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Augustin J, Andrees V, Czerniejewski A, Dallner R, Schulz CM, Mezger NCS. [The impact of the Ahr Valley flood on the health of the local population - an analysis based on SHI routine data]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:5-13. [PMID: 38193912 PMCID: PMC10776694 DOI: 10.1007/s00103-023-03809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/15/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND In recent decades, Germany has experienced flood events that posed a threat to the health of the local population. However, there is a paucity of studies on the health consequences of these events. Therefore, the aim of the study was to investigate the health consequences of the Ahr Valley flood in 2021. METHODS The data basis of this longitudinal study are nationwide billing data (inpatient/outpatient) of the BKK-Landesverband Nordwest. The study region was Ahrweiler and the study periods were the third quarters of 2020 and 2021. Among other things, prevalence rate ratio tests were used to determine which diagnoses (inpatient/outpatient) were spatially and temporally associated with the flood event on the basis of ICD-10 coding. RESULTS The results show a significant increase in billed services for some diagnosis groups in the inpatient sector. In particular, there was an increase in F diagnoses (mental and behavioural disorders), S diagnoses (injuries) and various diagnosis codes within Z codes (factors influencing health status and leading to healthcare utilisation). In the outpatient sector, a decrease was observed in many diagnosis groups (F and Z diagnoses). CONCLUSION The results of the study showed that the mental health of the local population was particularly affected by the floods. Healthcare was also affected. As floods are expected to become more frequent and severe in the future, measures to protect the population and health infrastructure need to be adapted accordingly.
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Affiliation(s)
- Jobst Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Valerie Andrees
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland
| | | | | | - Christian M Schulz
- KLUG - Deutsche Allianz Klimawandel und Gesundheit e. V., Berlin, Deutschland
- Medizincampus Oberfranken, Institut für Medizinmanagement und Gesundheitswissenschaften, Universität Bayreuth, Bayreuth, Deutschland
| | - Nikolaus Christian Simon Mezger
- Centre for Planetary Health Policy, Berlin, Deutschland
- Global Public Health Department, Karolinska Institut, Stockholm, Schweden
- Arbeitsgruppe Globale und Planetare Gesundheit, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Walldorf J, Mezger NCS, Weber L, Knothe A, Klose M, Moritz S, Kantelhardt EJ, Feller S, Schlitt A, Greinert R, Michl P. [Climate Crisis: What Gastrointestinal Complications of this Medical Emergency Should We Be Aware Of?]. Z Gastroenterol 2023; 61:1608-1617. [PMID: 37044125 DOI: 10.1055/a-2058-8883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
INTRODUCTION The climate crisis has serious consequences for many areas of life. This applies in particular to human health - also in Europe. While cardiovascular, pneumological and dermatological diseases related to the climate crisis are often discussed, the crisis' significant gastroenterological consequences for health must also be considered. METHODS A literature search (Pubmed, Cochrane Library) was used to identify papers with relevance particularly to the field of gastroenterology in (Central) Europe. Findings were supplemented and discussed by an interdisciplinary team. RESULTS The climate crisis impacts the frequency and severity of gastrointestinal diseases in Europe due to more frequent and severe heat waves, flooding and air pollution. While patients with intestinal diseases are particularly vulnerable to acute weather events, the main long-term consequences of climate change are gastrointestinal cancer and liver disease. In addition to gastroenteritis, other infectious diseases such as vector-borne diseases and parasites are important in the context of global warming, heat waves and floods. DISCUSSION Adaptation strategies must be consistently developed and implemented for vulnerable groups. Patients at risk should be informed about measures that can be implemented individually, such as avoiding heat, ensuring appropriate hydration and following hygiene instructions. Recommendations for physical activity and a healthy and sustainable diet are essential for the prevention of liver diseases and carcinomas. Measures for prevention and the promotion of resilience can be supported by the physicians at various levels. In addition to efforts fostering sustainability in the immediate working environment, a system-oriented commitment to climate protection is important.
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Affiliation(s)
- Jens Walldorf
- Klinik für Innere Medizin I, University Hospital Halle, Halle, Germany
| | - Nikolaus Christian Simon Mezger
- Arbeitsgruppe Global and Planetary Health, Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Lena Weber
- Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Anja Knothe
- Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Michelle Klose
- Klinik für Innere Medizin I, University Hospital Halle, Halle, Germany
| | - Stefan Moritz
- Klinische Infektiologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Eva Johanna Kantelhardt
- Arbeitsgruppe Global and Planetary Health, Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Stephan Feller
- Institut für Molekulare Medizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Axel Schlitt
- Paracelsus-Harz-Klinik Bad Suderode, Bad Suderode, Germany
| | - Robin Greinert
- Klinik für Innere Medizin I, University Hospital Halle, Halle, Germany
| | - Patrick Michl
- Klinik für Innere Medizin I, University Hospital Halle, Halle, Germany
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Mezger NCS, Hämmerl L, Griesel M, Seraphin TP, Joko-Fru YW, Feuchtner J, Zietsman A, Péko JF, Tadesse F, Buziba NG, Wabinga H, Nyanchama M, Chokunonga E, Kéita M, N’da G, Lorenzoni CF, Akele-Akpo MT, Mezger JM, Binder M, Liu B, Bauer M, Henke O, Jemal A, Kantelhardt EJ. Guideline Concordance of Treatment and Outcomes Among Adult Non-Hodgkin Lymphoma Patients in Sub-Saharan Africa: A Multinational, Population-Based Cohort. Oncologist 2023; 28:e1017-e1030. [PMID: 37368350 PMCID: PMC10628567 DOI: 10.1093/oncolo/oyad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Although non-Hodgkin lymphoma (NHL) is the 6th most common malignancy in Sub-Saharan Africa (SSA), little is known about its management and outcome. Herein, we examined treatment patterns and survival among NHL patients. METHODS We obtained a random sample of adult patients diagnosed between 2011 and 2015 from 11 population-based cancer registries in 10 SSA countries. Descriptive statistics for lymphoma-directed therapy (LDT) and degree of concordance with National Comprehensive Cancer Network (NCCN) guidelines were calculated, and survival rates were estimated. FINDINGS Of 516 patients included in the study, sub-classification was available for 42.1% (121 high-grade and 64 low-grade B-cell lymphoma, 15 T-cell lymphoma and 17 otherwise sub-classified NHL), whilst the remaining 57.9% were unclassified. Any LDT was identified for 195 of all patients (37.8%). NCCN guideline-recommended treatment was initiated in 21 patients. This corresponds to 4.1% of all 516 patients, and to 11.7% of 180 patients with sub-classified B-cell lymphoma and NCCN guidelines available. Deviations from guideline-recommended treatment were initiated in another 49 (9.5% of 516, 27.2% of 180). By registry, the proportion of all patients receiving guideline-concordant LDT ranged from 30.8% in Namibia to 0% in Maputo and Bamako. Concordance with treatment recommendations was not assessable in 75.1% of patients (records not traced (43.2%), traced but no sub-classification identified (27.8%), traced but no guidelines available (4.1%)). By registry, diagnostic work-up was in part importantly limited, thus impeding guideline evaluation significantly. Overall 1-year survival was 61.2% (95%CI 55.3%-67.1%). Poor ECOG performance status, advanced stage, less than 5 cycles and absence of chemo (immuno-) therapy were associated with unfavorable survival, while HIV status, age, and gender did not impact survival. In diffuse large B-cell lymphoma, initiation of guideline-concordant treatment was associated with favorable survival. INTERPRETATION This study shows that a majority of NHL patients in SSA are untreated or undertreated, resulting in unfavorable survival. Investments in enhanced diagnostic services, provision of chemo(immuno-)therapy and supportive care will likely improve outcomes in the region.
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Affiliation(s)
- Nikolaus Christian Simon Mezger
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lucia Hämmerl
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Mirko Griesel
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias Paul Seraphin
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Yvonne Walburga Joko-Fru
- African Cancer Registry Network, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jana Feuchtner
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Annelle Zietsman
- African Cancer Registry Network, Oxford, UK
- Dr AB May Cancer Care Centre, Windhoek, Namibia
| | - Jean-Félix Péko
- African Cancer Registry Network, Oxford, UK
- Registre des cancers de Brazzaville, Brazzaville, Republic of the Congo
| | - Fisihatsion Tadesse
- African Cancer Registry Network, Oxford, UK
- Division of Hematology, Department of Internal Medicine, University and Black Lion Hospital, Addis Ababa, Ethiopia
| | - Nathan Gyabi Buziba
- African Cancer Registry Network, Oxford, UK
- Eldoret Cancer Registry, School of Medicine, Moi University, Eldoret, Kenya
| | - Henry Wabinga
- African Cancer Registry Network, Oxford, UK
- Kampala Cancer Registry, Makerere University School of Medicine, Kampala, Uganda
| | - Mary Nyanchama
- African Cancer Registry Network, Oxford, UK
- National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eric Chokunonga
- African Cancer Registry Network, Oxford, UK
- Zimbabwe National Cancer Registry, Harare, Zimbabwe
| | - Mamadou Kéita
- African Cancer Registry Network, Oxford, UK
- Service du Laboratoire d’Anatomie et Cytologie Pathologique, Bamako, Mali
- CHU du point G , Bamako, Mali
| | - Guy N’da
- African Cancer Registry Network, Oxford, UK
- Registre des cancers d’Abidjan, Abidjan, Côte d’Ivoire
| | - Cesaltina Ferreira Lorenzoni
- African Cancer Registry Network, Oxford, UK
- Departamento de Patologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Hospital Central de Maputo, Mozambique
- Registo de Cancro, Ministério da Saúde, Maputo, Mozambique
| | - Marie-Thérèse Akele-Akpo
- African Cancer Registry Network, Oxford, UK
- Département d’anatomo-pathologie, Faculté des Sciences de la Santé, Cotonou, Benin
| | | | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Biying Liu
- African Cancer Registry Network, Oxford, UK
| | - Marcus Bauer
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Oliver Henke
- Section Global Health, Institute for Public Health and Hygiene, University Hospital Bonn, Germany
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, USA
| | - Eva Johanna Kantelhardt
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Mezger NCS, Eickel F, Lorenz R, Griesel M. Erratum zu: Nachhaltigkeit in der chirurgischen Niederlassung – ein narratives Review. Chirurgie (Heidelb) 2023:10.1007/s00104-023-01911-z. [PMID: 37326661 DOI: 10.1007/s00104-023-01911-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Nikolaus Christian Simon Mezger
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther Universität Halle-Wittenberg, Halle (Saale), Deutschland.
- Global and Public Health Department, Karolinska Institutet, Stockholm, Schweden.
- Centre for Planetary Health Policy (CPHP), c/o KLUG - Deutsche Allianz Klimawandel und Gesundheit e. V., Cuvrystr. 1, 10997, Berlin, Deutschland.
| | | | | | - Mirko Griesel
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Mezger NCS, Eickel F, Lorenz R, Griesel M. [Sustainability in private surgical practice-A narrative review]. Coloproctology 2023; 45:1-10. [PMID: 37362611 PMCID: PMC10158674 DOI: 10.1007/s00053-023-00711-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background Surgery is contributing to the climate crisis, not least in the outpatient sector. The present publication aims to identify the challenges this poses, and to provide clear, preferably evidence-based recommendations on environmental protection while simultaneously reducing costs. Method Narrative review with a non-systematic search and selection in PubMed/MEDLINE and grey area literature as well as expert interviews. Results Numerous primary articles, evidence syntheses, practical recommendations for action and checklists were identified and two experts were interviewed. Environmental issues were identified in the production and procurement, transport of people and goods, usage of materials, pharmaceuticals including anesthetic gases and energy consumption in the outpatient practice and also in disposal, recycling, and sterilization. High-quality publications do not describe a lack of knowledge on alternatives but on a lack of implementation in clinical practice. Therefore, the identified issues were classified in the 5‑R scheme (reduce, reuse, recycle, rethink, research) to present recommendations for action, which are synergetic in terms of cost reduction, patient and staff satisfaction. Furthermore, changes in regulatory frameworks are discussed. Conclusion Outpatient surgery comes with relevant consumption of resources and carbon emissions. There are numerous opportunities for action that combine environmental protection with cost reduction as well as patient and staff satisfaction. Incentives, guidelines, and legal framework conditions are needed for comprehensive environmental protection in the private sector.
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Affiliation(s)
- Nikolaus Christian Simon Mezger
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther Universität Halle-Wittenberg, Halle (Saale), Deutschland
- Global and Public Health Department, Karolinska Institutet, Stockholm, Schweden
- Centre for Planetary Health Policy (CPHP), c/o KLUG – Deutsche Allianz Klimawandel und Gesundheit e. V., Cuvrystr. 1, 10997 Berlin, Deutschland
| | | | | | - Mirko Griesel
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Mezger NCS, Eickel F, Lorenz R, Griesel M. [Sustainability in private surgical practice-A narrative review]. Chirurgie (Heidelb) 2023; 94:199-209. [PMID: 36602565 PMCID: PMC9813892 DOI: 10.1007/s00104-022-01785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Surgery is contributing to the climate crisis, not least in the outpatient sector. The present publication aims to identify the challenges this poses, and to provide clear, preferably evidence-based recommendations on environmental protection while simultaneously reducing costs. METHOD Narrative review with a non-systematic search and selection in PubMed/MEDLINE and grey area literature as well as expert interviews. RESULTS Numerous primary articles, evidence syntheses, practical recommendations for action and checklists were identified and two experts were interviewed. Environmental issues were identified in the production and procurement, transport of people and goods, usage of materials, pharmaceuticals including anesthetic gases and energy consumption in the outpatient practice and also in disposal, recycling, and sterilization. High-quality publications do not describe a lack of knowledge on alternatives but on a lack of implementation in clinical practice. Therefore, the identified issues were classified in the 5‑R scheme (reduce, reuse, recycle, rethink, research) to present recommendations for action, which are synergetic in terms of cost reduction, patient and staff satisfaction. Furthermore, changes in regulatory frameworks are discussed. CONCLUSION Outpatient surgery comes with relevant consumption of resources and carbon emissions. There are numerous opportunities for action that combine environmental protection with cost reduction as well as patient and staff satisfaction. Incentives, guidelines, and legal framework conditions are needed for comprehensive environmental protection in the private sector.
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Affiliation(s)
- Nikolaus Christian Simon Mezger
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther Universität Halle-Wittenberg, Halle (Saale), Deutschland. .,Global and Public Health Department, Karolinska Institutet, Stockholm, Deutschland. .,Centre for Planetary Health Policy (CPHP), c/o KLUG - Deutsche Allianz Klimawandel und Gesundheit e. V., Cuvrystr. 1, 10997, Berlin, Deutschland.
| | | | | | - Mirko Griesel
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Krippl N, Mezger NCS, Fischer H, Schildmann J, Mikolajczyk R, Danquah I, Kantelhardt EJ, Herrmann A. Climate-sensitive health counselling: a quantitative survey on addressing climate change. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Climate change and its mitigation have significant health implications. Hence, medical associations call on physicians to inform the population about health risks of climate change and possible health co-benefits of climate action. However, so far it is unclear what preferences the general public has about climate-sensitive health counselling (CSHC). Therefore, we developed a survey tool to a) characterize experiences of CSHC, b) identify preferences about communication methods and themes, and c) determine associations of socioeconomic characteristics and climate change attitudes with CSHC preferences.
Methods
The tool development for this cross-sectional online-based survey was embedded in a bigger research project on the conceptualization of CSHC, which follows an exploratory mixed-methods design. Results of preceding qualitative interviews about CSHC were integrated into the tool development. After two pilot tests, the tool was administered from April to June 2022 through the population-based HeReCa panel (Health Related Beliefs and Health Care Experiences in Germany), comprising 3200 participants from 5 federal states. Sociodemographic data is available for all participants.
Results
The final tool entails 46 items, sorted into 7 sections. Two sections serve as dependent variables for the association analysis: 13 items about the acceptability of different communicative approaches of CSHC and 18 items on preferences for themes in CSHC. Three sections serve as independent variables for the analysis: attitudes on climate change, level of engagement, and sociodemographic data. Two sections assess experiences with CSHC and preferred information channels to serve as descriptive results.
Conclusions
A rigorous methodology proved helpful for survey development within a mixed methods study. In triangulation with qualitative data, results of the survey will help physicians to deliver CSHC tailored to the preferences of different sociodemographic groups.
Key messages
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Affiliation(s)
- N Krippl
- Institute for Global Health, University of Heidelberg , Heidelberg, Germany
| | - NCS Mezger
- IMEBI, University of Halle-Wittenberg, Haale ( Saale), Germany
| | - H Fischer
- Perception and Action lab, Leibniz-Institut für Wissensmedien , Tübingen, Germany
| | - J Schildmann
- Institute for History and Ethics of Medicine, University of Halle-Wittenberg, Haale ( Saale), Germany
| | - R Mikolajczyk
- IMEBI, University of Halle-Wittenberg, Haale ( Saale), Germany
| | - I Danquah
- Institute for Global Health, University of Heidelberg , Heidelberg, Germany
| | - EJ Kantelhardt
- IMEBI, University of Halle-Wittenberg, Haale ( Saale), Germany
| | - A Herrmann
- Institute for Global Health, University of Heidelberg , Heidelberg, Germany
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Wabnitz K, Schwienhorst-Stich EM, Asbeck F, Fellmann CS, Gepp S, Leberl J, Mezger NCS, Eichinger M. National Planetary Health learning objectives for Germany: A steppingstone for medical education to promote transformative change. Front Public Health 2022; 10:1093720. [PMID: 36937826 PMCID: PMC10015604 DOI: 10.3389/fpubh.2022.1093720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/28/2022] [Indexed: 02/18/2023] Open
Abstract
Physicians play an important role in adapting to and mitigating the adverse health effects of the unfolding climate and ecological crises. To fully harness this potential, future physicians need to acquire knowledge, values, skills, and leadership attributes to care for patients presenting with environmental change-related conditions and to initiate and propel transformative change in healthcare and other sectors of society including, but not limited to, the decarbonization of healthcare systems, the transition to renewable energies and the transformation of transport and food systems. Despite the potential of Planetary Health Education (PHE) to support medical students in becoming agents of change, best-practice examples of mainstreaming PHE in medical curricula remain scarce both in Germany and internationally. The process of revising and updating the Medical Licensing Regulations and the National Competency-based Catalog of Learning Objectives for Medical Education in Germany provided a window of opportunity to address this implementation challenge. In this article, we describe the development and content of national Planetary Health learning objectives for Germany. We anticipate that the learning objectives will stimulate the development and implementation of innovative Planetary Health teaching, learning and exam formats in medical schools and inform similar initiatives in other health professions. The availability of Planetary Health learning objectives in other countries will provide opportunities for cross-country and interdisciplinary exchange of experiences and validation of content, thus supporting the consolidation of Planetary Health learning objectives and the improvement of PHE for all health professionals globally.
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Affiliation(s)
- Katharina Wabnitz
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Centre for Planetary Health Policy, Berlin, Germany
| | - Eva-Maria Schwienhorst-Stich
- Department of General Practice and Family Medicine, University Hospital Würzburg, Würzburg, Germany
- Teaching Clinic of the Faculty of Medicine and Institute of Medical Teaching and Medical Education Research, University Hospital Würzburg, Würzburg, Germany
- *Correspondence: Eva-Maria Schwienhorst-Stich
| | - Franziska Asbeck
- Department of General Practice and Family Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Cara Sophie Fellmann
- Department of General Practice and Family Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Sophie Gepp
- Centre for Planetary Health Policy, Berlin, Germany
- German Alliance on Climate Change and Health, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Nikolaus Christian Simon Mezger
- Centre for Planetary Health Policy, Berlin, Germany
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Michael Eichinger
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Joko-Fru WY, Griesel M, Mezger NCS, Hämmerl L, Seraphin TP, Feuchtner J, Wabinga H, N'da G, Mathewos A, Kamaté B, Nsonde Malanda J, Gnangnon FHR, Chesumbai GC, Korir A, Lorenzoni C, Zietsman A, Borok MZ, Liu B, Thomssen C, McGale P, Jemal A, Parkin DM, Kantelhardt EJ. Breast Cancer Diagnostics, Therapy, and Outcomes in Sub-Saharan Africa: A Population-Based Registry Study. J Natl Compr Canc Netw 2021; 20:jnccn20412. [PMID: 34965508 DOI: 10.6004/jnccn.2021.7011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer in sub-Saharan Africa (SSA). However, little is known about the actual therapy received by women with BC and their survival outcome at the population level in SSA. This study aims to describe the cancer-directed therapy received by patients with BC at the population level in SSA, compare these results with the NCCN Harmonized Guidelines for SSA (NCCN Harmonized Guidelines), and evaluate the impact on survival. METHODS Random samples of patients with BC (≥40 patients per registry), diagnosed from 2009 through 2015, were drawn from 11 urban population-based cancer registries from 10 countries (Benin, Congo, Cote d'Ivoire, Ethiopia, Kenya, Mali, Mozambique, Namibia, Uganda, and Zimbabwe). Active methods were used to update the therapy and outcome data of diagnosed patients ("traced patients"). Excess hazards of death by therapy use were modeled in a relative survival context. RESULTS A total of 809 patients were included. Additional information was traced for 517 patients (63.8%), and this proportion varied by registry. One in 5 traced patients met the minimum diagnostic criteria (cancer stage and hormone receptor status known) for use of the NCCN Harmonized Guidelines. The hormone receptor status was unknown for 72.5% of patients. Of the traced patients with stage I-III BC (n=320), 50.9% received inadequate or no cancer-directed therapy. Access to therapy differed by registry area. Initiation of adequate therapy and early-stage diagnosis were the most important determinants of survival. CONCLUSIONS Downstaging BC and improving access to diagnostics and care are necessary steps to increase guideline adherence and improve survival for women in SSA. It will also be important to strengthen health systems and facilities for data management in SSA to facilitate patient follow-up and disease surveillance.
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Affiliation(s)
- Walburga Yvonne Joko-Fru
- 1Nuffield Department of Population Health, University of Oxford
- 2The African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom
| | - Mirko Griesel
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Nikolaus Christian Simon Mezger
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lucia Hämmerl
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias Paul Seraphin
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jana Feuchtner
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Henry Wabinga
- 4Kampala Cancer Registry, Makerere University School of Medicine, Kampala, Uganda
| | - Guy N'da
- 5Registre des cancers d'Abidjan, Abidjan, Côte d'Ivoire
| | - Assefa Mathewos
- 6Radiotherapy Center, Addis-Ababa-University, Addis Ababa, Ethiopia
| | | | | | | | | | - Anne Korir
- 11Nairobi Cancer Registry, Nairobi, Kenya
| | - Cesaltina Lorenzoni
- 12Maputo City Cancer Registry, Maputo City, Mozambique
- 13Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo Central Hospital, Maputo, Mozambique
| | | | | | - Biying Liu
- 2The African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom
| | - Christoph Thomssen
- 16Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Paul McGale
- 1Nuffield Department of Population Health, University of Oxford
| | - Ahmedin Jemal
- 17Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Donald Maxwell Parkin
- 1Nuffield Department of Population Health, University of Oxford
- 2The African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom
- 18International Agency for Research in Cancer, Lyon, France
| | - Eva Johanna Kantelhardt
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- 16Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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10
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Seraphin TP, Joko-Fru WY, Hämmerl L, Griesel M, Mezger NCS, Feuchtner JC, Adoubi I, Egué MDD, Okerosi N, Wabinga H, Hansen R, Vuma S, Lorenzoni C, Coulibaly B, Odzebe SW, Buziba NG, Aynalem A, Liu B, Medenwald D, Mikolajczyk RT, Efstathiou JA, Parkin DM, Jemal A, Kantelhardt EJ. Presentation, patterns of care, and outcomes of patients with prostate cancer in sub-Saharan Africa: A population-based registry study. Cancer 2021; 127:4221-4232. [PMID: 34328216 DOI: 10.1002/cncr.33818] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/17/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although prostate cancer (PCa) is the most commonly diagnosed cancer in men of sub-Saharan Africa (SSA), little is known about its management and survival. The objective of the current study was to describe the presentation, patterns of diagnosis, treatment, and survival of patients with PCa in 10 countries of SSA. METHODS In this observational registry study with data collection from 2010 to 2018, the authors drew a random sample of 738 patients with PCa who were registered in 11 population-based cancer registries. They described proportions of patients receiving recommended care and presented survival estimates. Multivariable Cox regression was used to calculate hazard ratios comparing the survival of patients with and without cancer-directed therapies (CDTs). RESULTS The study included 693 patients, and tumor characteristics and treatment information were available for 365 patients, 37.3% of whom had metastatic disease. Only 11.2% had a complete diagnostic workup for risk stratification. Among the nonmetastatic patients, 17.5% received curative-intent therapy, and 27.5% received no CDT. Among the metastatic patients, 59.6% received androgen deprivation therapy. The 3- and 5-year age-standardized relative survival for 491 patients with survival time information was 58.8% (95% confidence interval [CI], 48.5%-67.7%) and 56.9% (95% CI, 39.8%-70.9%), respectively. In a multivariable analysis, survival was considerably poorer among patients without CDT versus those with therapy. CONCLUSIONS This study shows that a large proportion of patients with PCa in SSA are not staged or are insufficiently staged and undertreated, and this results in unfavorable survival. These findings reemphasize the need for improving diagnostic workup and access to care in SSA in order to mitigate the heavy burden of the disease in the region.
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Affiliation(s)
- Tobias Paul Seraphin
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walburga Yvonne Joko-Fru
- African Cancer Registry Network, International Network for Cancer Treatment and Research African Registry Programme, Oxford, United Kingdom
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lucia Hämmerl
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mirko Griesel
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Nikolaus Christian Simon Mezger
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jana Cathrin Feuchtner
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Innocent Adoubi
- Department of Immunology, Haematology and Oncology, University of Felix Houphouet-Boigny, Abidjan, Côte d'Ivoire
- Abidjan Cancer Registry, Programme National de Lutte contre le Cancer, Ministry of Health, Abidjan, Côte d'Ivoire
| | | | - Nathan Okerosi
- National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Henry Wabinga
- Kampala Cancer Registry, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rolf Hansen
- Namibia National Cancer Registry, Cancer Association of Namibia, Windhoek, Namibia
| | - Samukeliso Vuma
- Bulawayo Cancer Registry, Department of Radiotherapy, Mpilo Hospital, Bulawayo, Zimbabwe
| | - Cesaltina Lorenzoni
- National Cancer Control Programme, Ministry of Health, Maputo, Mozambique
- Maputo Cancer Registry, Department of Pathology, Hospital Central de Maputo, Maputo, Mozambique
| | - Bourama Coulibaly
- Cancer Registry of Bamako, Hôpital National du Point G, Bamako, Mali
| | - Sévérin W Odzebe
- Cancer Registry of Brazzaville, University Hospital Brazzaville, Brazzaville, Republic of Congo
| | - Nathan Gyabi Buziba
- Eldoret Cancer Registry, Moi Teaching Hospital, Eldoret, Kenya
- Department of Haematology and Blood Transfusion, Moi University School of Medicine, Eldoret, Kenya
| | - Abreha Aynalem
- Addis Ababa City Cancer Registry, Radiotherapy Center, Addis-Ababa-University, Addis Ababa, Ethiopia
| | - Biying Liu
- African Cancer Registry Network, International Network for Cancer Treatment and Research African Registry Programme, Oxford, United Kingdom
| | - Daniel Medenwald
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael T Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jason Alexander Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Claire and John Bertucci Center for Genitourinary Cancers Multidisciplinary Clinic, Massachusetts General Hospital, Boston, Massachusetts
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Gynecology, University Hospital Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
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11
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Mezger NCS, Thöne M, Wellstein I, Schneider F, Litke N, Führer AG, Clar C, Kantelhardt EJ. [Climate protection in practices - current status, motivation and challenges in outpatient care]. Z Evid Fortbild Qual Gesundhwes 2021; 166:44-54. [PMID: 34656461 DOI: 10.1016/j.zefq.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The impact of climate change on health and the necessity to reduce emissions in the health sector is becoming an increasingly discussed topic. Little is known about medical doctors' (MDs) attitude towards climate protection measures in outpatient practices. METHODS Between October 2020 and February 2021, a survey was conducted among MDs in German practices. 1,683 participants answered 39 questions on energy use, transportation, disposable materials, budget and patient counselling. Data were collected on status, motivation, obstacles and needs regarding climate protection in practices. RESULTS 83% considered climate change an urgent problem requiring immediate action. A majority reported climate effects on their patients' health. Most MDs felt responsible for climate protection in their practices, showing a high degree of willingness to implement climate-friendly measures. Obstacles reported include lack of information and institutional support as well as the expected financial burden. A majority of MDs called on professional associations and politics to develop climate-friendly strategies. CONCLUSION In view of national climate targets and the willingness of outpatient MDs to contribute to climate protection, support from medical associations is required, e. g. through practical recommendations and financial help, in order to transform the health sector in accordance with the idea of Planetary Health. Accompanying studies should provide further evidence on effective measures to reduce greenhouse gas emissions in practices.
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Affiliation(s)
- Nikolaus Christian Simon Mezger
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Marlene Thöne
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Inga Wellstein
- Medizinische Klinik III, Rheumatologie, Endokrinologie, Nephrologie, Universitätsklinikum, Leipzig, Deutschland
| | - Frederick Schneider
- Technische Universität München, TUM Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, München, Deutschland
| | - Nicola Litke
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Amand Gabriel Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | | | - Eva Johanna Kantelhardt
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland; Klinik und Poliklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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