[Climate change and child health: A nationwide survey among paediatricians in Germany]. / Klimawandel und Kindergesundheit: eine bundesweite Befragung von Pädiater*innen in Deutschland.

BACKGROUND: Children are a vulnerable group affected by climate change. Paediatricians are important actors in protecting children from climate change-related health risks and in identifying and treating relevant health effects. The main objectives of this study were to determine how paediatricians assess the relevance of climate change-related health impacts, through which channels paediatricians can be reached most effectively, how often climate change-specific prevention measures are implemented and how they are assessed. METHODS: Between February and July 2020, an online survey was conducted among paediatricians. The cross-sectional survey was designed to gather knowledge and attitudes about the relevance of climate change, sources of information and prevention measures. All participants who answered only one question or none at all were excluded. Differences between groups were determined using one-factorial analysis of variance. Correlations were determined using Pearson's bivariate correlation analysis and tested for two-sided significance. RESULTS: A total of 408 questionnaires were analysed. Over 95% of the respondents were paediatricians, with just under half of them working in children's hospitals and a good third in paediatric practices. According to paediatricians, climate change has a relevant impact on children's health. The most significant effects on children's health were considered to be longer and stronger pollen seasons, neophytes and neozoa, Lyme disease and TBE (tick-borne encephalitis, summer meningoencephalitis), UV radiation and air pollutants. Certified training options in professional journals and participation in lectures or workshops at relevant congresses were identified as the two preferred types of training. Especially professional journals as the most frequently used source of information could function as a suitable tool to reach as many paediatricians as possible. 76% of the paediatricians have not yet carried out any corresponding prevention activities, although information activities for parents or children were seen as being effective by 80%. Whereas the possibilities of integrating climate change-oriented prevention activities into everyday practice, were perceived less positively. The most frequent reason given was lack of time. DISCUSSION: To satisfy this future need for knowledge, but also for offerings from paediatricians for patients and their parents, concrete further continuous education and consultancy services must be prepared. In the future, further training offers, including the consultancy services, should be integrated into profession-specific training modules, presented at congresses, and then implemented into paediatricians' daily routine. CONCLUSION: The results of the study illustrate that the topic "climate change and health" has a high relevance for paediatricians and that information measures for parents are considered to be effective. Although paediatricians are concerned with the topic, there is an implementation deficit. Support is needed in the form of intensifying awareness-raising projects and educational modules for paediatricians to move from knowledge to action.

Non-pharmacological interventions for pollen-induced allergic symptoms: Systematic literature review.

BACKGROUND: Allergic diseases pose a health problem worldwide. Pollen are widespread aeroallergens which can cause symptoms like shortness of breath, cough, itchy eyes, or rhinitis. Apart from preventive measures and pharmacological treatment, also non-pharmacological interventions have been suggested to reduce symptoms. The objective of this work was to review studies investigating the effectiveness of non-pharmacologic interventions to reduce allergic symptoms. METHODS: PubMed, EMBASE, and CENTRAL were systematically reviewed in July 2018 and April 2020. Several authors worked on the screening of titles, abstracts, and full texts. One author for each literature search performed the data extraction and the risk of bias assessment. Studies were included if they met the inclusion criteria defined by the PECOs. Studies which investigating the effect of non-pharmacologic interventions on patients with allergic rhinitis were included. RESULTS: Twenty-nine studies investigating eleven types of non-pharmacologic interventions to avoid and reduce allergic symptoms due to pollen exposure were included in this review. Out of all studies, seven studies addressed nasal rinsing and 22 included acupuncture, air filtering, artisanal tears, individual allergen avoidance advice, various nasal applications, self-hypnosis, rhinophototherapy, and wraparound sunglasses. CONCLUSION: Most studies had a high risk of bias and small sample sizes. There were only a few high-quality studies that give hints about the effectiveness of non-pharmacological interventions. For future research, more high-quality studies are required to confirm the effectiveness of simple, safe, and cost-effective interventions.

The Burden of COPD Due to Ozone Exposure in Germany.

BACKGROUND: The chronic effects of ozone have only rarely been investigated in disease burden studies to date. Our goal was to determine this disease burden in Germany over the period 2007-2016, with particular attention to estimation based on effect estimates adjusted for particulate matter (PM2.5) and nitrogen dioxide (NO2). METHODS: The nationwide, high-spatial-resolution (2 km × 2 km), population-based exposure to ozone in the summer months ("summer ozone") was calculated on the basis of modeled ozone data and population counts in Germany. Next, risk estimates derived from cohort studies were used to quantify the burden of chronic obstructive pulmonary disease (COPD). Data on population counts, life expectancy, and mortality in Germany were used to reflect the situation across the country as accurately as possible. RESULTS: The estimates of years of life lost (YLL) due to summer ozone ranged from 18.33 per 100 000 people (95% confidence interval [14.02; 22.08]) in 2007 to 35.77 per 100 000 people [27.45; 42.98] in 2015. These findings indicate that ozone affects the COPD burden independently of other harmful components of the air. No clear secular trend in the COPD burden can be seen over the period 2007 to 2016. CONCLUSION: Long-term exposure to ozone contributes to the COPD burden among the general population in Germany. As climate change may lead to a rise in the ozone concentration, more intensive research is required on the effects of ozone on health.

COVID-19 and heat waves: New challenges for healthcare systems.

Heat waves and Covid-19 overlap, as this pandemic continues into summer 2021. Using a narrative review, we identified overlapping risk groups and propose coping strategies. The high-risk groups for heat-related health problems as well as for high-risk COVID-19 groups overlap considerably (elderly with pre-existing health conditions). Health care facilities will again be challenged by Covid-19 during heat waves. Health care personnel are also at risk of developing heat related health problems during hot periods due to the use of personal protective equipment to shield themselves from SARS-CoV-2 and must therefore be protected from excessive heat periods. Some existing recommendations for heat health protection contradict recommendations for COVID-19 protection. This paper provides a preliminary overview of possible strategies and interventions to tackle these ambiguities. The existing recommendations for protection against heat-related illnesses need revisions to determine whether they include essential aspects of infection control and occupational safety and how they may be supplemented.

Hot days and Covid-19: Online survey of nurses and nursing assistants to assess occupational heat stress in Germany during summer 2020.

Objectives: Our aim was to identify if working during hot days while wearing Covid-19 related personal protective equipment causes occupational heat stress for nurses and nursing assistants in Germany. Design: Using an online survey, we assessed the impact of hot weather on nurses and nursing assistants working with personal protective equipment. Respondents were recruited by distributing the link to the survey via personal communication, email and various social media channels to nursing staff from hospitals, nursing homes and outpatient care. Results: There were in total 428 participants (18.2% male, 82.5% female), mostly (30.5%) aged between 45 and 55 years. Half of respondents (48.3%) had more than 20 years of experience in nursing. Cardiac, pulmonary, or other pre-existing conditions were reported by 46.2%.Nurses and nursing assistants working in personal protective equipment during hot days were exposed to occupational heat stress. Work was found exhaustive by 96.5% of the participants during those days. 93.0% reported breathing problems and 85.8% reported difficulties with focusing on their work. Many workplaces did not provide adequate heat protection, with distinct differences concerning the amount of prophylactic and heat mitigating measures across institutions. There were significant differences across institutions when it comes to the number of drinks served (p < 0.001), the availability of room thermometers (p < 0.001), the use of mobile cooling devices (p < 0.001) and fans (p < 0.05). Conclusions: Results suggest employers must make more of an effort to provide adequate heat protection for their nursing staff. In order to ensure patient care, there is a need for action; in particular, attention must be paid to the pre-existing health conditions of the nursing staff.

[Training modules on climate change, heat, and health for medical assistants and nurses in outpatient care]. / Fortbildungsangebote zu Klimawandel, Hitze und Gesundheit für medizinische Fachangestellte und Pflegefachkräfte in der ambulanten Versorgung.

The number of heatwaves is going to increase due to climate change and will pose a high health risk especially for elderly people. Additional risk factors like immobility, the need for care, chronic and acute diseases (worsening of symptoms), and the intake of medications lead to an increased sensitivity to heat in this particular age group. Nursing staff and medical assistants working in general practices are two important professions to reach the risk group during heatwaves and provide preventive and curative care.The "Klinikum der Universität München" has developed an interprofessional blended-learning program to sensitize for this topic and to enable those two professional groups to react adequately to heat events. It combines independent learning with the help of online videos and presentations and a face-to-face component for the practical application of knowledge through examples. The concept, the results, as well as the conclusion of the project, which completed in October 2018, are presented in this article.Educational programs are part of the adaption strategies to heat events. The "Recommendations for the creation of Heat Action Plans for the Protection of Human Health" state that advanced trainings and education of healthcare and social workers help to communicate relevant content to adequately act during heat periods. The developed educational program fulfills this demand.To enable the widest possible use, the training materials are available free of charge and can be downloaded from www.klimawandelundbildung.de .

[Environmental burden of disease in Germany]. / Umweltbedingte Krankheitslasten in Deutschland.

BACKGROUND: Environmental risk factors can have a substantial impact on population health. With the environmental burden of disease (EBD) approach, the health losses attributable to environmental risk factors can be quantified using disability-adjusted life years (DALY). OBJECTIVES: The aim of this article is to present and discuss available EBD estimates with a focus on Germany. MATERIALS: Using current EBD studies, the share of the burden of disease attributable to environmental risk factors globally and DALYs for Germany are presented. Ambient particulate matter (PM), water-related risks and environmental noise are used as examples to emphasize the importance of availability and quality of input data for burden of disease assessments. RESULTS: The share of the global burden of disease attributable to environmental risk factors varies according to the available studies and lies between 13 and 22%. For Germany, EBD estimates are available for 12 environmental risk factors. Most estimates are available for particulate matter in ambient air, however, the estimated burden differs greatly. Nonetheless, according to current knowledge, particulate matter pollution is the environmental risk factor with the highest burden of disease in Germany. CONCLUSIONS: Differences in the estimated burden of disease for the considered risk factors are due to varying underlying assumptions, e. g. for life expectancy or counterfactual value and the input data used.