The environment in which we are born, live, work, and age is an important determinant of human health. This review summarises key epidemiological studies conducted over the past 15 years at the Department of Public Health, Faculty of Medicine, University of Ljubljana, in collaboration with experts in public health, clinical medicine, and other health and environmental disciplines. Methodological approaches for linking health and environmental data, including advanced spatial epidemiological methods to assess the impact of ambient air pollutants on respiratory diseases and diabetes, were highlighted. Considering the observed health outcomes among children and adolescents, new tools were developed and validated to estimate the prevalence of asthma and sleep-related problems among youths. In adults, the review examines the lifetime prevalence of first and recurrent systemic allergic reactions to bee venom among beekeepers, emphasising the need for effective risk-management strategies. Overall, the studies demonstrated the value of integrating health and environmental data to better understand and address public health challenges in Slovenia. The findings underscore the importance of interdisciplinary collaboration in developing evidence-based public health policies to mitigate environmental health risks and promote a high quality of life for present and future generations.

Introduction:This study aimed to develop a suitable instrument for assessing excessive daytime sleepiness (EDS) in Slovenian children and adolescents by translating the ESS-CHAD and psychometrically validating its Slovenian version (ESS-CHAD-SI). Methods:The ESS-CHAD was translated and back-translated according to established cross-cultural adaptation guidelines, and content validity was assessed by eleven experts from relevant clinical and research disciplines. A nationwide sample of 3,314 adolescents (≈52% females), with an overall mean age of 15.4±1.7 years, completed the questionnaire. Reliability was evaluated using Cronbach's α and Guttman's λ2, and construct validity was examined using exploratory and confirmatory factor analyses. Results:All items met the predefined thresholds for content relevance, while clarity indices were acceptable for the majority of items. Factor analyses indicated that a two-factor model provided a better fit to the data than the original unidimensional structure, distinguishing between passive sleepiness and more clinically concerning manifestations of sleepiness. The ESS-CHAD-SI demonstrated adequate internal consistency. Conclusions:The ESS-CHAD-SI is a reliable, valid, and culturally adapted instrument for assessing excessive daytime sleepiness in Slovenian adolescents. The identified two-factor structure enhances its clinical and public health relevance by enabling differentiation between sleepiness related to modifiable sleep behaviours and potentially pathological somnolence. The scale is suitable for use in school-based screening, clinical practice, and epidemiological research.

Objective: This systematic review evaluates the thiamin status of the European adult population, identifying critical gaps and priorities for future research. Methods: The review was conducted according to a pre-registered protocol (PROSPERO: CRD420251101630) and PRISMA guidelines. A systematic search of PubMed and Scopus was carried out to identify observational studies reporting relevant thiamin status biomarkers (erythrocyte transketolase activity coefficient (ETKAC), whole blood thiamin diphosphate (WB ThDP), total thiamin in whole blood, or erythrocyte thiamin diphosphate - RBC ThDP) in apparently healthy, community-dwelling adults (≥18 years) from European countries. Results: A total of 19 cross-sectional studies from 11 countries, published between 1976 and 2024, met the inclusion criteria, providing data on 1687 individuals. The prevalence of thiamin deficiency (ETKAC >1.25, WB ThDP <70 nmol/L, total thiamin <75 nmol/L, RBC ThDP <280 ng/g Hb) ranged from 0 % to 41.2 %. When pregnant and post-partum women were excluded, the prevalence of thiamin deficiency ranged from 0 % to 10 %. Discussion: The prevalence of thiamin deficiency in Europe has not been reliably established owing to the lack of representative, population-based studies. Representative studies using harmonized thiamin biomarkers are urgently needed to establish the prevalence and public health significance of thiamin deficiency in Europe. Particular attention should be given to prevention of thiamin deficiency in high-risk groups, such as pregnant and lactating women, individuals following low-carbohydrate high-fat (LCHF) diets, and people with alcohol use disorder. Conclusions: It is commonly assumed that thiamin deficiency is not a problem in Europe, but the main finding of this systematic review is that there is virtually no representative data to support this assumption.

The detailed spatial and temporal emission inventory, prepared on an hourly basis and at a 250 × 250-meter grid, coupled with the local dispersion modeling system GRAMM/GRAL, helps to identify the impact of primary emission sources on air pollution. Our study was conducted in the complex subalpine city of Ljubljana. We prepared a detailed emission inventory for the most contributive sectors, which are industry, transport, small combustion, and agriculture for NOx, PM10, PM2.5, NMVOCs, and NH3 emissions in the year 2021. The total estimated annual emissions for Ljubljana were 1,935 tons of NOₓ, 393 tons of PM10, 315 tons of PM2.5, 1,847 tons of NMVOCs, and 168 tons of NH3. A comprehensive uncertainty analysis was conducted to assess the reliability of the emission inventory. Results from the GRAMM/GRAL dispersion model illustrate the spatial distribution of pollutants, which closely follows the geographical patterns of emission sources. Statistical comparison between modeled and observed concentrations indicates moderate agreement for PM10 and stronger agreement for NO2. Additionally, PMF analysis at the Vič monitoring station shows a consistent representation of primary emission sources compared with the model results. Overall, the results of this study improve understanding of atmospheric emission dynamics and provide a scientific basis for evidence-based decision-making aimed at reducing pollutant concentrations and protecting public health.

Air quality is becoming an important asset of modern society. Europe is adopting regulations that will enable better air quality for residents and encourage detailed study of emissions sources. Transport is recognized as a flourishing sector with the yearly growth of vehicle numbers. Even if the transport emissions trend slightly decreases, there is a concern that the increase in vehicle numbers on the road will slow down the process. Data from the bottom-up approach, estimating emissions from transit vehicles and tourism activities, was identified as a critical knowledge gap. Our study identifies and evaluates the issue of vehicle congestion on the roads during the summer, primarily driven by transit demands and tourism activities. The methodology to capture an understanding of traffic-related emissions from the summer vehicle peak was developed. Summer traffic peak was estimated by comparing the summer vehicle numbers with those of other parts of the year. Vehicle numbers were recognized by vehicle counters located on a Slovenian highway junction in the year 2021. Moreover, the study also revealed the emissions from the summer traffic peak, calculated by the COPERT emission model. We observed that, on an average summer day, there are up to 11,520 additional vehicles on Slovenian roads. It was estimated that the peak in summer passenger cars contributes up to 41,875 kg, 9542 kg, and 3057 kg of NOx, NMVOCs, and PM2.5 emissions. The maximum emissions of NOx and PM2.5 from light duty vehicles are 17,108 kg and 867 kg. There are non-negligible emissions of NMVOCs from motorcycles and these represent up to 3042 kg.

ABSTRACT Objectives To estimate the lifetime prevalence of first and recurrent systemic allergic reaction to bee venom among Slovenian beekeepers. Additionally, we aimed to elucidate the risk factors predisposing beekeepers to developing systemic allergic reaction to bee venom. Methods A nationwide cross-sectional study was conducted among 1,080 beekeepers who are members of the Slovenian beekeeper’s association, between 1 November 2021 and 31 May 2023. Epidemiological data were collected using a validated questionnaire, with the clinician-confirmed observed health outcome. Results The estimated overall lifetime prevalence of self-reported first systemic allergic reaction to bee venom was 9.4% (102/1,080), with 40.7% (24/59) of the clinician-confirmed cases being severe (grade III-IV according to the Mueller classification). The estimated overall lifetime prevalence of reported recurrent systemic allergic reaction to bee venom was lower at 3.7% (40/1,080), with 60.0% (9/15) of the clinician-confirmed cases being severe (grade III-IV according to the Mueller classification). Risk factors associated with the first systemic allergic reaction to bee venom included age, male sex, number of bee stings per season, a history of large local reaction and experiencing nasal symptoms while working at hives. Younger male beekeepers, with a low number of bee stings per season, a history of large local reaction and nasal symptoms while working at hives, are at a high risk of having systemic allergic reaction to bee venom. Conclusions High lifetime prevalence of clinician-confirmed severe first and recurrent systemic allergic reaction to bee venom underscored the importance of targeted public health strategies and clinical interventions to protect this high-risk population.

Background:This study assessed discrepancies between self-reported and administrative data sources in identifying mental health issues in Slovenia, and investigated associated socio-demographic factors. Methods:Data were linked from the 2019 Slovenian European Health Interview Survey (EHIS; n=9,900) and national health administrative databases capturing inpatient hospitalisations, outpatient prescription drugs and mental health-related sick leave. Mental health issues were identified in EHIS by self-report and in administrative databases using diagnostic codes and medication claims. Socio-demographic factors were obtained from EHIS. Discrepancies were assessed and multinomial logistic regression was used to analyse the association between these factors and the source of case identification. Results:Of the 9,900 EHIS respondents, 1,336 (13.5%) self-reported mental health issues, while 1,675 (16.9%) were identified in administrative databases. Only 613 individuals (4.6% of the total sample) were identified in both sources. Older age was associated with being identified in both data sources and administrative data only compared to not being identified. Females and unemployed persons were more likely than males and employed persons to be identified as having mental health issues, regardless of the data source. Compared to those with primary education or lower, individuals with higher education were less likely to be identified in administrative data only or in both data sources. Conclusions:discrepancies exist between self-reported and administrative data sources in identifying mental health issues. Discrepancies are associated with socio-demographic factors and may lead to different interpretations of population mental health. This study underscores the importance of cautiously interpreting self-reported and administrative health data in public health.

Air pollution, particular aerosols and their precursors, has a substantial impacts on local weather and climate by increasing cloud condensation nuclei and altering how much solar energy is absorbed or reflected by the atmosphere. To accurately model these impacts, emissions inventories, dispersion models, and receptor models perform best when using high-resolution inputs. Currently, Europe has adopted regulations aimed at improving air quality and encouraging detailed studies of emission sources. While emission records over time indicate an overall decline, the transport sector has grown in recent decades, mostly because an annual increase in vehicle numbers. Although advancements in vehicle technology aim to reduce emissions, concerns remain that the increasing number of vehicles on the road may hinder this progress. Additionally, a critical knowledge gap has been identified in the bottom-up approach used to estimate emissions from transit vehicles and tourism activities.Our study identifies and evaluates the issue of vehicle congestion on the roads during the summer, primarily driven by transit demands and tourism activities.The methodology to capture an understanding of traffic-related emissions from the summer vehicle peak was developed. Summer traffic peak was estimated by comparing the summer vehicle numbers with those of other parts of the year. Vehicle numbers were recognized by vehicle counters located on a Slovenian highway junction in the year 2021. Moreover, the study also revealed the emissions from the summer traffic peak, calculated by the COPERT emission model.We observed that, on an average summer day, there are up to 11,520 additional vehicles on Slovenian roads. Our study found that in the year 2021, on average, there were increases of 85%, 19%, 34%, and 17%, with up to 88%, 33%, 63%, and 32% increases in motorcycles, buses, passenger cars, and light duty vehicles. Meanwhile, it is recognized that the decrease in heavy duty vehicles is, on average, −14%. Those results help to understand contributions to estimation of urban source of emissions, which lead to improve the inputs data for the dispersion and additional atmosphere models. The methodology could also be copied in other places.

Campylobacter concisus is recognized as a potential pathogen in gastrointestinal diseases, particularly in patients with chronic intestinal diseases. This study investigates the genomic characteristics, phylogenetic distribution, virulence factors, resistance genes and presence of plasmids in C. concisus isolates from Slovenian patients with community-acquired infectious diarrhoea. Prospectively collected isolates were analysed using whole-genome sequencing (WGS). WGS analysis revealed substantial genetic diversity among isolates, with distinct differences observed between two genomospecies (GS1, GS2). GS1 isolates had smaller genomes, lower GC content, and fewer coding regions than GS2 isolates. Multilocus sequence typing confirmed a high degree of genetic diversity, with most isolates belonging to novel sequence types. Plasmids, including pSma1 and pICON, were more prevalent in GS2 isolates. The virulence factors Zot and Exo9 toxins were detected in both genomospecies, with Zot predominantly found in GS1 and Exo9 in GS2. The T6 secretion system was prevalent in both groups, whereas the T4SS was less frequently observed. The combination of the T6SS, plasmids, and toxins suggests a complex mechanism of pathogenicity. This study highlights the high genetic diversity of C. concisus and provides new insights into its genomic features and virulence factors. The presence of plasmids and secretion systems, particularly the T6SS, underscores the potential of C. concisus for adaptation and pathogenicity.

Emergency departments (ED) are struggling with an increased influx of patients. One of the methods to help departments prepare for surges of admittance is time series forecasting (TSF). The aim of this study was to create an overview of current literature to help guide future research. Firstly, we aimed to identify external variables used. Secondly, we tried to identify TSF methods used and their performance. We included model development or validation studies that were forecasting patient arrivals to the ED and used external variables. We included studies on any forecast horizon and any forecasting methodology. Literature search was done through PubMed, Scopus, Web of Science, CINAHL and Embase databases. We extracted data on methods and variables used. The study is reported according to TRIPOD-SRMA guidelines. The risk of bias was assessed using PROBAST and authors’ own dimensions. We included 30 studies. Our analysis has identified 10 different groups of variables used in models. Weather and calendar variables were commonly used. We found 3 different families of TSF methods. However, none of the studies followed reporting guidelines and model code was seldom published. Our results identify the need for better reported results of model development and validation to better understand the role of external variables used in created models, as well as for more uniform reporting of results between different research groups and external validation of created models. Based on our findings, we also suggest a future research agenda for this field. Not applicable.

This article explores the connections between the environment and health, focusing on the impacts of air pollution, noise, extreme weather events, and urban heat islands on people’s health, particularly vulnerable populations. It also presents potential solutions for mitigating these negative impacts, such as green infrastructure and awareness-raising tools. The paper is based on the findings of the Partnership for Environment and Health (POZ 3.0) project and includes educational infographics that are also suitable for use in schools.

The effective identification of bacterial and fungal isolates is essential for microbiological monitoring in environments like speleotherapeutic caves. This study compares MALDI-TOF MS and the OmniLog ID System, two high-throughput culture-based identification methods. MALDI-TOF MS identified 80.0% of bacterial isolates to the species level, while the OmniLog ID System identified 92.9%. However, species-level matches between the methods were only 48.8%, revealing considerable discrepancies. For discrepant results, MALDI-TOF MS matched molecular identification at the genus level in 90.5% of cases, while the OmniLog ID System matched only in 28.6%, demonstrating MALDI-TOF MS’s superiority. The OmniLog ID System had difficulties identifying genera from the order Micrococcales. Fungal identification success with MALDI-TOF MS was 30.6% at the species level, potentially improvable with a customised spectral library, compared to the OmniLog ID System’s 16.7%. Metagenomic approaches detected around 100 times more microbial taxa than culture-based methods, highlighting human-associated microorganisms, especially Staphylococcus spp. In addition to Staphylococcus spp. and Micrococcus spp. as indicators of cave anthropisation, metagenomics revealed another indicator, Cutibacterium acnes. This study advocates a multi-method approach combining MALDI-TOF MS, the OmniLog ID System, culture-based, and metagenomic analyses for comprehensive microbial identification. Metagenomic sampling on nitrocellulose filters provided superior read quality and microbial representation over liquid sampling, making it preferable for cave air sample collection.

Abstract Introduction Accurately measuring mental health disorder prevalence is crucial for public health planning. Administrative and survey data are common methods, but often yield differing results. This study compares case identification of mental health issues across these data sources in Slovenia. Methods We linked the 2019 European Health Interview Survey (EHIS) with three Slovenian health administrative databases: the National Hospital Health Care Statistics Database, Outpatient Prescription Drugs Database, and Absence From Work Database. Case identification utilized self-report of any mental health issue in the past 12 months and healthcare utilization records in 12 months preceding participation in EHIS. Multinomial logistic regression was used to examine the association between socio-demographic factors and case identification across data sources. Results Significant differences were found in 12 month prevalence of any mental health issue estimates between data sources. Only 45.9% of self-reported cases were identified in administrative data, and 36.6% of administrative cases self-reported mental health issues (Kappa = 0.302). Socio-demographics, including age, gender, education, and employment status, were significantly associated with the likelihood of identification in specific data sources. Discussion Our findings underscore the importance of data source and assessment tool selection on mental health prevalence estimates. Variations in identification across population subgroups could reflect differences in healthcare access and self-disclosure biases. Linking data sources and considering their inherent limitations is crucial for accurate burden estimation. Key messages • Data source and assessment methods significantly impact how we identify individuals with mental health issues in the past year. • Combining data sources and understanding their limitations is essential for improving mental health burden estimation.

Aim:To make the treatment approach in patients suffering a European hornet sting allergy reaction more personalized, preparing them also for possible future risks.Methods:In Slovenia an extended retrospective observational cohort epidemiological study about the natural history of Hymenoptera venom sensitivity is in progress. The study is based on data from the healthcare records of the University Clinic Golnik (UCG) and data collected by a questionnaire sent to patients from May 2019 to April 2021. For a pilot study, we selected patients who were referred to UCG because of an allergic reaction to European hornet sting and had been re-stung later by a wasp (n=68). The association between severe systemic allergic reactions (SSAR) after wasp sting and potential risk factors in subjects with a history of hornet sting allergy was assessed univariately using the likelihood ratio test.Results:Among 68 European hornet allergic patients 27 reacted with an SSAR and 41 reacted with a mild SAR. Among 27 patients with SSAR, 4 reacted with an SSAR also to a subsequent wasp sting. Among 41 patients with a mild European hornet sting SAR nobody reacted with an SSAR to a subsequent wasp sting. The association between the severity of the wasp SAR reaction in European hornet allergic patients was statistically significant (p=0.022).Conclusion:Our results suggest that patients with severe European hornet SAR should be considered for wasp venom immunotherapy or prophylactic prescription of epinephrine auto-injector as they are at risk for an SSAR also after wasp string.

Abstract Background Sleep constitutes a fundamental biological necessity, occupying approximately one-third of our lifespan. Consequently, the field of sleep research has experienced an increase in interest, prompted by the recognition of insufficient sleep as a significant public health challenge. As the majority of existing questionnaires in Slovenia have yet to undergo official translation and validation processes, the aim of our study was to conduct content validation of a questionnaire designed to assess the sleep quality among adolescents. Methods We developed a test battery for assessing the sleep quality of adolescents by combining a diverse array of questionnaires. We employed the Adolescent Sleep-Wake Scale, Pediatric Daytime Sleepiness Scale, Epworth Sleepiness Scale for Children and Adolescents, and Children’s Morningness-Eveningness Scale. Following the development of the entire test battery, a process of back-translation from English to Slovene occurred, followed by cultural adaptation. Results The designed questionnaire underwent content validation by a panel of 10 experts drawn from diverse disciplines. Evaluation of questionnaire items followed a planned methodology tailored for the content validation of measurement instruments, focusing on content relevance, clarity, and classification into subscales or factors. Our analysis revealed that the individual questionnaires demonstrate content validity, supported by notably high indices of content validity. Conclusions Translated questionnaires demonstrate decent content validity, thus rendering them valid clinical and research tools for assessing sleep quality in adolescents in Slovenia. Key messages • Our research indicates the availability of content-valid tools for sleep research. • Further investigation is needed to determine the reliability, specificity, sensitivity, and appropriateness of the factorial structure of measures for the quality of sleep.

Abstract Purpose The purpose of this study was to examine the results of the latest European health interview survey (EHIS 2019) to analyze the prevalence of non-communicable diseases (NCDs) and the association between them and physical activity (PA) in adults in Slovenia, and to determine the role of socio-economic and other factors. The main hypothesis was that people who achieve the World Health Organization’s recommended physical activity have less diseases than those who do not. The innovative approach was the use of multivariate analysis to examine the correlations between different factors. Methods Data from the EHIS 2019 survey was used. It is a cross-sectional study of a representative sample of adults aged 15 and over, conducted periodically in EU member states. 9900 adults participated in the Slovenian study. Chi-square test was used to assess the statistical difference between the observed outcomes and explanatory variables and binary logistic regression to assess the interdependence of all selected variables. Results People who met PA recommendations had a lower prevalence of NCDs compared to those who did not (36.3% vs. 50.7%, p < 0.001), as well as those who met the muscle strengthening recommendations (32.2% vs. 40.7%, p < 0.001). The higher percentages of individuals meeting the recommendations were among women, younger age groups, single individuals, those who didn’t have NCDs, those sitting less than 4 hours per day, and those with a normal body mass index. In multivariate analysis, there was a significant difference between those achieving the recommended PA and those who did not; the latter had an approximately 1.4-fold higher odds ratio of having at least one NCD (p < 0.001). People who sit for 12 hours or more per day had approximately 1.8-fold higher odds ratio of having an NCD (p = 0.019). Conclusions Based on the results of the study, it would be useful to emphasize the importance of physical inactivity and prolonged sitting for health and to strengthen public health programmes to promote PA and reduce sitting time. Support/Funding Source This study didn’t receive funding.

From a public health perspective, it is necessary to improve indoor air quality (IAQ) in schools. This study aims to assess the state of perceived IAQ in Slovenian school classrooms and its association with the selected IAQ factors to improve the understanding of perceived IAQ for designing public health interventions aimed to improve IAQ in schools. A national cross-sectional study was performed in all 454 Slovenian primary schools in the school year 2019/2020. The questionnaires were filled out by the 3rd-grade teachers with the support of the caretakers. Teachers rated the IAQ in the classroom as the worst in winter. We found that the teachers’ perceived IAQ in the classroom is statistically significantly associated with the micro location of the school and some of the IAQ factors. Poor IAQ is associated with reduced manual airing of classrooms due to the thermal comfort of the occupants. Interventions should be aimed at improving occupants’ adaptive behaviors to increase the frequency of natural ventilation in classrooms.

Background and objective: The main source of Vitamin D is the synthesis of cholecalciferol (D3) from 7-dehydrocholesterol in the skin when exposed to ultraviolet radiation. A significant intake can be obtained from supplementation and fortified foods and to a lesser extent from fatty fish and eggs. The objective of our study was to assess vitamin D intake and status in Slovenian premenopausal and postmenopausal women. Methods: A cross-sectional study was conducted between March and May 2021, involving 319 women aged 44 to 65 years. After considering exclusion criteria and the completeness of data, 176 participants were included in the final analysis. Vitamin D status was determined by measuring the concentrations of total 25-hydroxyvitamin D (25(OH)D), vitamin D-binding protein (DBP), and albumin and by calculating bioavailable and free 25(OH)D. Vitamin D intake from fish (fatty and lean separately), eggs, and food supplements or drugs was assessed using a vitamin D-focused food frequency questionnaire (FFQ). In addition, sun exposure, menstrual status, socio-demographic characteristics, and health status were assessed. Results: Vitamin D insufficiency (total 25(OH)D < 75 nmol/L) was observed in 77% of premenopausal and 62% of postmenopausal women. Premenopausal women had 12% lower total 25(OH)D and 32% lower bioavailable 25(OH)D compared to postmenopausal women. The average milk and yoghurt consumption was 135 ± 161 mL/day; egg consumption was 3.2 ± 2.4 eggs/week. The mean vitamin D intakes from food and supplementation were 2.2 ± 1.3 µg/day and 21.7 ± 26.2 µg/day, respectively. In total, 61% of the participants supplemented with a mean dose of 35.4 ± 25.3 µg/day, with no statistically significant differences between premenopausal and postmenopausal women. The odds ratio (OR) for vitamin D insufficiency (25(OH)D < 75 nmol/L) among participants who did not supplement with vitamin D was 6.23; p ≤ 0.001. Premenopausal women had a statistically non-significant lower supplementation rate. Discussion and conclusions: Vitamin D status among Slovenian postmenopausal women is significantly more favourable than among premenopausal women. Despite a high supplementation rate, vitamin D insufficiency is still present in the majority of the population. With limited milk consumption, milk fortification alone is not feasible. However, egg biofortification could offer a viable contribution to increasing vitamin D intake.

Background:Beekeepers represent a high-allergic risk population group due to their unavoidable seasonal or persistent exposure to the elicitors of Hymenoptera venom allergy, bees in particular. A systematic literature review and meta-analysis aimed to estimate the prevalence of self-reported systemic allergic reaction to Hymenoptera venom among beekeepers worldwide.Methods:We rigorously reviewed and conducted meta-analysis on observational studies retrieved from seven electronic databases (MEDLINE via PubMed, Web of Science Core Collection, Scopus, Academic Search Complete, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature, Zoological Record), spanning data from inception to August 1, 2023. The Joanna Briggs Institute Prevalence Critical Appraisal Tool was employed to assess the risk of bias. A meta-analysis was conducted to synthesize evidence.Results:Out of 468 studies, eight original articles met the inclusion criteria. The estimated overall lifetime and one-year prevalence of self-reported systemic allergic reaction to bee venom were 23.7% (95% CI: 7.7-53.4) and 7.3% (95% CI: 5.8-9.2), respectively. The estimated lifetime prevalence of self-reported systemic allergic reaction to bee venom for grades III-IV (severe systemic allergic reaction) was 6.0% (95% CI: 3.0-11.7). In general, substantial heterogeneity and a high risk of bias were observed across the majority of studies. The impact of geographical location and climate differences on the estimated lifetime prevalence is suggestive for severe systemic allergic reaction.Conclusions:Future observational cross-sectional studies should employ rigorous study designs, using validated questionnaires, and thoroughly report the observed health outcomes, verified by physicians.