[Mental disorders from climate and environmental changes using the example of dermatology]. / Psychische Folgen von Klima- und Umweltveränderungen am Beispiel der Dermatologie.

BACKGROUND: Global climate and environmental changes impose a significant impact on human health by increasing prevalences of chronic and acute skin diseases. Climate-associated environmental changes can also trigger or intensify mental illnesses independently of a skin disease. AIM: Discussion of the effects of the climate and environmental changes on dermatological diseases applying the biopsychosocial model. MATERIALS AND METHODS: A selective literature search in the PubMed database and other sources was conducted. RESULTS: The biopsychosocial model considers complex interactions between biological, psychological, and social factors. In view of the consequences of climate and environmental changes, an extension of the model is proposed for the first time in order to address new challenges. The modified presentation supports the understanding of the dynamics and underscores that in dermatological care not only direct health effects of climate and environmental changes have to be dealt with, but also with an increasing number of mental illnesses, which in turn are to be regarded as direct and indirect health effects. CONCLUSION: Coping with the predicted increase in the burden of disease and the decline in the available labor force associated with demographic change poses a major challenge. In order to maintain the functionality of the healthcare system, the prompt implementation of resource-efficient, sustainable measures in all areas of society is essential. The integrative consideration of dermatological and psychological complaints in the context of climate and environmental changes requires the adaptation of content for the education, training, and continuing education of specialists.

[Greenhouse gas equivalents and water consumption of product sample packaging in dermatology]. / Treibhausgasäquivalente und Nutzwasserverbrauch durch dermatologische Produktprobenverpackungen.

BACKGROUND: Sampling refers to the free supply of small product samples. In this process, the packaging can be disproportionate to the contents leading to raw material consumption and, in the case of poor recyclability, environmental pollution. OBJECTIVE: In this article, calculations regarding the ratio between packaging and product weight for commonly used types of packaging (sachet, tube, jar) of dermatological product samples are presented. The usefulness of sampling is discussed considering environmental and economic criteria. MATERIAL AND METHODS: A total of 43 dermatological product samples from different manufacturers were manually weighed and classified. Packaging was disassembled into its structural components. The proportional weights or the weight of the bottle/tube body were calculated with database values for the respective material in terms of greenhouse gas equivalents (CO2eq) and freshwater consumption. Subsequently, a total sum for the impact of each packaging was formed. Only the material and manufacturing process were considered because there were no valid data available for transport, utilization, and end of life (EoL) impacts. RESULTS: The smallest and lightest product sample (1.24 g) generated ca. 15 g CO2eq and approximately 700 ml of freshwater consumption. The largest and heaviest product sample (37 g) generated 53 g CO2eq and 5.78 l of freshwater consumption. Assuming an annual distribution of 10 million units of the 43 product samples examined here, ca. 8000 t of CO2eq are produced by the packaging alone. Additionally, 880,000,000 l of water are used and approximately 2300 t of packaging waste are generated. DISCUSSION: Sampling shows an unfavorable ratio between CO2eq/water consumption and utility, especially in comparison to larger units of packaging. Millions of product samples are distributed annually in doctor's practices, hospitals and pharmacies, particularly in dermatology. The practice of sampling should be questioned both ecologically and economically.

[Crisis resilience in medical practices and clinics]. / Krisenresilienz in Praxen und Kliniken.

BACKGROUND: Climate change because of anthropogenic greenhouse gas emissions increasingly triggers extreme weather events. Of all the continents, Europe is warming the fastest. Heat and drought, forest fires and floods will worsen in Europe even in optimistic global warming scenarios, affecting living conditions across the continent. Extreme weather events threaten energy and food security, ecosystems, infrastructure, water resources, financial stability, and people's healthcare. Many of these risks have already reached critical levels and could take on catastrophic proportions without immediate, decisive action. OBJECTIVES: This paper outlines current challenges for medical practices and clinics in the context of climate change and provides examples and guidance for strengthening crisis resilience. MATERIALS AND METHODS: Selective literature review on the different requirements for crisis resilience in practices and clinics was performed. RESULTS: Medical practices and clinics achieve crisis resilience by high degrees of adaptability and flexibility. They prepare for climate change-related challenges and are, therefore, able to protect themselves and maintain their function in the healthcare system. Recent weather events in Germany revealed insufficient resilience among the healthcare sector; hence, improvements are necessary. CONCLUSIONS: Changing environmental conditions urgently require the healthcare sector to adapt and effectively strengthen crisis resilience in order to ensure that critical infrastructure remains functional and the population has access to healthcare.

Sustainability of dermatological offices and clinics: challenges and potential solutions.

Ongoing high consumption of resources results in exceeding the planetary boundaries. Modern healthcare systems contribute to this problem. To address this issue, this article provides an overview of various aspects of sustainable actions in medical offices and clinics that can also be applied to dermatology. Specific fields of action include energy consumption, structural measures, traffic and mobility, organization including digitalization as well as personnel and evaluation. Moreover, we discuss specific topics such as hygiene and cleansing, dermatosurgery and prescription practices. External treatments and cosmetics are discussed separately as dermatological peculiarities. Finally, we provide information on established initiatives for more sustainable health care in Germany. We aim to encourage critical reappraisal of currently established practices and to stimulate the implementation of sustainable measures.

[Microplastic and dermatological care]. / Mikroplastik und dermatologische Versorgung.

BACKGROUND: Synthetic polymers (plastics) from fossil resources are produced in large quantities and reach the environment as microplastics due to improper disposal and via various entry routes. This may lead to implications on flora, fauna, and humans. OBJECTIVES: This article aims to provide a concise overview for dermatologists about this complex topic and how it relates to daily medical practice. MATERIALS AND METHODS: We performed a selective literature review regarding microplastics and sustainability in dermatology in liaison with the collaborative research center on microplastics at the University of Bayreuth. RESULTS: Primary and secondary microplastics are released into the environment on a large scale and accumulate in aquatic and terrestrial ecosystems. This may lead to their disruption and bears potential to create ecological niches for human pathogenic species. Humans and animals inhale and ingest microplastics, and the health consequences have not been sufficiently investigated. This is mainly because microplastics are not a homogenous group of substances, and potential effects depend on various properties (e.g., type of polymer, size, shape, additivation, surface charge). Dermatological care is resource intensive and contributes in various ways to this matter. CONCLUSION: Plastics are currently indispensable in many fields. Nevertheless, physicians have the responsibility to prevent negative consequences for the health of society (precautionary principle). Extensive efforts are thus necessary for better sustainability; this includes medical care.

[Sustainable transformation of practices and outpatient clinics]. / Nachhaltige Transformation von Praxen und Ambulanzen.

BACKGROUND: Climate change as a consequence of anthropogenic greenhouse gas emissions (CO2e) favors weather extremes. This challenges the healthcare system to cope with negative consequences and to remain functional at the same time. Despite rising costs and shortage of staff, sick people in an aging society must be increasingly cared for in a resource-efficient and climate-neutral manner without compromising the quality of care. AIM: This article summarizes current challenges for practices and outpatient clinics due to climate change and societal transformation. In addition, steps to implement transformative interventions are discussed. MATERIALS AND METHODS: Selective literature review in PubMed database was conducted on the impact of climate change on the healthcare system, crisis resilience, climate management, overprescription, and co-benefits. RESULTS: Crisis-resilient practices are attuned to challenges resulting from climate change. Communicating co-benefits in the physician-patient conversation can accelerate the transformation to a sustainable society. CONCLUSION: Rapidly changing environmental conditions require adaptation on the part of the healthcare system. Education and prevention are key to meet this challenge. Transformation to sustainable practices is an ongoing process and it represents a holistic concept that encompasses social, environmental, and economic aspects, which are interdependent and cannot be considered separately.