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Kalankesh LR, Khajavian N, Soori H, Vaziri MH, Saeedi R, Hajighasemkhan A. Association metrological factors with Covid-19 mortality in Tehran, Iran (2020-2021). INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:1725-1736. [PMID: 37504381 DOI: 10.1080/09603123.2023.2239721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
The outbreak of the Coronavirus disease (COVID-19) has raised questions about the potential role of climate and environmental factors in disease transmission. This study examined meteorological and demographic factors to determine their impact on mortality and hospitalization rates in Tehran, Iran from January 1, 2021, to December 31, 2022. Notably, hospitalization cases were positively associated with temperature (P-value: 0.001 in spring, P-value: 0.045 in winter) and pressure (P-value: 0.004 in spring), while being negatively associated with wind speed (P-value: 0.03 in spring, P-value: 0.01 in autumn) and humidity (P-value: 0.001 in autumn) during the spring and autumn seasons. Conversely, mortality was associated with wind speed (P-value: 0.01) and pressure (P-value: 0.02) during winter and spring, respectively. Moreover, temperature was associated with mortality in both spring (P-value: 0.00) and winter (P-value: 0.04). The findings suggest that identifying the environmental factors that contribute to the spread of COVID-19 can help prevent future waves of the pandemic in Tehran.
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Affiliation(s)
- Laleh R Kalankesh
- Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Nasim Khajavian
- Department of Biostatistics, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
| | - Hamid Soori
- Faculty of Medicine, Cyprus International University, Nicosia, North Cyprus
| | - Mohammad Hossein Vaziri
- Workplace Health Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Health, Safety and Environment (HSE), School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Saeedi
- Department of Health, Safety and Environment (HSE), School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Hajighasemkhan
- Workplace Health Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Occupational Health Engineering and Safety, School of Public Health and Safety, Shahid Beheshti University of Medical Science, Tehran, Iran
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Houweling L, Maitland-Van der Zee AH, Holtjer JCS, Bazdar S, Vermeulen RCH, Downward GS, Bloemsma LD. The effect of the urban exposome on COVID-19 health outcomes: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2024; 240:117351. [PMID: 37852458 DOI: 10.1016/j.envres.2023.117351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The global severity of SARS-CoV-2 illness has been associated with various urban characteristics, including exposure to ambient air pollutants. This systematic review and meta-analysis aims to synthesize findings from ecological and non-ecological studies to investigate the impact of multiple urban-related features on a variety of COVID-19 health outcomes. METHODS On December 5, 2022, PubMed was searched to identify all types of observational studies that examined one or more urban exposome characteristics in relation to various COVID-19 health outcomes such as infection severity, the need for hospitalization, ICU admission, COVID pneumonia, and mortality. RESULTS A total of 38 non-ecological and 241 ecological studies were included in this review. Non-ecological studies highlighted the significant effects of population density, urbanization, and exposure to ambient air pollutants, particularly PM2.5. The meta-analyses revealed that a 1 μg/m3 increase in PM2.5 was associated with a higher likelihood of COVID-19 hospitalization (pooled OR 1.08 (95% CI:1.02-1.14)) and death (pooled OR 1.06 (95% CI:1.03-1.09)). Ecological studies, in addition to confirming the findings of non-ecological studies, also indicated that higher exposure to nitrogen dioxide (NO2), ozone (O3), sulphur dioxide (SO2), and carbon monoxide (CO), as well as lower ambient temperature, humidity, ultraviolet (UV) radiation, and less green and blue space exposure, were associated with increased COVID-19 morbidity and mortality. CONCLUSION This systematic review has identified several key vulnerability features related to urban areas in the context of the recent COVID-19 pandemic. The findings underscore the importance of improving policies related to urban exposures and implementing measures to protect individuals from these harmful environmental stressors.
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Affiliation(s)
- Laura Houweling
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; Dept. of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Anke-Hilse Maitland-Van der Zee
- Dept. of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands
| | - Judith C S Holtjer
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Somayeh Bazdar
- Dept. of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands
| | - Roel C H Vermeulen
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - George S Downward
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lizan D Bloemsma
- Dept. of Pulmonary Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands; Amsterdam Public Health, Amsterdam, the Netherlands
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Xu S, Li H, Wang J, Lu L, Dai Z. Relationship between meteorological factors and mortality in patients with coronavirus disease 2019: A cross-sectional study. Heliyon 2023; 9:e18565. [PMID: 37576230 PMCID: PMC10412992 DOI: 10.1016/j.heliyon.2023.e18565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background Recent studies on COVID-19 have demonstrated that poverty, comorbidities, race/ethnicity, population density, mobility, hygiene and use of masks are some of the important correlates of COVID-19 outcomes. In fact, weather conditions also play an important role in enhancing or eradicating health issues. Based on Chinese experience, the development of SARS and COVID-19 is partially associated with alterations in climate that align with the seasonal shifts of the "24 solar terms." However, the applicability of this pattern to other countries, particularly the United States, which has the highest global incidence and mortality rates, remains subject to ongoing investigation. We need to find more evidence to in the U.S. states verify the relationship between meteorological factors and COVID-19 outcomes to provide epidemiological and environmental support for the COVID-19 pandemic prevention and resource preservation. Objective To evaluate the relationship between meteorological factors and Coronavirus Disease 2019 (COVID-19) mortality. Methods We conducted an ecological cross-sectional study to evaluate the relationship between meteorological factors (maximum temperature, minimum temperature, humidity, wind speed, precipitation, atmospheric pressure) and COVID-19 mortality. This retrospective observational study examines mortality rates among COVID-19 patients in the three US states, California, Texas, and New York, with the highest fatality numbers, between March 7, 2020 and March 7, 2021. The study draws upon data sourced from the publicly accessible Dryad database. The daily corresponding meteorological conditions were retrieved from the National Oceanic and Atmospheric Administration Global Meteorological website (https://www.ncei.noaa.gov/maps/hourly/). This study employed multivariate linear regression analysis to assess the correlation between six meteorological factors and COVID-19 mortality. Gaussian distribution models were utilized to generate smooth curves for examining the linear association between maximum or minimum temperature and mortality. Additionally, breakpoint analysis was conducted to evaluate the threshold effect of temperature. Results We found that the death toll of patients with COVID-19 decreased with an increase in the highest and lowest ambient temperatures (p < 0.001). In our study, we observed a seasonal difference in mortality rates, with a higher number of deaths occurring during winter months, particularly in January and February. However, mortality rates decreased significantly in March. Notably, we found no statistically significant correlation between relative humidity, average precipitation, and average wind speed with COVID-19 mortality (all p > 0.05). Daily COVID-19 death was negatively correlated with the maximum temperature (β = -22, 95% CI, -26.2 to -17.79 -, p < 0.01), while the maximum temperature was below 30 °C. Similarly, the number of deaths was negatively correlated with the minimum temperature (β = -27.46, 95% CI, -31.48 to -23.45, p < 0.01), when the minimum temperature was below 8 °C. Our study found a significant association between temperature and COVID-19 mortality, with every 1 °C increase in maximum or minimum temperature resulting in a decrease of 22 and 27 deceased cases, respectively. The relationship between atmospheric pressure and COVID-19 mortality was not fully elucidated due to its complex interaction with maximum temperature. Conclusions This empirical study adds to the existing body of research on the impact of climate factors on COVID-19 prevention and resource allocation. Policymakers and health scientists may find these findings useful in conjunction with other social factors when making decisions related to COVID-19 prevention and resource allocation.
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Affiliation(s)
- Shanshan Xu
- Office of Infection Management, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Haibo Li
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Juan Wang
- Musculoskeletal Pain Rehabilitation Department, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450002, China
| | - Lin Lu
- Department of Trade Union, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210029, China
| | - Zhengxiang Dai
- Office of Infection Management, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210029, China
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Moazeni M, Rahimi M, Ebrahimi A. What are the Effects of Climate Variables on COVID-19 Pandemic? A Systematic Review and Current Update. Adv Biomed Res 2023; 12:33. [PMID: 37057247 PMCID: PMC10086649 DOI: 10.4103/abr.abr_145_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 04/15/2023] Open
Abstract
The climatological parameters can be different in various geographical locations. Moreover, they have possible impacts on COVID-19 incidence. Therefore, the purpose of this systematic review article was to describe the effects of climatic variables on COVID-19 pandemic in different countries. Systematic literature search was performed in Scopus, ISI Web of Science, and PubMed databases using ("Climate" OR "Climate Change" OR "Global Warming" OR "Global Climate Change" OR "Meteorological Parameters" OR "Temperature" OR "Precipitation" OR "Relative Humidity" OR "Wind Speed" OR "Sunshine" OR "Climate Extremes" OR "Weather Extremes") AND ("COVID" OR "Coronavirus disease 2019" OR "COVID-19" OR "SARS-CoV-2" OR "Novel Coronavirus") keywords. From 5229 articles, 424 were screened and 149 were selected for further analysis. The relationship between meteorological parameters is variable in different geographical locations. The results indicate that among the climatic indicators, the temperature is the most significant factor that influences on COVID-19 pandemic in most countries. Some studies were proved that warm and wet climates can decrease COVID-19 incidence; however, the other studies represented that warm location can be a high risk of COVID-19 incidence. It could be suggested that all climate variables such as temperature, humidity, rainfall, precipitation, solar radiation, ultraviolet index, and wind speed could cause spread of COVID-19. Thus, it is recommended that future studies will survey the role of all meteorological variables and interaction between them on COVID-19 spread in specific small areas such as cities of each country and comparison between them.
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Affiliation(s)
- Malihe Moazeni
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Rahimi
- Department of Combat Desertification, Faculty of Desert Studies, Semnan University, Semnan, Iran
| | - Afshin Ebrahimi
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
- Address for correspondence: Dr. Afshin Ebrahimi, Department of Environmental Health Engineering, School of Health, Hezar-Jerib Ave., Isfahan University of Medical Sciences, Isfahan, 81676 − 36954, Iran. E-mail:
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Effects of climatic factors on COVID-19 transmission in Ethiopia. Sci Rep 2022; 12:19722. [PMID: 36385128 PMCID: PMC9668213 DOI: 10.1038/s41598-022-24024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
Climatic conditions play a key role in the transmission and pathophysiology of respiratory tract infections, either directly or indirectly. However, their impact on the COVID-19 pandemic propagation is yet to be studied. This study aimed to evaluate the effects of climatic factors such as temperature, rainfall, relative humidity, sunshine duration, and wind speed on the number of daily COVID-19 cases in Addis Ababa, Ethiopia. Data on confirmed COVID-19 cases were obtained from the National Data Management Center at the Ethiopian Public Health Institute for the period 10th March 2020 to 31st October 2021. Data for climatic factors were obtained from the Ethiopia National Meteorology Agency. The correlation between daily confirmed COVID-19 cases and climatic factors was measured using the Spearman rank correlation test. The log-link negative binomial regression model was used to fit the effect of climatic factors on COVID-19 transmission, from lag 0 to lag 14 days. During the study period, a total of 245,101 COVID-19 cases were recorded in Addis Ababa, with a median of 337 new cases per day and a maximum of 1903 instances per day. A significant correlation between COVID-19 cases and humidity was observed with a 1% increase in relative humidity associated with a 1.1% [IRRs (95%CI) 0.989, 95% (0.97-0.99)] and 1.2% [IRRs (95%CI) 0.988, (0.97-0.99)] decrease in COVID-19 cases for 4 and 5 lag days prior to detection, respectively. The highest increase in the effect of wind speed and rainfall on COVID-19 was observed at 14 lag days prior to detection with IRRs of 1.85 (95%CI 1.26-2.74) and 1.078 (95%CI 1.04-1.12), respectively. The lowest IRR was 1.109 (95%CI 0.93-1.31) and 1.007 (95%CI 0.99-1.02) both in lag 0, respectively. The findings revealed that none of the climatic variables influenced the number of COVID-19 cases on the day of case detection (lag 0), and that daily average temperature and sunshine duration were not significantly linked with COVID-19 risk across the full lag period (p > 0.05). Climatic factors such as humidity, rainfall, and wind speed influence the transmission of COVID-19 in Addis Ababa, Ethiopia. COVID-19 cases have shown seasonal variations with the highest number of cases reported during the rainy season and the lowest number of cases reported during the dry season. These findings suggest the need to design strategies for the prevention and control of COVID-19 before the rainy seasons.
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Wei Y, Dong Z, Fan W, Xu K, Tang S, Wang Y, Wu F. A narrative review on the role of temperature and humidity in COVID-19: Transmission, persistence, and epidemiological evidence. ECO-ENVIRONMENT & HEALTH (ONLINE) 2022; 1:73-85. [PMID: 38013745 PMCID: PMC9181277 DOI: 10.1016/j.eehl.2022.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/30/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022]
Abstract
Since December 2019, the 2019 coronavirus disease (COVID-19) outbreak has become a global pandemic. Understanding the role of environmental conditions is important in impeding the spread of COVID-19. Given that airborne spread and contact transmission are considered the main pathways for the spread of COVID-19, this narrative review first summarized the role of temperature and humidity in the airborne trajectory of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Meanwhile, we reviewed the persistence of the virus in aerosols and on inert surfaces and summarized how the persistence of SARS-CoV-2 is affected by temperature and humidity. We also examined the existing epidemiological evidence and addressed the limitations of these epidemiological studies. Although uncertainty remains, more evidence may support the idea that high temperature is slightly and negatively associated with COVID-19 growth, while the conclusion for humidity is still conflicting. Nonetheless, the spread of COVID-19 appears to have been controlled primarily by government interventions rather than environmental factors.
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Affiliation(s)
- Yuan Wei
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Zhaomin Dong
- School of Space and Environment, Beihang University, Beijing 102206, China
| | - Wenhong Fan
- School of Space and Environment, Beihang University, Beijing 102206, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100083, China
| | - Kaiqiang Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Song Tang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ying Wang
- School of Space and Environment, Beihang University, Beijing 102206, China
| | - Fengchang Wu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
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Application of Machine Learning to Study the Association between Environmental Factors and COVID-19 Cases in Mississippi, USA. MATHEMATICS 2022; 10. [PMID: 36092863 PMCID: PMC9455279 DOI: 10.3390/math10060850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because of the large-scale impact of COVID-19 on human health, several investigations are being conducted to understand the underlying mechanisms affecting the spread and transmission of the disease. The present study aimed to assess the effects of selected environmental factors such as temperature, humidity, dew point, wind speed, pressure, and precipitation on the daily increase in COVID-19 cases in Mississippi, USA, during the period from January 2020 to August 2021. A machine learning model was used to predict COVID-19 cases and implement preventive measures if necessary. A statistical analysis using Python programming showed that the humidity ranged from 56% to 78%, and COVID-19 cases increased from 634 to 3546. Negative correlations were found between temperature and COVID-19 incidence rate (−0.22) and between humidity and COVID-19 incidence rate (−0.15). The linear regression model showed the model linear coefficients to be 0.92 and −1.29, respectively, with the intercept being 55.64. For the test dataset, the R2 score was 0.053. The statistical analysis and machine learning show that there is no linear dependence of temperature and humidity with the COVID-19 incidence rate.
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Romero Starke K, Mauer R, Karskens E, Pretzsch A, Reissig D, Nienhaus A, Seidler AL, Seidler A. The Effect of Ambient Environmental Conditions on COVID-19 Mortality: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126665. [PMID: 34205714 PMCID: PMC8296503 DOI: 10.3390/ijerph18126665] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
Weather conditions may have an impact on SARS-CoV-2 virus transmission, as has been shown for seasonal influenza. Virus transmission most likely favors low temperature and low humidity conditions. This systematic review aimed to collect evidence on the impact of temperature and humidity on COVID-19 mortality. This review was registered with PROSPERO (registration no. CRD42020196055). We searched the Pubmed, Embase, and Cochrane COVID-19 databases for observational epidemiological studies. Two independent reviewers screened the title/abstracts and full texts of the studies. Two reviewers also performed data extraction and quality assessment. From 5051 identified studies, 11 were included in the review. Although the results were inconsistent, most studies imply that a decrease in temperature and humidity contributes to an increase in mortality. To establish the association with greater certainty, future studies should consider accurate exposure measurements and important covariates, such as government lockdowns and population density, sufficient lag times, and non-linear associations.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
- Correspondence:
| | - René Mauer
- Institute for Medical Informatics and Biometry (IMB), Faculty of Medicine Carl Gustav Carus, Technische Universität, 01307 Dresden, Germany;
| | - Ethel Karskens
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
| | - Anna Pretzsch
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
| | - David Reissig
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
| | - Albert Nienhaus
- Department of Occupational Medicine, Toxic Substances and Health Research, Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW), 22089 Hamburg, Germany;
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (E.K.); (A.P.); (D.R.); (A.S.)
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