Pollen threshold values used in public warning systems are intended to inform people of the risk of developing allergy symptoms. However, there is no consensus about which pollen concentrations ...provoke allergy symptoms. The aim of this systematic review was the evaluation of studies investigating the relationship between pollen concentrations (alder, ash, birch, hazel, mugwort and ragweed) and the number of cases in which participants visited a doctor, drug consumption and allergy symptoms. This systematic literature review is registered in PROSPERO (CRD42019112369). A PubMed search was applied and enriched by consultation with experts and a snowball strategy. The included studies were checked for risk of bias (RoB), and extensive data were extracted and compared. Of 511 studies, 22 were eligible according to the previously established inclusion criteria, and 17 from these showed a low RoB. The strongest evidence was reported for ash (
Fraxinus
) pollen, where an increase of number of doctor’s visits at an interquartile range (IQR) of 18–28 grains/m
3
was detected by three studies. Five studies about birch (
Betula
) pollen showed a threshold value of 45 grains/m
3
for increased drug consumption. The evidence of a threshold value was limited for alder (
Alnus
), hazel (
Corylus
), mugwort (
Artemisia
) and ragweed (
Ambrosia
) pollen. The inconsistent results concerning all types of pollen, except ash pollen, can be the result of multiple factors, e.g., age, gender, allergen content of pollen and individual sensitivity. These influencing factors should be investigated more closely in future research.
Concerns about smoking displacement from public places to private amenities aroused following smoking ban implementation in Bavaria in 2008. We analysed children's exposure to second-hand smoke (SHS) ...before and after the ban, its effect on children's health and prevalence of active smoking in adults.
Six cross-sectional surveys (n = 32,443) on pre-school children in Bavaria were analysed, two surveys before the smoking ban in years 2004 and 2005 (S1 and S2) and four after the ban in 2008, 2012, 2014 and 2016 (S4, S6, S7 and S8). Using multivariable logistic regression, we analysed change in children's intra- and extrauterine SHS exposure and its adverse health effects (Asthma, wheezing, bronchitis and neurodermatitis) as well as change in parental active smoking.
The response rates were 78% for S1, 73% for S2, 61% for S4, 62% for S6, 56% for S7 and 54% for S8. Odds of parents never smoked at home in presence of children increased significantly from before to after the ban with odds ratios (OR) 1.17 (CI
1.01-1.35), 1.65 (CI
1.39-1.95), 2.85 (CI
2.32-3.51), 2.24 (CI
1.84-2.72) and 3.66 (CI
2.89-4.63) for S2, S4, S6, S7 and S8, respectively with S1 as reference. Compared to S4, odds of parents who were not actively smoking is significantly higher in S7 (OR = 1.13 (CI
1.03-1.24)) and S8 (OR = 1.24 (CI
1.13-1.36)). The odds of mothers who never smoked during pregnancy increased over time with OR = 1.22 (CI
1.06-1.40) for S2 and 1.57 (CI
1.33-1.86) for S8 compared to S1. Adverse health effects related to children's exposure to SHS are significantly less in S8 compared to S1.
After 11 years of smoking ban in Bavaria, smoking displacement to homes was disproved. Exposure of children to SHS intrauterine and at home is decreasing. Number of parents who are not actively smoking is increasing over time. Prevalence of health problems in children related to exposure to SHS is decreasing.
Introduction: Children’s skin is particularly susceptible to the carcinogenic effects of ultraviolet radiation. Young children are dependent on sun protection measures taken by parents and other ...caregivers. Objective: The aim of the study is to evaluate parental sun protection behavior and sun protection measures at preschool at 2 points in time (2010/11 and 2018/19) in Bavaria and to test for a secular trend. Methods: Two cross-sectional surveys were carried out. For each survey, more than 4,000 parents of preschoolers completed a self-administered questionnaire about parental sun protection behavior and sun protection measures at preschool. To identify possible associations between parental sun protection behavior and sociodemographic characteristics, logistic regression analysis was carried out. Results: In the survey of 2018/19, 6 out of 8 sun protection measures are adequately applied by over two-thirds of the parents. Two out of 8 sun protection measures are adequately applied by less than one-third of the parents. Those 2 measures are aligning sun protection to actual UV index and preschoolers wearing sunglasses. The comparison of the study population of the survey of 2010/11 and of 2018/19 shows an improvement in parental sun protection behavior for 7 out of 8 sun protection measures. In both surveys more than 80% of parents state that preschool staff ensures preschoolers wearing sun hats and sunscreen outside on sunny days. Conclusion: Future campaigns should focus on the use of sunglasses and promote the UV index, as these sun protection measures are used very little.
Airborne grass (Poaceae) pollen measurements are used in public warning systems to inform people about the risk of allergic symptoms. However, there is no consensus about which exact thresholds of ...pollen concentrations provoke the allergic symptoms. The aim of this study was to review the relevant scientific information on the relationship between grass pollen concentrations and the occurrence of emergency department (ED) visits, hospital admissions (HA), drug consumption and allergic symptoms. Literature search was conducted by experts’ consultation and snowball strategy. Studies meeting the criteria for inclusion were assessed regarding their risk of bias (RoB). A high RoB resulted in exclusion of the study from data synthesis. Extensive data were extracted and qualitatively compared. The review is registered in PROSPERO. 32 Studies were eligible while 18 showed a low RoB and were qualitatively synthesised. Emergency department visits and hospital admissions were mostly investigated. Threshold values of 10 grains/m
3
and 12 grains/m
3
were reported for ED visits and HA. Evidence exists that an increase of 10 grains/m
3
of air leads to a significant increase in adverse health outcomes. Especially at a three-day lag, adverse health effects were shown. Variations in exposure and outcome measurement make the definition of pollen thresholds difficult. As a consequence, no defined pollen threshold values could be identified. Studies with uniform exposure measures and statistical methods are necessary to gain a better understanding of the impact of grass pollen on human health. Determining personal thresholds could be beneficial for affected people.
Occupational asthma is commonly observed in bakers and confectioners. Endogenous and exogenous risk factors contribute to bakers' asthma. A heightened awareness of this and early diagnosis can be ...helpful in terms of prevention. The aim of the study was to identify a temporal relationship between the years of training, as well as possible technical, procedural, and individual risk factors for the development of flour-exposure related atopic symptoms such as rhinitis, cough, and rash in young professionals.PURPOSEOccupational asthma is commonly observed in bakers and confectioners. Endogenous and exogenous risk factors contribute to bakers' asthma. A heightened awareness of this and early diagnosis can be helpful in terms of prevention. The aim of the study was to identify a temporal relationship between the years of training, as well as possible technical, procedural, and individual risk factors for the development of flour-exposure related atopic symptoms such as rhinitis, cough, and rash in young professionals.127 bakers and confectioner trainees were observed over a one-year period. Two questionnaires served as test instruments. It was investigated whether the rates of atopic symptoms change over the course of a school year and which conditions in the workplace could be responsible for this. Descriptive statistics were used to answer the research questions concerning flour exposure and symptom rates. The Pearson-Chi-Square test was used for testing statistical differences between different groups (e.g. year of training, working conditions).METHODS127 bakers and confectioner trainees were observed over a one-year period. Two questionnaires served as test instruments. It was investigated whether the rates of atopic symptoms change over the course of a school year and which conditions in the workplace could be responsible for this. Descriptive statistics were used to answer the research questions concerning flour exposure and symptom rates. The Pearson-Chi-Square test was used for testing statistical differences between different groups (e.g. year of training, working conditions).An increase in rates of self-reported rhinitis, coughing, and rashes throughout the duration of traineeship was shown (e.g. rhinitis of bakers at work: 0% in the first year of training, 20% in the second and 33% in the third year of training). The installation of vapour extraction systems and low-dust transfer of baking agents led to fewer symptoms in the workplace (30% of participants with rhinitis symptoms worked with no installed vapour extraction systems). A medical history of atopy was positively correlated with the occurrence of symptoms.RESULTSAn increase in rates of self-reported rhinitis, coughing, and rashes throughout the duration of traineeship was shown (e.g. rhinitis of bakers at work: 0% in the first year of training, 20% in the second and 33% in the third year of training). The installation of vapour extraction systems and low-dust transfer of baking agents led to fewer symptoms in the workplace (30% of participants with rhinitis symptoms worked with no installed vapour extraction systems). A medical history of atopy was positively correlated with the occurrence of symptoms.To prevent the development of asthma in bakers, methods to improve occupational health and safety should be developed. Creating low dust working conditions e.g., due to the use of vapour extraction systems should be considered.CONCLUSIONTo prevent the development of asthma in bakers, methods to improve occupational health and safety should be developed. Creating low dust working conditions e.g., due to the use of vapour extraction systems should be considered.
To observe total leisure noise (TLN) exposure and to investigate determinants of risky TLN exposure among adolescents and young adults over a ten-year observation period.
OHRKAN is a longitudinal ...study with five equidistantly distributed questionnaires (waves) over ten years. Risky TLN exposure was defined as exceeding ≥85dB(A) averaged over 40h per week. To identify determinants of risky TLN exposure longitudinally, generalised estimating equations were applied.
A subgroup (n = 661; mean age 25.6 years in the fifth wave; 58.4% female) of the closed cohort study OHRKAN was analysed. Included participants took part in the fifth wave prior to the study break due to COVID-19.
Analysis of participants' data from all five waves showed that risky TLN exposure was highest during the second wave (72.0%), when participants were aged 17-19 years, and thereafter steadily declined. Among young adults, attendance at discotheques and private parties, especially, caused very high exposure. Determinants of risky TLN exposure were wave time point, male gender, a higher level of education, and smoking.
As TLN exposure is highest among older adolescents, prevention programs should target younger teenagers and be tailored to the identified risk groups. The risk from private parties should be addressed.
Airborne pollen is a recognized biological indicator and its monitoring has multiple uses such as providing a tool for allergy diagnosis and prevention. There is a knowledge gap related to the ...distribution of pollen traps needed to achieve representative biomonitoring in a region. The aim of this manuscript is to suggest a method for setting up a pollen network (monitoring method, monitoring conditions, number and location of samplers etc.). As a case study, we describe the distribution of pollen across Bavaria and the design of the Bavarian pollen monitoring network (ePIN), the first operational automatic pollen network worldwide.
We established and ran a dense pollen monitoring network of 27 manual Hirst-type pollen traps across Bavaria, Germany, during 2015. Hierarchical cluster analysis of the data was then performed to select the locations for the sites of the final pollen monitoring network. According to our method, Bavaria can be clustered into three large pollen regions with eight zones. Within each zone, pollen diversity and distribution among different locations does not vary significantly. Based on the pollen zones, we opted to place one automatic monitoring station per zone resulting in the ePIN network, serving 13 million inhabitants. The described method defines stations representative for a homogeneous aeropalynologically region, which reduces redundancy within the network and subsequent costs (in the study case from 27 to 8 locations). Following this method, resources in pollen monitoring networks can be optimized and allergic citizens can then be informed in a timely and effective way, even in larger geographical areas.
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•The first automatic pollen monitoring network in the world was built in Bavaria, based on the pollen robot BAA500.•Collapsing a dense network by clustering analysis determined the number and position of monitoring stations.•Bavaria (Germany) can be clustered in 3 pollen zones and 8 sub-zones, based on airborne pollen concentrations.•In the studied network, the most abundant pollen types in Bavaria are: Pinus, Betula, Urticaceae and Poaceae.•In the studied network, the main pollination period in Bavaria ranges from February (Alnus) to October (Ambrosia).
A compulsory school entrance examination of pre-school children (SEU) is administered in the German state of Bavaria. Every second year since 2004, the examinations are expanded in six study regions ...using a cross-sectional survey design (GME). However, the extent to which the results of the GME surveys are generalizable to the SEU population is unknown. Therefore, this study carried out a poststratification of two different GME surveys. The aim was to observe the impact of poststratification on an exemplary analysis of influencing factors for three allergy and asthma related outcomes (hay fever, asthma, wheezing) and thus to better understand this important question.
First, poststratification was applied to correct for deviances of the GME sample in comparison to the SEU population. Logistic regression was used to determine the auxiliary variables for the poststratification. Following this, a composite variable as a linear combination was created to calculate weighting factors. Next, logistic regression analyses were applied to analyze possible influencing factors for three allergy and asthma related outcomes (hay fever, asthma and wheezing) in two GME surveys (2005/2006 and 2012/2013). Subsequently, the differences arising from poststratification were examined in more detail.
This study supports the hypothesis that the GME sample deviates from the SEU population. Mother tongue other than German of at least one parent, complete vaccination status and conspicuous visuomotor test results were positively associated with participation in both GME surveys. The prevalence for hay fever, asthma and frequent wheeze did not change statistically significant from 2005/2006 to 2012/2013. In the twelve analyses before and after poststratification, male sex was statistically significant associated with the three allergy and asthma related outcomes (e.g. asthma 2005/2006 after poststratification, aOR: 2.06, 95%-CI: 1.56–2.71). A high body mass index was positively associated with asthma (e.g. 2005/2006 after poststratification, aOR: 1.12, 95%-CI: 1.05–1.20). Poststratification caused a significant change in the sample composition.
It might be suggested that a poststratification should be performed for each GME survey. Poststratification tended to make results more comparable with previous research. In accordance with previous research, this study confirmed that male sex and high BMI are associated with asthma.
•Samples of Bavarian health monitoring units deviates from population.•Higher share of non-native speakers of German in participating regions of the sample.•Poststratification caused a significant change in the sample composition.•Further evidence for the association between male sex/high BMI and asthma.•No significant change of prevalence of asthma from 2006 to 2013.
Zusammenfassung
Der Klimawandel und seine Folgen können unsere Gesundheit beeinträchtigen. Beispielsweise kann es infolge der Klimaveränderungen zu einer Zunahme von übertragbaren Erkrankungen oder ...Hitzeereignissen kommen. Zum Schutz unserer Gesundheit sind Maßnahmen zur Anpassung an die Folgen des Klimawandels unabdingbar. Hierbei kommt dem Öffentlichen Gesundheitsdienst (ÖGD) eine tragende Rolle zu.
Introduction: Asthma is among the most common chronic conditions in children. The aim of this publication is to describe prevalence rates and factors associated with asthmatic or wheezing ...preschoolers and to evaluate medical care and treatment with regard to urban-rural differences.
Methods: Data for this cross-sectional study were collected through a questionnaire, which was distributed to parents within the Health Monitoring Units in Bavaria (HMU), Germany. Data from 4767 children were available (2016/17). Those children were classified into four diagnostic groups: Unremitting Wheeze, International Study of Asthma and Allergies in Children (ISAAC) Asthma, Physician-diagnosed Asthma, and healthy control group. Urban-rural differences were tested by Pearson's chi-squared test or by Fisher's exact test. Independent variables were factors associated with health outcomes, for example, residency or migrant status. To examine associations between independent and outcome variables multivariate logistic regression analysis was performed.
Results: Prevalence rates were 6.3% for 'Unremitting Wheeze', 5.2% for 'ISAAC Asthma', and 1.2% for 'Physician-diagnosed Asthma'. Factors associated with health outcomes were the occurrence of asthma in first-degree relatives, male sex, and migrant status. Generally, higher rates of doctor's visits, positive allergy tests, and corticosteroids intake in the diagnostic groups in rural compared to urban areas were observed. Rates of performed allergy tests were 55.6% for 'ISAAC Asthma' and 74.6% for 'Physician-diagnosed Asthma'.
Conclusions: Prevalence rates of the diagnostic groups decreased compared to the HMU 2014/15. According to previous studies, factors associated with asthmatic or wheezing health outcomes could be confirmed. Children in rural areas generally received more medical care.
Key points
Children's prevalence rates of asthma or wheezing disorders decreased in the past 2 years within Bavaria.
This study is consistent with risk factors for asthma from the literature: asthma in the family, male gender, and migrant status.
Children in rural areas receive more medical care than children in urban areas.
There should me more allergy tests among children with medical diagnosis in Bavaria as low rates indicate gaps in care.
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