Bremer Umweltinstitut

Marked socioeconomic divides and unequal advances in renewable energy transition across Europe have raised concerns about widening inequalities in air pollution exposure and related health risks. Here we analyzed 88.8 million deaths across 653 contiguous regions in 31 European countries, encompassing the entire urban and rural population of 521 million people from 2003 to 2019, to investigate how socioeconomic conditions and renewable energy adoption relate to regional disparities in acute air pollution-related mortality risks and their trends over time. Regions with higher gross domestic product per capita, lower poverty rates and longer life expectancy-primarily in Western and Northern Europe-showed lower and declining risks in air pollution-related mortality compared to other regions in Europe. We assessed renewable energy transition as both an upstream driver and an effect modifier of the relationship between air pollution and mortality. As an upstream driver, greater renewable energy adoption was associated with 15-54% lower air pollutant levels and, consequently, 12-53% fewer attributable deaths. As an effect modifier, high renewable adoption was significantly associated with lower and declining mortality risks. Taken together, our findings show that differences in socioeconomic conditions and energy transition are associated with widening disparities in air pollution-related health risks across Europe.

Aims This registry-based study aimed to evaluate the long-term survivorship of dual-mobility components (DMCs) compared to conventional components (CCs) in primary total hip arthroplasty (THA), and to assess potential adverse effects, particularly in younger patients (aged < 75 years). Methods Data from 58,314 primary THAs recorded between January 2006 and December 2023 in the French national SOFCOT/RENACOT registry were analyzed, including 25,545 DMCs (46%). The primary outcome was revision for any cause. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare implant survivorship, adjusting for age, sex, primary diagnosis, and fixation method. Results Among the 25,545 primary THAs performed with a DMC, 284 revisions (1.1%) were recorded. In adjusted Cox regression analysis, DMC use was not significantly associated with an increased risk of revision compared to CCs (hazard ratio 0.83 (95% CI 0.66 to 1.04); p = 0.118). Periprosthetic fracture was the leading cause of revision in the DMC group (98/284, 34.5%), occurring significantly more frequently than in the CC group (77/493, 15.6%; p < 0.001), while dislocation-related revisions were less common with DMCs. Overall, the combined proportion of revisions due to dislocation or fracture was lower in the DMC group (112/284, 39.4%) than in the CC group (254/493, 51.5%). No risk factors for implant failure were identified in multivariable Cox regression analysis. Conclusion DMCs provide excellent long-term survivorship and effectively reduce the risk of dislocation in primary THA. Although a higher incidence of periprosthetic fractures was observed with DMCs, the overall outcomes support their safe and effective use. Nevertheless, ongoing surveillance remains important to monitor these risks.

Background Higher doses of anthracyclines and heart-relevant radiotherapy increase cardiovascular disease (CVD) risk. This study assessed CVD and CVD risk factors among adult childhood cancer survivors (CCSs) across cardiotoxic treatment risk groups and examined associations between lifestyle behaviors and treatment risks.Methods We invited CCSs aged ≥18 years at study, diagnosed at ages 0-20, who survived ≥5 years for an assessment of anthropometry, CVD, CVD risk factors, lifestyle, and cancer history. We classified participants into three cardiotoxic treatment risk groups (no/low risk, moderate risk, high risk) based on anthracyclines and heart-relevant radiotherapy. Multinomial logistic regression assessed lifestyle differences across groups.Results With a median age at study of 33 years (IQR: 26-39; 53% male), 356 CCSs participated in this study divided into the no/low risk (25%), moderate risk (40%), or high risk (35%) cardiotoxic treatment groups. Overall, CVD prevalence was 6% and similar across the three risk groups. Heart valve problems were rare, though more common in the high-risk group (no/low risk, 0%; moderate risk, 1%; vs. high risk, 4%; p = 0.037). CVD risk factors were present in 44% of CCSs-including dyslipidemia, obesity, hypertension, and diabetes-without variation across risk groups. Overall adherence to health behavior recommendations was low, with no differences in diet adherence, physical activity (PA), sedentary behavior, smoking, or alcohol consumption across cardiotoxic risk groups.Conclusion We found no differences in CVD, CVD risk factors, or lifestyle behaviors across cardiotoxic treatment risk groups. Health promotion that engages diet, PA, smoking cessation, and alcohol reduction should be prioritized for all CCSs regardless of cardiotoxic treatment risk levels.

Background Suicidal thoughts and behaviours (STBs) are traditionally framed as arising from mental health problems, however, emerging evidence highlights the importance of social determinants in contributing to suicide risk. We examined STBs and their socioeconomic, psychosocial and clinical correlates in two peri-urban communities in Cape Town.Methods We conducted psychiatric diagnostic interviews (MINI) at three public-sector facilities (2023-2024). Adults aged ≥18 years, with and without HIV, were recruited in a 2:1 ratio. We examined STB prevalence and associations between past 30-day suicidal ideation and sociodemographic factors, violence exposure, perceived stress, mental disorders, and HIV.Results We enrolled 613 participants (63.9% female; 65.4% HIV-positive; median age 39). The prevalence of past 30-day suicidal ideation was 14.0%, while 22.2% reported a lifetime suicide attempt. Odds of past 30-day ideation were higher in females (OR 2.07, 95% CI 1.21-3.54), those who had experienced violence in their community (1.93, 1.09-3.41) or family (3.00, 1.55-5.81), those with high perceived stress (4.57, 1.93-10.81), and in those with depression (6.62, 3.39-12.92), post-traumatic stress disorder (6.69, 2.97-15.04), and an alcohol use disorder (2.27, 1.23-4.17). Associations with high perceived stress and community violence persisted after adjustment for mental disorders. HIV and other sociodemographic factors were not significantly associated.Conclusion STB prevalence was high in peri-urban communities in Cape Town and strongly associated with mental disorders, violence exposure, and perceived stress. These findings underscore the role of structural and psychosocial stressors in shaping suicide risk in low-income communities.

Ziel: Im Rahmen des BMBF-geförderten Forschungsprojektes: “Kosten/Nutzen- und Kosten/Wirksamkeitsanalysen verschiedener Versorgungsangebote in der Geburtshilfe“ wurde die Effizienz des Hebammenkreißsaals (HKS) und des üblichen Kreißsaals (ÜKS) evaluiert. Es wurde in Deutschland somit erstmalig eine vergleichende gesundheitsökonomische Evaluation in der geburtshilflichen Versorgung durchgeführt.

Hintergrund/Einleitung: Soziales Kapital spielt eine entscheidende Rolle bei der Erklärung von Gesundheitsunterschieden zwischen Ländern und Gesellschaften. Es beschreibt Merkmale sozialer Organisationen wie Vertrauen in die Lebensumwelt, Normen und soziale Netzwerke, die die Effizienz der Gesellschaft durch die Erleichterung koordinierten Vorgehens verbessern können. Diese Studie vergleicht den Gesundheitsstatus, das Niveau Sozialen Kapitals und die Beziehung zwischen Sozialem Kapital und Gesundheit in Estland und Deutschland. Diese Fragestellungen wurden für Estland bislang noch nicht und für Deutschland nur wenig erforscht. Daten und Methoden: Datengrundlage dieser Studie war der European Social Survey (ESS) (2006/2007), welcher durch ein standardisiertes Interview erhoben wurde. Der subjektive Gesundheitsstand und die Verteilung von Indikatoren des Sozialen Kapitals (Vertrauen in die Lebensumgebung, Reziprozität und soziale Partizipation), innerhalb und zwischen Estland und Deutschland, wurden mithilfe einer One-Way ANOVA verglichen. Um die Beziehung zwischen den einzelnen Indikatoren und subjektiver Gesundheit in Estland und Deutschland zu untersuchen, wurden logistische Regressionsanalysen, adjustiert für Alter, Geschlecht, Bildungsstand, Wohngebiet, emotionale Unterstützung, sozialen Kontakt und Beziehungsstatus berechnet. Ergebnisse: In Deutschland wurden 2916, in Estland 1517 Frauen und Männer in die Studie eingeschlossen. Das Niveau subjektiver Gesundheit in Estland ist höher als in Deutschland. Die Verteilung der Indikatoren des Sozialen Kapitals zeigt ein höheres Niveau an Vertrauen, ein niedrigeres Niveau an Reziprozität und sozialer Partizipation in Estland als in Deutschland. In Estland hat Vertrauen einen Einfluss auf den subjektiven Gesundheitszustand (OR=1,7, 95% CI 1,03–1,15). In Deutschland haben Vertrauen (OR=1,17, 95% CI 1,12–1,21), Reziprozität (OR=1,13, 95% CI 1,08–1,17) und soziale Partizipation (OR=1,07, 95% CI 1,01–1,13) einen Einfluss auf die subjektive Gesundheit. Diskussion/Schlussfolgerungen: Die Indikatoren des Sozialen Kapitals sind in Estland und Deutschland unterschiedlich stark mit subjektiver Gesundheit verbunden. In Deutschland ist diese Beziehung weitestgehend unabhängig von demografischen Variablen. Um die Gesundheitszustände in Ost- und Westeuropa anzugleichen ist es sinnvoll, in die Stärkung von Sozialem Kapital zu investieren.

The present study was designed to assess work stress and strain of German general practitioners as well as their health situation by means of standardised and validated instruments. A further objective was to investigate potential means to systematically prevent stress in the target population. The Institute of Occupational, Social and Environmental Medicine of the University Medical Centre of Mainz carried out a state-wide anonymous survey between June and July 2009. Altogether, 2 092 practice-based GPs in the federal German state of Rhineland-Palatinate were asked to take part in the cross-sectional study via postal mail. 808 GPs participated (response rate 38.6%), n=790 of these were eligible for the analysis. We found high levels of work strain and perceived stress. The estimated weekly workload was 54.4 h, about one quarter of which (13.4 h) was dedicated to administrative work. 86.8% of the GPs exceeded the cut-off >1 of the ERI-Q (short version) indicating a high stress level. In the preceding year, participants had kept up their work on an average of 8 days on which they actually felt too sick to work. Measures to prevent stress, as suggested by the general practitioners themselves aim at a reduction of administrative work, an improvement of the financial situation - especially in terms of a higher financial security - and a decrease of the workload. Users of professional supervision and systematic relaxation techniques rated these as helpful regarding stress reduction. The present study is an important first step to systematically assess the working situation and health of GPs in Germany. The results reported here indicate an urgent need for actions to prevent stress.

A quality assured colonoscopy screening was implemented in Germany in the year 2002. Persons aged 55 years or older with a health insurance are eligible. The primary aim of colonoscopy screening is the early detection of cancer. Furthermore, an incidence decrease is expected due to systematic adenomectomy. Up to date, neither a systematic monitoring of epidemiological data nor a mortality evaluation has been contracted by law. Four population-based cancer registries of the federal states Bremen, Hamburg, Saarland, and Schleswig-Holstein in Germany provided incidence data on colorectal cancers during 2000 - 2006. Age-standardised and stage-specific incidence rates and time trends (Joinpoint analysis and APC method) are reported. Overall 34,100 colorectal cancers were registered, of which 91 % were within the screening-eligible age group. The incidence rise of in situ-cancers of the colon and rectum was significant. Changes in tumours of the T 3- and T 4-categories were not consistent. There seems to be a temporal linkage between the implementation of a quality assured colonoscopy screening and the epidemiology of colorectal cancers in Germany. The observed changes cannot be attributed definitively to the screening activities, because required data are not available on the population level. A linkage of screenees and cancer data from registered tumour patients, which allows an individual follow-up and a mortality evaluation, would be desirable.

Hintergrund: Forschungsergebnisse zeigen positive Effekte körperlicher Aktivität (KA) aber nur einen schwachen Einfluss von Milch- und Milchprodukten (MM) auf den kindlichen Knochenstatus, erfasst mit digitalen Röntgenverfahren. In der IDEFICS-Studie wurde die Knochensteifigkeit (KS) mit quantitativer Ultrasonografie (QUS; Vorteile: keine Strahlungsbelastung, kostengünstig, transportabel) erfasst und deren Abhängigkeit von MM, KA und Kardiorespiratorischer Fitness (KRF) untersucht. Material und Methoden: In der Basiserhebung (2007–2008) wurden 16.224 2–9-jährige Kinder in 8 europäischen Ländern untersucht. In die vorliegende Analyse gehen 6–9-jährige Kinder ein. Als mögliche Einflussvariablen auf die KS (Stiffness-Index; SI), gemessen mit QUS, wurden MM (Food-Frequency Fragebogen; Verzehrhäufigkeit/Woche), KA (Accelerometer; counts/15 Sek.) und KRF (40m Sprintzeit; Sekunden) betrachtet. KA wurde in hohe (≥ geschlechtsspezifischer Median) und niedrige KA (< geschlechtsspezifischer Median) eingeteilt. Der Einfluss von MM, KA und Sprintzeit auf die KS wurde mittels multipler linearer Regression untersucht, adjustiert für Alter, Geschlecht und BMI. Ergebnisse: Der durchschnittliche SI der KS bei den Kindern betrug 79,2 (Std.±12,3), die mittlere Sprintzeit 9,2 Sek. (Std.±1,1 Sek.). MM zeigte keinen Effekt auf die KS. Demgegenüber konnte für Kinder mit hoher KA (β=2,35, p ≤0,0001) und einer niedrigen Sprintzeit (β=–1,68, p≤0,0001) eine höhere KS nachgewiesen werden, gegenüber Kindern mit niedriger KA und hohen Sprintzeit. Im Vergleich zu normalgewichtigen hatten übergewichtige (β=1,82, p=0,001) und adipöse Kinder (β=4,39, p≤0,0001) eine höhere KS, untergewichtige Kinder hingegen eine geringere KS (β=2,67, p≤0,0001). Schlussfolgerung: Der berichtete Verzehr von MM zeigte keinen nachweisbaren Einfluss auf die KS bei IDEFICS-Kindern. Ein bedeutender Effekt konnte für KA, KRF und BMI gefunden werden. Ähnliche Trends zeigen Forschungsergebnisse, die den Knochenstatus mit digitalen Röntgenverfahren erfassten. Weitere Studien sind nötig, um diese beobachteten Zusammenhänge zu unterstützen und QUS mit seinen Vorteilen für das Screening kindlicher Knochengesundheit anzubieten.

In 1982, 89 men from all over the FRG participated in an investigation of sperm density and the presence of selected persistent environmental chemicals in their semen. Semen concentrations for the following chemicals were measured: lead, cadmium, hexachlorobenzene (HCBC), a-hexachlorocyclohexane (a-BHC), DDT and metabolites, dieldrin and polychlorobiphenyls (PBC). Heavy metal analyses were performed by Zeeman-AAS with direct sample measurement. A method for the quantitative determination of chlorinated hydrocarbons in semen by liquid-liquid extraction, clean-up and quantitation by gas chromatography with an electron capture detector. Recovery rates ranged from 72 to 120%. Compound identification in samples was confirmed by negative chemical ionization mass spectrometry. Heavy metals and organochlorine compounds in semen were present in the same concentration range as in blood or other biofluids. Occupational exposure as well as extraordinary environmental exposure appeared to influence semen concentrations. Students in chemistry showed elevated levels of organochlorine compounds. Men who lived in the vicinity of an atmospheric source of heavy metals showed strikingly the vicinity of an atmospheric source of heavy metals showed strikingly elevated levels of semen lead and cadmium. We were unable to find a statistically significant correlation between sperm density and any of the variables examined in this study including: orgonochlorine compounds summed or individually; lead and/or cadmium; and tobacco consumption. Significant correlations were found between the simultaneous occurrence of lead and cadmium and between the simultaneous occurrence of HCB, DDT and DDE.