Frostbite is a thermal injury that can occur when temperatures drop low enough for tissue to freeze. On rewarming the tissues, an inflammatory process develops which is often associated with tissue loss. The extent of the tissue loss reflects the severity of the cold exposure and includes factors such as temperature, duration, wind chill, altitude, and systemic hypothermia. This review discusses the epidemiology, the pathophysiological processes involved, and the clinical management of frostbite injuries. Practical advice is given on both the field and hospital management and how to seek expert advice from remote situations. The review also discusses newer developments in frostbite treatment such as intra-vascular thrombolysis and adjunctive treatments such as the use of intravenous vasodilators.

Aim Previous studies have demonstrated a positive effect of school-based life skills programmes on the prevention of substance abuse and other health-risk behaviours in children and adolescents. However, the comparison and interpretation of study results is difficult due to methodological problems. In particular, the effectiveness of such programmes within high-risk groups remains uncertain. In this study, we investigated the effects of two school-based life skills programmes on substance abuse and subjective health in a sample with a high proportion of socially disadvantaged pupils. Subjects and methods We conducted a randomised controlled intervention study with repeated measurements over time. The sample included pupils of secondary schools in northern Germany with an overrepresentation of pupils with low socioeconomic status. We evaluated effects of the programmes on substance abuse and psychosocial outcomes. In addition, we conducted a process evaluation. ResultsThe sample included 102 classes with a total of 1,561 pupils. Twenty-five per cent of the pupils were of a low socioeconomic status. We found significant positive effects regarding the reduction of smoking and some improvements in the pupils' life skills in the intervention group compared to the control group. Socioeconomic status had no moderating effect on the results. Conclusion School-based life skills programmes have a positive effect on smoking prevention regardless of socioeconomic status. Socially disadvantaged children benefit from such programmes to a similar extent as other pupils. Pupils and teachers appreciate the programmes. A supportive school environment appears to be an important factor in the successful implementation of school-based life skills programmes.

If applied according to the instructions the device manages a satisfactory inactivation of bacteria. However, it bears the danger of user errors relevant to health. Therefore, education on the risks of incorrect application should be included in the travel medical consultation. Also there are still aspects that need to be subject to further independent research.

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More and more persons are exposed to hypoxia while working at altitude, e.g. when working for cable cars or ski areas in the Alps, for business in South America or Asia, as airline crews, or in rooms with reduced oxygen pressure for hypoxia training or fire protection. Unfortunately, the different countries have a multitude of regulations for occupational health and safety concerning hypoxia -most of them with major deficiencies and a significant lack of knowledge about hypoxia and possible specific risks. So far, no national regulation differentiates the different types of hypoxia and the environment, both having significant influence on the specific risk profile of employees and consequences for occupational health and safety.As the world's umbrella body for preventive medicine at altitude / hypoxia, the Medical Commission of the Union Internationale des Associations d'Alpinisme (UIAA MedCom) recently established a recommendation to enable the national bodies to establish knowledge-based pragmatic procedures for occupational health and safety [1]. The most important message is as follows: Any environment with oxygen concentration of 14.0% or more or an altitude of 3,000 m or less is safe for any non-acclimatized person without severe cardiopulmonary disease (10 g/dl) and an exposure limited to a few hours (one work shift). These environments include most alpine cable cars, ski areas, aircrafts flying on long-range distances, most towns or villages where businessmen might go to, and rooms for fire protection. For longer exposure (sleep at high altitude) or higher environments the persons should be acclimatized or exposed for a short time only. Details how to manage health and safety in such environments are given.