Climate change and public health in Germany - A synthesis of options for action from the German status report on climate change and health 2023.

Background: This article represents the conclusion of the updated German status report on climate change and health, which was jointly written by authors from over 30 national institutions and organisations. The objectives are (a) to synthesise the options for action formulated in the report, (b) to combine them into clusters and guiding principles, (c) to address the success factors for implementation, and (d) to combine the options for action into target parameters. Methods: The options for action from the individual contributions of the status report were systematically recorded and categorised (n=236). Topical clusters were then formed with reference to Essential Public Health Functions, and options for action were assigned to them. Results: Eight topical clusters of options for action and ten guiding principles were identified. These can be summarised in four overarching meta-levels of action: (a) cross-sectorally coordinated structural and behavioural prevention, (b) monitoring, surveillance, and digitalisation (including early warning systems), (c) development of an ecologically sustainable and resilient public health system, and (d) information, communication, and participation. The main success factors for implementation are the design of governance, positive storytelling and risk communication, proactive management of conflicting goals, and a cross-sectoral co-benefit approach. Conclusions: Based on the status report, systematically compiled target parameters and concrete options for action are available for public health.

Climate change and public health in Germany - An introduction to the German status report on climate change and health 2023.

Global warming of 1.5°C and even 2°C is likely to be exceeded during the 21st century. Climate change poses a worldwide threat and has direct and indirect effects on infectious diseases, on non-communicable diseases and on mental health. Not all people are equally able to protect themselves against the impacts of climate change; particularly populations that are vulnerable due to individual factors (children, older persons, those immunocompromised or with pre-existing conditions), social factors (the socially disadvantaged), or living and working conditions (e. g. people who work outdoors) are subject to an increased risk. Concepts such as One Health or Planetary Health provide a framework to frame both climate change itself and adaptation strategies or sets of actions for environmental human and animal health. Knowledge of climate change impacts has grown in recent years, and mitigation and adaptation strategies have been developed.

WICID framework version 1.0: criteria and considerations to guide evidence-informed decision-making on non-pharmacological interventions targeting COVID-19.

INTRODUCTION: Public health decision-making requires the balancing of numerous, often conflicting factors. However, participatory, evidence-informed decision-making processes to identify and weigh these factors are often not possible- especially, in the context of the SARS-CoV-2 pandemic. While evidence-to-decision frameworks are not able or intended to replace stakeholder participation, they can serve as a tool to approach relevancy and comprehensiveness of the criteria considered. OBJECTIVE: To develop a decision-making framework adapted to the challenges of decision-making on non-pharmacological interventions to contain the global SARS-CoV-2 pandemic. METHODS: We employed the 'best fit' framework synthesis technique and used the WHO-INTEGRATE framework as a starting point. First, we adapted the framework through brainstorming exercises and application to case studies. Next, we conducted a content analysis of comprehensive strategy documents intended to guide policymakers on the phasing out of applied lockdown measures in Germany. Based on factors and criteria identified in this process, we developed the WICID (WHO-INTEGRATE COVID-19) framework version 1.0. RESULTS: Twelve comprehensive strategy documents were analysed. The revised framework consists of 11+1 criteria, supported by 48 aspects, and embraces a complex systems perspective. The criteria cover implications for the health of individuals and populations due to and beyond COVID-19, infringement on liberties and fundamental human rights, acceptability and equity considerations, societal, environmental and economic implications, as well as implementation, resource and feasibility considerations. DISCUSSION: The proposed framework will be expanded through a comprehensive document analysis focusing on key stakeholder groups across the society. The WICID framework can be a tool to support comprehensive evidence-informed decision-making processes.

[Education and Training in Public Health - Results of the Working Group 9 of the Forum Future Public Health, Berlin 2016]. / Lehre, Fort- und Weiterbildung in Public Health.

The need for a qualified public health workforce can only be met by appropriate provision of a wide spectrum of basic, advanced and continuing education and training programs on public health that meet international standards. At the same time, efforts must be made to offer young academics attractive career opportunities. Training in public health competences must also be provided for allied professionals in health care and for professions with influence on the determinants of health such as urban planning or agricultural science. This report from a working group meeting at the 'Public Health Zukunftsforum 2016' in Berlin presents ideas for the further development of training in public health in Germany.

[A minimally invasive dorsal approach to the medial femoral condyle as a donor site for osteochondral transfer procedures]. / Entnahme osteochondraler Zylinder aus der medialen dorsalen Femurkondyle über einen minimalinvasiven Zugang.

OBJECTIVE: Long-lasting reconstruction of joint surface by using an osteochondral transfer procedure (OCT). Reduction of donor site morbidity by using a minimally invasive approach to the dorsal medial femoral condyle. INDICATIONS: Grade 3 and 4 cartilage lesions (according to ICRS [International Cartilage Repair Society]), osteochondral lesions, and osteochondrosis dissecans. CONTRAINDICATIONS: Grade 2 or higher-graded cartilage lesions at the dorsal medial femoral condyle, infection, axis deviation of more than 5 degrees in the frontal plane, advanced osteoarthritis. SURGICAL TECHNIQUE: Cylinders at recipient site are removed first, thereby determining number and diameter of donor cylinders. Supine position, skin incision over the dorsal medial femoral condyle. After dissection of soft tissue and superficial fascia, semitendinosus tendon and medial gastrocnemius muscle are retracted to the lateral side, followed by arthrotomy, introduction of two Hohmann retractors medial and lateral of the condyle, and harvesting of the donor cylinders with a tubular chisel. Advantages of the described approach: reduction of soft-tissue trauma, easy surgical technique, additional donor site area besides femoral trochlea and intercondylar notch. POSTOPERATIVE MANAGEMENT: Partial weight bearing of 10-20 kg for 4-6 weeks. Limitation of knee flexion to 90 degrees for 6 weeks. RESULTS: Between 01/2006 and 04/2007, the dorsal medial femoral condyle was used as a donor site in 16 patients. All patients were evaluated preoperatively and after 1 year using the American Knee Society Score (KSS), the Western Ontario and McMaster Universities (WOMAC) Score, the Tegner Score, and the visual analog scale (VAS) pain. The mean follow- up was 13.9 (+/-4.3) months. The mean defect area was 4.6 (+/-2.2) cm(2). The mean KSS, Tegner Score, and WOMAC Score improved from 123.1 (+/-41.5), 2.8 (+/-0.9), and 73.3 (+/-50.2) points preoperatively to 171.3 (+/-16.9), 3.4 (+/-0.6), and 26.1 (+/-17.6) points after 13.9 months (p < 0.05). The VAS pain improved from 5.3 (+/-2.7) to 2.4 (+/-1.8) points (p < 0.05). One patient with an osteochondral defect of 8 cm(2) at the medial femoral condyle (Ahlbäck's disease) still complains of pain during deep squatting. The dorsal medial femoral condyle can be recommended as donor site for OCT. The minimally invasive approach has proven to be safe and simple with a low complication rate.

Lack of HLA class II antigen expression in microsatellite unstable colorectal carcinomas is caused by mutations in HLA class II regulatory genes.

Colorectal cancers (CRCs) develop on the basis of a deficient DNA mismatch repair (MMR) system in about 15% of cases. MMR-deficient CRC lesions show high-level microsatellite instability (MSI-H) and accumulate numerous mutations located at coding microsatellite loci that lead to the generation of immunogenic neopeptides. Consequently, the host's antitumoral immune response is of high importance for the course of the disease in MSI-H CRC patients. Accordingly, immune evasion mediated by impairment of HLA class I antigen presentation is frequently observed in these cancers. In this study, we aimed at a systematic analysis of alterations affecting HLA class II antigen expression in MSI-H CRC. HLA class II antigens are expressed by only two-thirds of MSI-H CRCs. The mechanisms underlying the lack of HLA class II antigens in a subset of MSI-H CRCs remain unknown. We here screened HLA class II regulatory genes for the presence of coding microsatellites and identified mutations of the essential regulator genes RFX5 in 9 (26.9%) out of 34 and CIITA in 1 (2.9%) out of 34 MSI-H CRCs. RFX5 mutations were related to lack of or faint HLA class II antigen expression (p = 0.006, Fisher's exact test). Transfection with wild-type RFX5 was sufficient to restore interferon gamma-inducible HLA class II antigen expression in the RFX5-mutant cell line HDC108. We conclude that somatic mutations of the RFX5 gene represent a novel mechanism of loss of HLA class II antigen expression in tumor cells, potentially contributing to immune evasion in MSI-H CRCs.