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      Auswirkungen von hohen Außentemperaturen und Hitzewellen auf Lungenerkrankungen : Rolle von Pneumolog:innen beim gesundheitlichen Hitzeschutz Translated title: Impact of high outdoor temperatures and heat waves on pulmonary diseases : Role of pneumologists in health-related heat protection

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          Abstract

          Hintergrund

          Der fortschreitende Klimawandel führt zu häufigeren und intensiveren Hitzewellen. Im Vergleich zu 1951 erlebt Deutschland bereits heute im Durchschnitt nicht nur etwa 3 heiße Tage im Sommer, sondern 8,8 heiße Tage. Für die Sommer 2018, 2019, 2020 und 2022 wurden insgesamt etwa 23.800 hitzebedingte Todesfälle durch Modellierung der Übersterblichkeit berechnet. Für vulnerable Bevölkerungsgruppen stellen Hitzewellen ein erhöhtes Gesundheitsrisiko dar. Zu ihnen gehören ältere Menschen und Menschen mit Vorerkrankungen sowie Säuglinge, Schwangere und Personen, die im Freien körperlich schwer arbeiten oder Sport treiben. Hitze kann zu Hitzeerschöpfung und lebensbedrohlichem Hitzschlag führen und Herzinfarkte und Schlaganfälle auslösen.

          Problemstellung

          Menschen mit Atemwegserkrankungen sind besonders betroffen, wenn die hohen Temperaturen zusätzlich mit erhöhter Luftverschmutzung einhergehen. Hitzebedingte Lungenprobleme wie eine erhöhte pulmonale Belastung etwa durch hitzebedingte Hyperventilation und erhöhte Luftverschmutzung sowie mit kardialer Beeinträchtigung und Pneumonien assoziierte Effekte erhöhen das Risiko für Mortalität und Morbidität während Hitzewellen für betroffene Patient:innen.

          Schlussfolgerungen

          Pneumolog:innen können durch hitzespezifische Beratung und Behandlung einen maßgeblichen Beitrag zu gesundheitsbezogenem Hitzeschutz leisten. Sie sind daher aufgefordert, sich in ihrem Fachbereich entsprechend zu informieren und Hitzeschutzmaßnahmen zum Schutz ihrer Patient:innen und Mitarbeiter:innen in Praxen und Krankenhausabteilungen umzusetzen.

          Translated abstract

          Background

          The progressing climate change leads to more frequent and more intense heat waves. Compared to 1951, Germany now experiences on average 8.8 hot days over the summer instead of 3 hot days. For the summers of 2018, 2019, 2020 and 2022 a cumulative number of 23,800 heat-related deaths were calculated based on excess mortality modelling. For vulnerable population groups, heat waves pose an increased risk to health. These groups include the elderly, people with chronic diseases, infants, pregnant women, and people who perform physically hard work or carry out sports outdoors. High temperatures can lead to heat exhaustion and life-threatening heatstroke as well as triggering myocardial infarction and stroke.

          Objective

          Individuals with chronic pulmonary diseases are particularly affected when high temperatures coincide with high levels of air pollution. Heat-related lung problems, such as increased pulmonary load through heat-related hyperventilation together with increased air pollution as well as effects associated with cardiac impairment and pneumonia increase the risk of morbidity and mortality for affected patients during heat waves.

          Conclusion

          Pulmonologists can contribute to health-related heat protection for their patients through heat-specific advice and treatment. Pulmonologists are therefore required to be well-informed regarding measures in their field and to implement heat protection measures for the protection of their patients and employees in their practices and hospital departments.

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          Most cited references31

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          Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

          Summary Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding Bill & Melinda Gates Foundation.
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            The changing landscape of atherosclerosis

            Emerging evidence has spurred a considerable evolution of concepts relating to atherosclerosis, and has called into question many previous notions. Here I review this evidence, and discuss its implications for understanding of atherosclerosis. The risk of developing atherosclerosis is no longer concentrated in Western countries, and it is instead involved in the majority of deaths worldwide. Atherosclerosis now affects younger people, and more women and individuals from a diverse range of ethnic backgrounds, than was formerly the case. The risk factor profile has shifted as levels of low-density lipoprotein (LDL) cholesterol, blood pressure and smoking have decreased. Recent research has challenged the protective effects of high-density lipoprotein, and now focuses on triglyceride-rich lipoproteins in addition to low-density lipoprotein as causal in atherosclerosis. Non-traditional drivers of atherosclerosis-such as disturbed sleep, physical inactivity, the microbiome, air pollution and environmental stress-have also gained attention. Inflammatory pathways and leukocytes link traditional and emerging risk factors alike to the altered behaviour of arterial wall cells. Probing the pathogenesis of atherosclerosis has highlighted the role of the bone marrow: somatic mutations in stem cells can cause clonal haematopoiesis, which represents a previously unrecognized but common and potent age-related contributor to the risk of developing cardiovascular disease. Characterizations of the mechanisms that underpin thrombotic complications of atherosclerosis have evolved beyond the 'vulnerable plaque' concept. These advances in our understanding of the biology of atherosclerosis have opened avenues to therapeutic interventions that promise to improve the prevention and treatment of now-ubiquitous atherosclerotic diseases.
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              Hot weather and heat extremes: health risks

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                Author and article information

                Contributors
                franziska.matthies@helmholtz-muenchen.de
                Journal
                Z Pneumologie
                Zeitschrift Für Pneumologie
                Springer Medizin (Heidelberg )
                2731-7404
                2731-7412
                24 March 2023
                24 March 2023
                : 1-8
                Affiliations
                [1 ]GRID grid.4567.0, ISNI 0000 0004 0483 2525, Institut für Epidemiologie, , Helmholtz Zentrum München – Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), ; Ingolstädter Landstr. 1, 85764 Neuherberg, Deutschland
                [2 ]KLUG – Deutsche Allianz Klimawandel und Gesundheit e. V., Cuvrystr. 1, 10997 Berlin, Deutschland
                [3 ]GRID grid.5252.0, ISNI 0000 0004 1936 973X, Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Klinikum der Universität München, , LMU München, ; München, Deutschland
                Author notes
                [Redaktion]

                B. Hoffmann, Düsseldorf

                Article
                500
                10.1007/s10405-023-00500-5
                10038368
                8736bf07-6a23-4268-935b-6d8b2e01cd07
                © The Author(s) 2023

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

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                History
                : 13 February 2023
                Categories
                Leitthema

                klimawandel,atemwegserkrankungen,herz-kreislauf-erkrankungen,gesundheitsbezogene hitzeschutzmaßnahmen,gesundheitsrisiko,climate change,respiratory diseases,cardiovascular diseases,health-related heat protection measures,health risk

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