January 2020 to July 2020 in Germany. The RSV ranging between 0-100 was compared to new SARS-CoV-2 infections per day on a national level and to the cumulative infection numbers on a state level, as well as to important infectiological and political events. RESULTS: The most striking search peaks occurred after the first reported SARS-CoV-2 infection in Germany (January 27), during a major local outbreak in Heinsberg (February 25), after school closings (March 13) and the largest peak after nationwide contact restrictions (March 22) were announced. On a state level, peaks in RSV were observed after the first reported infection in each respective state. In addition, a higher RSV was recorded in states with higher numbers of infections (r=0,6, p=0,014) such as in Bavaria (RSV=96, 391 infections/100,000 inhabitants) and Baden-Württemberg (RSV=98, 340 infections/100,000 inhabitants). The lowest RSV (n=83) and lowest number of infections (50 infections/100,000 inhabitants) was observed in Mecklenburg-Western Pomerania. Since the end of May, SARS-CoV-2 related RSV remained at low level even when numbers of infections were temporarily rising due to local outbreaks such as the outbreak in Gütersloh, North Rhine-Westphalia. CONCLUSION: RSV related to "coronavirus" precisely reflected public interest during the beginning of the COVID-19 pandemic. As public interest has strongly declined, information distribution regarding the newest developments over the entire course of the pandemic will be a major public health challenge. ZIEL DER STUDIE: Während Pandemien ist die gesamte Gesellschaft zur gleichen Zeit mit derselben Erkrankung konfrontiert, was zu großem öffentlichen Interesse führt. Die aktuelle COVID-19 Pandemie hat die ganze Welt in einen einmaligen Ausnahmezustand versetzt. Ziel dieser Studie war es zu untersuchen ob das Pandemiegeschehen in Deutschland anhand von Google Suchanfragen retrospektiv rekonstruiert werden kann und ob lokale Ausbrüche mithilfe von Google Daten detektiert werden können. METHODIK: Das relative Google Suchvolumen (RSV) zum Thema "Coronavirus" wurde für den Zeitraum von Januar bis Juli 2020 mit Google Trends analysiert. Das RSV, das zwischen 0 und 100 betragen kann, wurde auf Bundesebene mit den täglich neu gemeldeten SARS-CoV-2 Infektionszahlen und auf Länderebene mit den kumulativen Infektionszahlen pro Bundesland sowie wichtigen infektiologischen und politischen Ereignissen verglichen. ERGEBNISSE: Höchstwerte im Google Suchvolumen nach der ersten gemeldeten SARS-CoV-2-Infektion in Deutschland (27. Januar), während des lokalen Ausbruchs in Heinsberg (25. Februar), nach den Schulschließungen (13. März) sowie, der absolute Höchstwert, nach Verkündung der bundesweiten Kontaktbeschränkungen (22. März) verzeichnet worden. Auf Bundesländerebene wurde immer dann ein Anstieg im Suchvolumen beobachtet, wenn die erste SARS-CoV-2 Infektion im jeweiligen Bundesland gemeldet wurde. Zudem wurde ein höheres RSV in Bundesländern mit mehr gemeldeten SARS-CoV-2-Infektionen registriert (r=0,6, p=0,014), wie z. B. in Bayern (RSV=96, 391 Infektionen/100 000 Einwohner) und Baden-Württemberg (RSV=98, 340 Infektionen/100 000 Einwohner). Das niedrigste RSV (n=83) und die niedrigste Anzahl an Infektionen (50 Infektionen/100 000 Einwohner) wurde in Mecklenburg-Vorpommern beobachtet. Seit Ende Mai ist das RSV bezüglich SARS-CoV-2 konstant gering, obwohl die Zahl an Neuinfektionen zwischenzeitlich aufgrund lokaler Ausbrüche gestiegen war wie z. B. der lokale Ausbruch in Gütersloh, Nordrhein-Westfalen. SCHLUßFOLGERUNG: Das RSV zum Thema "Coronavirus" bildeten das öffentliche Interesse während der ersten Monate der COVID-19 Pandemie präzise ab. Da das öffentliche Interesse jedoch stark nachgelassen hat, könnte es eine zentrale Herausforderung im weiteren Verlauf der Pandemie darstellen, die Bevölkerung weiterhin über neueste Entwicklungen und Maßnahmen informiert zu halten.

Genital Psoriasis and Associated Factors of Sexual Avoidance - A People-centered Cross-sectional Study in Germany.

Patients with genital psoriasis show poorer outcomes regarding quality of life and sexual distress than those without. This study aimed to assess the occurrence of genital psoriasis and to determine factors associated with the avoidance of sexual activities due to psoriasis in a non-clinical setting. A cross-sectional, person-centered, and online-based nationwide survey was conducted in Germany between March and June 2019. A multiple logistic regression model was used to analyze the data. Furthermore, free-text answers were provided. Overall, 344 individuals with psoriasis participated. Of these, 198 (57.6%) reported having genital psoriasis and 261 (75.9%) currently received medical care. Duration of psoriasis, subjective overall severity, and pain during sex were associated with the avoidance of sexual activities. Most prevalent reasons to avoid sexual activities were 'shame,' 'pain,' and 'fear of rejection.' Sexual distress was high in this sample and a person-centered care approach needs to be further promoted.

Googling for Ticks and Borreliosis in Germany: Nationwide Google Search Analysis From 2015 to 2018.

BACKGROUND: Borreliosis is the most frequently transmitted tick-borne disease in Europe. It is difficult to estimate the incidence of tick bites and associated diseases in the German population due to the lack of an obligation to register across all 16 federal states of Germany. OBJECTIVE: The aim of this study is to show that Google data can be used to generate general trends of infectious diseases on the basis of borreliosis and tick bites. In addition, the possibility of using Google AdWord data to estimate incidences of infectious diseases, where there is inconsistency in the obligation to notify authorities, is investigated with the perspective to facilitate public health studies. METHODS: Google AdWords Keyword Planner was used to identify search terms related to ticks and borreliosis in Germany from January 2015 to December 2018. The search volume data from the identified search terms was assessed using Excel version 15.23. In addition, SPSS version 24.0 was used to calculate the correlation between search volumes, registered cases, and temperature. RESULTS: A total of 1999 tick-related and 542 borreliosis-related search terms were identified, with a total of 209,679,640 Google searches in all 16 German federal states in the period under review. The analysis showed a high correlation between temperature and borreliosis (r=0.88), and temperature and tick bite (r=0.83), and a very high correlation between borreliosis and tick bite (r=0.94). Furthermore, a high to very high correlation between Google searches and registered cases in each federal state was observed (Brandenburg r=0.80, Mecklenburg-West Pomerania r= 0.77, Saxony r= 0.74, and Saxony-Anhalt r=0.90; all P<.001). CONCLUSIONS: Our study provides insight into annual trends concerning interest in ticks and borreliosis that are relevant to the German population exemplary in the data of a large internet search engine. Public health studies collecting incidence data may benefit from the results indicating a significant correlation between internet search data and incidences of infectious diseases.

Great green tea ingredient? A narrative literature review on epigallocatechin gallate and its biophysical properties for topical use in dermatology.

The purpose of this review is to examine epigallocatechin-3-gallate (EGCG) regarding its stability in different conditions (pH-value, concentration, temperature), its interactions with common cosmetic ingredients, and its application in the dermatological field. The literature research considered published journal articles (clinical trials and scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Higher concentrations of EGCG were reported to correlate with better stability and the same can be said for low temperatures and pH values. The interaction between EGCG and hyaluronic acid strengthens its antioxidant activities. Titanium dioxide coated with EGCG proved a suitable ingredient in sunscreens. The polyphenol possesses antioxidant properties, which proved effective in the prevention of UV-induced skin damage and to alleviate the symptoms of Imiquimod-induced psoriasis. The three endpoints of this review not only showed interesting results but also highlighted some limitations of EGCG. Studies show that the molecule is unstable, which may hinder its dermatological and cosmetic applications. The reported interactions with cosmetic ingredients were limited. As the health aspects of EGCG are well-reported, ECGC has become a focus of interest for health professionals trying to treat common dermatological diseases.

[Effects of an unconventional skin cancer prevention campaign : Impacts on the sun protection behavior of outdoor workers]. / Effekte einer unkonventionellen Hautkrebs-Präventionskampagne : Auswirkungen auf das Sonnenschutzverhalten von Außenberufstätigen.

BACKGROUND: The disease burden of actinic keratoses and keratinocyte carcinoma can be reduced by primary and secondary prevention. However, these measures are often poorly received, especially among the high-risk group of outdoor workers. OBJECTIVES: The aim of this follow-up study was to investigate whether an improvement in sun protection and awareness of skin changes could be observed among the study population, especially outdoor workers, one year after a prevention campaign focusing on this topic. MATERIALS AND METHODS: In 2017, all participants who initially participated in a study at the Bavarian Central Agricultural Festival 2016 and agreed to participate in the follow-up study were contacted by mail and received the same questionnaire and evaluation questions regarding possible behavioral changes. RESULTS: A total of 400 people took part in the follow-up study (response rate 52.8%). Of the 240 outdoor workers, 45.0% said they were more conscious of protecting themselves from the sun and 68.8% said they were more aware of skin changes. About 85.0% of outdoor workers indicated that they would consult a dermatologist earlier and 65.8% desired further prevention campaigns regarding skin cancer and sun protection. CONCLUSION: Overall, the majority of participants reported that they had improved sun protection behavior and awareness of skin changes after the intervention. Based on the participants' self-disclosure, especially outdoor workers tended to use sun protection measure more frequently. These findings underline the importance of target group-oriented awareness and prevention campaigns to reduce the burden of skin cancer.

Stigmatization caused by hair loss - a systematic literature review.

Hair loss is a symptom that can cause stigmatization and severe impairment of quality of life. The aim of this systematic review was to evaluate the literature on stigmatization of hair loss. Using predefined MeSH terms and keywords, a systematic search was performed in the databases MEDLINE (PubMed), EMBASE, PsycINFO and PsycNET. No time restriction was chosen (last update: May 07, 2019; PROSPERO registration number: CRD42019122966). A total of 98 studies were identified, of which eleven were selected for inclusion in this work. The Hairdex, a questionnaire on disease-specific quality of life, was the most frequently used instrument for the quantitative assessment of stigma. The studies were highly heterogeneous and values for stigmatization of androgenetic alopecia varied widely. However, regardless of the pathogenesis, patients with hair loss often suffer from stigmatization which limits their quality of life. Stigmatization of people with visible skin lesions has often been neglected in clinical practice and in daily contact with affected individuals. Studies that specifically address the stigma of hair loss are rare. Further studies are needed to achieve comparability within pathogeneses as well as with other visible dermatoses in order to better understand the enormous psychosocial burden of hair loss.

Interest in Skin Cancer in Urban Populations: A Retrospective Analysis of Google Search Terms in Nine Large German Cities.

Skin cancer is a major public health issue, which could be reduced through prevention programmes. How-ever, prevention utilization is not very prevalent. It is therefore important to understand individuals' interest in skin cancer. Google AdWords Keyword Planner was used to identify the search volume of terms relating to skin cancer in 9 German cities between July 2014 and June 2018. From a total of 1,203 identified keywords, 1,047 search terms were related to skin cancer, which had a search volume of 3,460,980 queries for the study period. Most terms referred to "identifying skin cancer". For melanoma, the number of Google searches per 100,000 inhabitants correlated with the cancer registry data for melanoma incidence rates (men: r = 0.810, women: r = 0.569). Assessment of this data for the different cities further enabled identification of regional variations, which could help to identify areas with a high need for targeted prevention campaigns.

Influence of Climate on Google Internet Searches for Pruritus Across 16 German Cities: Retrospective Analysis.

BACKGROUND: The burden of pruritus is high, especially among patients with dermatologic diseases. Identifying trends in pruritus burden and people's medical needs is challenging, since not all affected people consult a physician. OBJECTIVE: The purpose of this study was to investigate pruritus search behavior trends in Germany and identify associations with weather factors. METHODS: Google AdWords Keyword Planner was used to quantify pruritus-related search queries in 16 German cities from August 2014 to July 2018. All identified keywords were qualitatively categorized and pruritus-related terms were descriptively analyzed. The number of search queries per 100,000 inhabitants of each city was compared to environmental factors such as temperature, humidity, particulate matter 10 micrometers or less in diameter (PM10), and sunshine duration to investigate potential correlations. RESULTS: We included 1150 pruritus-related keywords, which resulted in 2,851,290 queries. "Pruritus" (n=115,680) and "anal pruritus" (n=102,390) were the most-searched-for keywords. Nearly half of all queries were related to the category localization, with Berlin and Munich having a comparatively high proportion of people that searched for pruritus in the genital and anal areas. People searched more frequently for information on chronic compared to acute pruritus. The most populated cities had the lowest number of queries per 100,000 inhabitants (Berlin, n=13,641; Hamburg, n=18,303; and Munich, n=21,363), while smaller cities (Kiel, n=35,027; and Freiburg, n=39,501) had the highest. Temperature had a greater effect on search query number (beta -7.94, 95% CI -10.74 to -5.15) than did PM10 (beta -5.13, 95% CI -7.04 to -3.22), humidity (beta 4.73, 95% CI 2.70 to 6.75), or sunshine duration (beta 0.66, 95% CI 0.36 to 0.97). The highest relative number of search queries occurred during the winter (ie, December to February). CONCLUSIONS: By taking into account the study results, Google data analysis helps to examine people's search frequency, behavior, and interest across cities and regions. The results indicated a general increase in search queries during the winter as well as differences across cities located in the same region; for example, there was a decline in search volume in Saarbrucken, while there were increases in Cologne, Frankfurt, and Dortmund. In addition, the detected correlation between search volume and weather data seems to be valuable in predicting an increase in pruritus burden, since a significant association with rising humidity and sunshine duration, as well as declining temperature and PM10, was found. Accordingly, this is an unconventional and inexpensive method to identify search behavior trends and respective inhabitants' needs.