Health impacts of extreme weather events - Cascading risks in a changing climate.

Background: Extreme weather events represent one of the most tangible impacts of anthropogenic climate change. They have increased in number and severity and a further increase is expected. This is accompanied by direct and indirect negative consequences for human health. Methods: Flooding events, storms and droughts are analysed here for Germany from a systemic perspective on the basis of a comprehensive literature review. Cascading risks beyond the initial event are also taken into account in order to depict downstream consequences. Results: In addition to the immediate health burdens caused by extreme weather events such as injuries, long-term consequences such as stress-related mental disorders occur. These stresses particularly affect certain vulnerable groups, e.g. older persons, children, pregnant women or first responders. Conclusions: A look at the cascading risks described in the international literature allows us to develop precautionary measures for adaptation to the consequences of climate change. Many adaptation measures protect against different risks at the same time. In addition to planning measures, these include, above all, increasing the population's ability to protect itself through knowledge and strengthening of social networks.

Occurrence of venlafaxine, other antidepressants and selected metabolites in the Rhine catchment in the face of climate change.

Fate and occurrence of 4 selective serotonin reuptake inhibitors, one serotonin-noradrenergic reuptake inhibitor and one noradrenergic-dopamineric reuptake inhibitor and their human metabolites were determined in a German municipal wastewater treatment plant as well as in the Rhine River and selected tributaries. The enantiomeric fractions of venlafaxine and its metabolites were not altered during wastewater treatment and were similar in all river samples underlining that no appreciable biodegradation occurs. In the Rhine catchment area highest concentrations were detected for venlafaxine, citalopram and their human metabolites. Projected future climate change would lead to an increased portion of treated wastewater in rivers due to reduced discharges during low flow situations by the end of the 21st century. However, the effect of climate change on the pattern and concentrations of antidepressants is predicted to be of minor importance in comparison to altered consumption quantities caused by demographic developments and changes in life styles.

Incidence of cross-border emergency care and outcomes of cardiopulmonary resuscitation in a unique European region.

BACKGROUND: Emergency medical service (EMS) systems in Europe have developed differently due to legal, educational and organisational aspects. The aim of the present study was to compare cardiopulmonary resuscitation (CPR) outcomes and characteristics in three differently organised and staffed EMS systems in close vicinity. METHODS: We analysed the charts of patients treated in the EMS systems of the cities of Aachen (Germany), Heerlen (The Netherlands) and Eupen (Belgium), retrospectively. Main outcome measures were the rate of return of spontaneous circulation (ROSC), hospital discharge and cerebral performance after 1 year. Furthermore, factors influencing neurological outcome and the incidence of cross-border emergency assistance were assessed. RESULTS: Of 852 patients found unresponsive with no palpable pulse and/or the absence of breathing, CPR was performed in 322 patients. The overall rate of ROSC was 44.1 and 13.7% of patients were discharged alive. A good neurological outcome was observed in 95.5% of survivors. The rate of ventricular fibrillation was significantly higher (46.9% versus 21.9 and 21.2%, p < 0.05) and the total amount of epinephrine given during CPR significantly lower (4.5+/-5.2 mg versus 9.8+/-10.8 and 8.4+/-6.2 mg, p < 0.05) in the Dutch system. No significant differences in outcome variables were observed between the systems. Neurological outcome was favourable when the arrest was witnessed, occurred in a public place, the initial rhythm was shockable, a low total amount of adrenaline (epinephrine) was given and the call-response interval was short. In 1.2% of the cases cross-border emergency care was provided. CONCLUSIONS: Despite medical and organisational discrepancies, outcomes of CPR in three neighbouring EMS systems are comparable. Neurological outcome is influenced by demographical, organisational and medical factors. Cross-border emergency assistance for CPR is almost undetectable and needs improvement.