Investigating International Time Trends in the Incidence and Prevalence of Atopic Eczema 1990-2010: A Systematic Review of Epidemiological Studies

The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner

Compound events in Germany in 2018: drivers and case studies

The European continent is regularly affected by a wide range of extreme events and natural hazards including heatwaves, extreme precipitation, droughts, cold spells, windstorms, and storm surges. Many of these events do not occur as single extreme events, but rather show a multivariate character, the so-called compound events. Within the scope of the interdisciplinary project climXtreme (https://climxtreme.net/), we investigate the interplay of extreme weather events, their characteristics and changes, intensity, frequency and uncertainties in the past, present and future and associated impacts on various socio-economic sectors in Germany and Central Europe. This contribution presents several case studies with special emphasis on the calendar year of 2018, which is of particular interest given the exceptional sequence of different compound events across large parts of Europe, with devastating impacts on human lives, ecosystems and infrastructure. We provide new evidence on drivers of spatially and temporally compound events (heat and drought; heavy precipitation in combination with extreme winds) with adverse impacts on ecosystems and society using large-scale atmospheric patterns. We shed light on the interannual influence of droughts on surface water and the impact of water scarcity and heatwaves on agriculture and forests. We assessed projected changes in compound events at different current and future global surface temperature levels, demonstrating the importance of better quantifying the likelihood of future extreme events for adaptation planning. Finally, we addressed research needs and future pathways, emphasising the need to define composite events primarily in terms of their impacts prior to their statistical characterisation

The extremely hot and dry 2018 summer in central and northern Europe from a multi-faceted weather and climate perspective

The summer of 2018 was an extraordinary season in climatological terms for northern and central Europe, bringing simultaneous, widespread, and concurrent heat and drought extremes in large parts of the continent with extensive impacts on agriculture, forests, water supply, and the socio-economic sector. Here, we present a comprehensive, multi-faceted analysis of the 2018 extreme summer in terms of heat and drought in central and northern Europe, with a particular focus on Germany. The heatwave first affected Scandinavia in mid-July and shifted towards central Europe in late July, while Iberia was primarily affected in early August. The atmospheric circulation was characterized by strongly positive blocking anomalies over Europe, in combination with a positive summer North Atlantic Oscillation and a double jet stream configuration before the initiation of the heatwave. In terms of possible precursors common to previous European heatwaves, the Eurasian double-jet structure and a tripolar sea surface temperature anomaly over the North Atlantic were already identified in spring. While in the early stages over Scandinavia the air masses at mid and upper levels were often of a remote, maritime origin, at later stages over Iberia the air masses primarily had a local-to-regional origin. The drought affected Germany the most, starting with warmer than average conditions in spring, associated with enhanced latent heat release that initiated a severe depletion of soil moisture. During summer, a continued precipitation deficit exacerbated the problem, leading to hydrological and agricultural drought. A probabilistic attribution assessment of the heatwave in Germany showed that such events of prolonged heat have become more likely due to anthropogenic global warming. Regarding future projections, an extreme summer such as that of 2018 is expected to occur every 2 out of 3 years in Europe in a +1.5 ∘C warmer world and virtually every single year in a +2 ∘C warmer world. With such large-scale and impactful extreme events becoming more frequent and intense under anthropogenic climate change, comprehensive and multi-faceted studies like the one presented here quantify the multitude of their effects and provide valuable information as a basis for adaptation and mitigation strategies

Verletzungen bei Kindern und Jugendlichen (1–17 Jahre) und Umsetzung von persönlichen Schutzmaßnahmen

Die Befragung der Eltern zu Unfällen ihrer Kinder und Unfall vorbeugenden Maßnahmen im Kinder- und Jugendgesundheitssurvey (KiGGS) verfolgt das Ziel, repräsentative alters- und geschlechtsspezifische Daten zu Verletzungen im Kindes- und Jugendalter zu erhalten, um Risikogruppen und Risikofaktoren für die Unfallprävention zu identifizieren. Befragt wurden 16.706 Eltern zu Verletzungen ihrer Kinder (1–17 Jahre) in den letzten 12 Monaten, die ärztlich behandelt werden mussten, und zu Merkmalen des Unfallgeschehens wie Unfallort, Unfallmechanismus, Verletzungsfolgen und ambulante bzw. stationäre Behandlung. Darüber hinaus wurden sowohl Eltern als auch Kinder und Jugendliche zwischen 11 und 17 Jahren (n = 6813) zu Schutzmaßnahmen befragt. 15,9 % der Kinder und Jugendlichen (1–17 Jahre) hatten nach Elternangaben mindestens eine Verletzung, davon 15,2 % durch einen Unfall und 0,8 % durch Gewalt bei tätlicher Auseinandersetzung. In der Altersgruppe der Ein- bis unter 18-Jährigen verunglückten Jungen signifikant (p < 0,001) häufiger als Mädchen (17,9 % vs. 14,0 %). Insgesamt mussten 13,3 % von 2410 verletzten Kindern und Jugendlichen im Krankenhaus behandelt werden. Bei den Unfallorten dominierten die häuslichen Unfälle mit 60 % bei den Kleinkindern (1–4 Jahre), während Sport- und Freizeitunfälle bei den 5- bis unter 15-Jährigen und 15- bis unter 18-Jährigen im Vordergrund standen (32,1 % bzw. 38,9 %). Der Anteil der Unfälle in den Betreuungs- und Bildungseinrichtungen verdreifachte sich vom Kleinkindalter zum Schulalter (5–14 Jahre) von 10,9 % auf 28,7 % und ebenso der Anteil der Straßenverkehrsunfälle von 5,6 % auf 16,7 %. Die 3 häufigsten Verletzungsmechanismen bei Kindern und Jugendlichen (1–17 Jahre) waren Stürze in der Ebene (35,2 %), aus der Höhe (25,2 %) und Zusammenstöße (20,6 %). Stürze aus der Höhe hatten ihren Häufigkeitsgipfel im Kleinkindalter (35,8 %). Prellungen, Verrenkungen und Zerrungen erreichten im Jugendalter (15–17 Jahre) mit 50,9 % einen Höchstwert; ebenso nahm der Anteil der Knochenbrüche von 10,7 % bei Kleinkindern auf 21,8 % bei den 15- bis unter 18-jährigen Jugendlichen stark zu. Während ein Zusammenhang zwischen Unfällen und Sozialstatus bei den Unfällen insgesamt und einzelnen Verletzungsfolgen nicht festgestellt werden konnte, zeigten sich jedoch bei den Verkehrsunfällen für ein- bis unter 18-jährige Mädchen (p = 0,047) und Jungen (p = 0.019) signifikant höhere Raten bei niedrigem Sozialstatus der Eltern verglichen zum hohen Sozialstatus. Bei der Umsetzung von Schutzmaßnahmen lagen die Raten bei den 15- bis unter 18-jährigen Jugendlichen am niedrigsten. Während nach Elternangaben die 3- bis unter 5-jährigen Jungen und Mädchen hohe Helmtragequoten beim Fahrradfahren und Inlineskaten von ca. 90 % erreichten, waren diese bei den 5- bis unter 15-Jährigen Jungen und Mädchen mit über 60 % deutlich geringer und bei den 15- bis unter 18-Jährigen mit nur noch knapp 15 % am niedrigsten. Ebenfalls waren auch die Tragequoten für Protektoren bei den 15- bis unter 18-jährigen Jugendlichen am niedrigsten (Jungen 41,8 % vs. 52,2 % bei Mädchen). Die Selbstangaben der 11- bis unter 18-Jährigen lagen deutlich unter den Elternangaben. Der Sozial- und Migrationsstatus zeigte in allen Altersgruppen einen signifikanten Zusammenhang mit niedrigen Tragequoten bezogen auf Helme und Protektoren. Die altersgruppenbezogene Datenanalyse sollte Ausgangspunkt für zielgruppenbezogene Präventionsmaßnahmen sein und insbesondere den Sozial- und Migrationsstatus berücksichtigen. Dabei sind Präventionsaktivitäten im Verkehrsbereich insbesondere auf Familien mit niedrigem Sozialstatus auszurichten. Jugendliche sollten bei der Aufklärung über den Nutzen von Schutzmaßnahmen beim Fahrradfahren und Skaten verstärkt und adäquat angesprochen werden.Parent interviews with regard to their children's accidents and to accident protective measures in the Health Interview and Examination Survey for Children and Adolescents (KiGGS) aimed at extending our knowledge of age- and gender-specific injuries and to identify risk groups and risk factors for injury prevention. The parents of 16,706 children (aged 1–17 years) were asked about their children's injuries within the last 12 months which were medically treated, and about accident mechanisms, consequences of injuries, and ambulatory and hospital treatment. In addition, parents and children aged 11 to 17 years (n = 6813) were asked to give information on protective measures. According to the parents 15.9 % of the children had at least one injury within the last 12 months, 15.2 % because of an accident and 0.8 % because of assault. In the age group 1–17 boys have been injured significantly more often than girls (17.9 % vs. 14,0 %). Overall, 13.3 % of 2,410 injured children and adolescents were hospitalized. Two thirds of the accidents among toddlers were domestic accidents (60 %) whereas leisure and sport accidents were most prevalent in children and adolescents aged 5–14 years and 15–17 years (32.1 % and 38.9 %). The proportion of accidents in child care facilities and educational institutions tripled from infancy to school age (age 5–14 years) (10.9–28.7 %), as did traffic accidents (5.6–16.7 %). The three most frequent injury mechanisms in the age range 1–17 years were falls on level ground (35.2 %), falls from heights (25.2 %) and collisions with objects or persons (20.6 %). Falls from heights showed the highest risk in toddlers (35.8 %). Contusions, sprains and strains increased to a highest level of 50.9 % in adolescents; likewise, bone fractures increased from 10.7 % in toddlers to 21.8 % in adolescents aged 15–17 years. An influence of socioeconomic status on injuries overall and on consequences of injuries was not seen. For traffic accidents in children aged 1–17 years boys (p = 0.019) and girls (p = 0.047) from families with lower socioeconomic status showed higher rates of accidents than children from families with higher socioeconomic status. The application of protective measures was lowest in the age group 14–17 years. While according to the parents about 90 % of children aged 3–4 years wear a helmet when riding a bicycle or when skating, this quote was lower in the age group 5–14 (60 %) and dropped to about 15 % in the age group 14–17 (about 15 %). Also the rate for using protective clothes was lowest in age group 14–17 (boys 41.8 %; girls 52.2 %). In children and adolescents the rate of self-reported helmet use is lower than estimated by their parents. In all age groups migration background and low socioeconomic status were associated with lower use of protective measures (helmets and protective clothes). The age related data analysis should be the starting point in prevention measures for specific risk groups considering migration and socioeconomic status. Prevention activities in traffic should focus on families with low social status. Adolescents should be specifically and adequately addressed regarding the benefits of certain safety measures when riding a bicycle and when skating