***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate the impact of childhood atopic eczema on families and assess the personal financial cost of its management . DESIGN Cross sectional survey . SETTING Paediatric dermatology and paediatric diabetology outpatient clinics . PATIENTS Parents of 48 r and omly selected children with atopic eczema and 46 with insulin dependent diabetes mellitus . MAIN OUTCOME MEASURES The impact on family score , the reported cost of relevant medical treatments , medical consultations , relevant hospitalisation , and income loss . RESULTS Families of children with moderate or severe atopic eczema had a significantly higher impact on family score than families of diabetic children . A conservative estimate of the annual personal financial cost of managing mild , moderate , and severe eczema was Aus$330 , 818 , and 1255 , respectively . The financial cost to the community for the management of atopic eczema in the study groups was greater . The personal financial cost of managing eczema was greater than for asthma . CONCLUSION Childhood atopic eczema has a profound impact on the social , personal , emotional , and financial perspectives of families Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Eczema is one of the most common chronic inflammatory skin diseases , affecting about 20 % of children . The pathogenic mechanisms of eczema are still not fully understood , and current treatment of moderate-severe eczema is often difficult . Recently , it has been suggested that Vitamin D plays a key role in this disease , even if mechanisms are only partially known . OBJECTIVE The purpose of our study was to assess the  25-Hydroxyvitamin D serum levels in a pediatric population suffering from chronic eczema ( IgE-mediated and non-IgE-mediated ) , and to correlate these phenotypes with the SCORAD severity and selected clinical and biological parameters . Moreover , we aim ed to evaluate whether a supplementation of Vitamin D3 could affect the same clinical and laboratory parameters . METHODS 89 children with chronic eczema were enrolled in the study . Severity of eczema was assessed with the SCORAD index . Past and present history was taken , and patients were divided into two groups according to the state of sensitization . According to a r and omization schedule , the enrolled children were assigned to the following groups : supplementation group , which received a daily oral Vitamin D3 supplementation ( 2000 IUs ) for 3 months ; control group which received no supplementation . RESULTS  Vitamin D concentrations in patients with moderate and severe eczema were not statistically different from Vitamin D concentration detected in the serum of patients with mild eczema . Furthermore , we did not find any correlation between Vitamin D levels , total IgEs and SCORAD index , both in the Sensitized and in the Not-Sensitized group . The Vitamin D3 supplementation did not influence the SCORAD severity or the total IgEs concentration . CONCLUSION To our knowledge , our study is the first one that shows no correlation between serum levels of Vitamin D , eczema severity and IgE sensitization in a pediatric population suffering from chronic eczema Aims : To investigate the association between climate and atopic diseases using worldwide data from 146 centres of the International Study of Asthma and Allergies in Childhood ( ISAAC ) . Methods : Between 1992 and 1996 , each centre studied r and om sample s of children aged 13–14 and 6–7 years ( approx . 3000 per age group and centre ) using st and ardised written and video question naires on  symptoms of asthma , allergic rhinoconjunctivitis , and atopic eczema during the past 12 months . Data on long term climatic conditions in the centres were abstract ed from one st and ardised source , and mixed linear regression models calculated to take the clustering of centres within countries into account . Results : In Western Europe ( 57 centres in 12 countries ) , the prevalence of asthma symptoms , assessed by written question naire , increased by 2.7 % ( 95 % CI 1.0 % to 4.5 % ) with an increase in the estimated annual mean of indoor relative humidity of 10 % . Similar associations were seen for the video question naire and the younger age group . Altitude and the annual variation of temperature and relative humidity outdoors were negatively associated with asthma symptoms . The prevalence of eczema symptoms correlated with latitude ( positively ) and mean annual outdoor temperature ( negatively ) . Conclusions : Results suggest that climate may affect the prevalence of asthma and atopic eczema in children BACKGROUND Little is known about the prevalence of atopic eczema outside Northern Europe . OBJECTIVES We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world . METHODS A cross-sectional question naire survey was conducted on r and om sample s of schoolchildren aged 6 to 7 years and 13 to 14 years from centers in 56 countries throughout the world . Those children with a positive response to being question ed about the presence of an itchy relapsing skin rash in the last 12 months that had affected their skin creases were considered to have atopic eczema . Children whose atopic eczema symptoms result ed in sleep disturbance for 1 or more nights per week were considered to have severe atopic eczema . RESULTS Complete data was available for 256,410 children aged 6 to 7 years in 90 centers and 458,623 children aged 13 to 14 years in 153 centers . The prevalence range for symptoms of atopic eczema was from less than 2 % in Iran to over 16 % in Japan and Sweden in the 6 to 7 year age range and less than 1 % in Albania to over 17 % in Nigeria for the 13 to 14 year age range . Higher prevalences of atopic eczema symptoms were reported in Australasia and Northern Europe , and lower prevalences were reported in Eastern and Central Europe and Asia . Similar patterns were seen for symptoms of severe atopic eczema . CONCLUSIONS Atopic eczema is a common health problem for children and adolescents throughout the world . Symptoms of atopic eczema exhibit wide variations in prevalence both within and between countries inhabited by similar ethnic groups , suggesting that environmental factors may be critical in determining disease expression . Studies that include objective skin examinations are required to confirm these findings BACKGROUND An increase in Staphylococcus aureus skin colonization in atopic dermatitis patients result ed from the reduction of cathelicidin production in these patients . Recently , an in vivo study demonstrated that vitamin D could stimulate cathelicidin production . Oral supplements of vitamin D might be beneficial in atopic dermatitis . OBJECTIVE To determine the effects of oral vitamin D supplements on clinical impact including Staphylococcus aureus skin colonization evaluation in atopic dermatitis patients . MATERIAL AND METHOD Twenty-four atopic dermatitis patients were included in this double-blind , placebo-controlled study . They were r and omly assigned into 2 groups for oral 2,000 IUs/day of vitamin D , supplement and placebo . The lesional swab culture for S. aureus was done at week 0 , 2 and 4 . Clinical outcomes were assessed by SCORAD score , mexameter for erythema index and konometer for conductance were done at week 0 , 2 and 4 . Serum vitamin D levels were also determined at week 0 and 4 . RESULTS Twenty patients completed the protocol .  S. aureus skin colonization , SCORAD score and erythema index were significantly reduced from baseline to week 4for vitamin D treated group comparing with placebo ( p = 0.022 , 0.028 and 0.014 , respectively ) . There was an inverse correlation between serum vitamin D levels with S. aureus skin colonization and SCORAD score ( r = -1.0 , p < 0.001 ) . CONCLUSION Oral vitamin D supplement could reduce skin colonization of S. aureus and demonstrated the clinical improvement of patients with atopic dermatitis The active metabolite of vitamin D , 1,25-(OH)2D3 , has immunomodulatory properties in addition to its more established action on bone and calcium metabolism . Recently vitamin D has been proposed as one of several environmental factors responsible for the increase in atopic diseases during the last decades . The objective of this study was to determine whether the estimated dose of dietary vitamin D3 during the first year of life is associated with atopic diseases up to the age of 6 years . In a prospect i ve birth cohort study 123 six-year-old children were investigated for the cumulative incidence of atopic dermatitis , allergic rhinitis or asthma by means of a postal question naire . Their vitamin D3 intake during infancy was recorded in a previous study and the relationship between lower or higher vitamin D3 intake and atopic illness later in childhood was assessed . Atopic manifestations were more prevalent in the group with higher intake of vitamin D3 . Although small , this study supports previous investigations suggesting a role of vitamin D intake during infancy in the development of atopic allergy later in childhood . If these findings are confirmed in prospect i ve controlled clinical trials , prevention through modified vitamin D3 supplementation in infancy could be discussed to reduce the burden of atopic illnesses 
    Output:
    
In children , the majority of existing literature confirmed a link between serum VD levels and AD severity .
Weak evidence was found supporting improvement of AD with VD supplementation .