Trends in incidence and mortality of early-onset cancer in Germany between 1999 and 2019.

Evidence on the recent temporal trend in the incidence and mortality of early-onset cancer, i.e., cancer diagnosed at ages of < 50 years, in Germany is scarce. To estimate the temporal trend in the incidence and mortality of early-onset cancer in Germany between 1999 and 2019. Input data were obtained from the Centre for Cancer Registry Data (Zentrum für Krebsregisterdaten, ZfKD). The analysis comprised all ages until 50 years and all types of cancer classified by the International Classification of Diseases (ICD-10)-codes C00-C97 (excl. C44). Temporal trends were estimated using negative binomial regression, differentiated by sex and cancer type. Between 1999 and 2019 in Germany, we observed stable or slightly increasing trends (0% and 1%) in the incidence of all early-onset cancers combined (C00-C97) for men and women, respectively, and strict declines in the mortality for both, men and women (-2% and - 3%). However, the trends differ largely with respect to sex and the individual cancer types. Early-onset cancer should be closely monitored to see whether stable and decreasing trends in the incidence and mortality continue. Knowing that despite decreasing incidence, the prevalence of a disease can rise due to their interplay with mortality, we recommend to maintain precise surveillance, efforts in prevention and early detection, as well as appropriate investments into healthcare resources, research and development.

[Sustainable Urban Health as a conceptual and action approach]. / Nachhaltige StadtGesundheit als Denk- und Handlungsansatz.

The field of urban health, i.e., the application of public health for people in the city, is oriented towards both scientific knowledge and practical action. In the international arena, a scientific infrastructure exists for this purpose. Despite the common roots of public health and urban planning in Germany, the connection between these fields of work was not very apparent for a long time. Legal requirements for the participation of public health service in (urban) planning processes have had little impact so far. The aim of this study was to connect to international urban health developments in order to make the topic more visible, to support professional exchange and to give impulses for research and practice. To express the close links between human health, ecological stability and social justice, the approach was conceived as sustainable urban health. With this in mind, the program "City of the Future - Healthy, Sustainable Metropolises" was initiated in 2011.This article characterizes the basic approach as integrating and describes the underlying guiding principles, i.e., "View field expansion" as an epistemological principle and "Bridge building" as an action-guiding principle, and outlines the details. The spectrum of topics ranges from medical and nursing care over "classical" prevention and health promotion to health in all policies. Within this approach, "smaller" tasks can be pursued, e.g., an overview of local health actions and actors, networking promotion, or preserving significant developments in collective memory. At the same time, it is about contributions to the solution of "big" tasks, e.g., the derivation of conclusions from the Corona learning experience, a more consistent implementation of health in all policies, or transformation steps towards an ecologically sustainable development of society. Legal norms, public health services, health reporting, and urban planning come up as leitmotifs. The article also outlines the genesis of the position papers in this supplementary volume and concludes with an outlook.

[Research program "City of the Future - Healthy and Sustainable Metropolises"]. / Forschungsförderprogramm "Stadt der Zukunft ­ gesunde und nachhaltige Metropolen".

Urbanization is advancing worldwide and thus, cities are increasingly living spaces for people. Therefore, it is essential to place the health and well-being of city dwellers at the center of urban planning. The research funding program "City of the Future - Healthy and Sustainable Metropolises" from the Fritz and Hildegard Berg Foundation at the German Stiftungszentrum has been providing important inter- and transdisciplinary research impulses on this topic since 2010. Junior research groups at the interfaces of health sciences and other disciplines in the natural and social sciences were funded. One focus of the research program is to enable intensive cooperation with practitioners, in order to reflect upon and work on problems and issues from practice using the best possible scientific methods and to catalyze the transfer of knowledge. The research consortia are accompanied by annual conferences on a wide variety of urban health topics at various venues in Germany. In addition, transdisciplinary networks have been established and further initiatives (e. g., founding of an institute) have been launched. In this paper, the development of the multifaceted research funding program "City of the Future - Healthy and Sustainable Metropolises" is presented, including an outlook into its future development.

[COVID-19 vaccination - motivation and stress factors: A cross-sectional survey of physicians and medical assistants in Germany]. / COVID-19-Impfung: Motivations- und Belastungsfaktoren ­ Eine Querschnittserhebung bei Ärzt*innen und Medizinischen Fachangestellten in Deutschland.

AIM: The aim of the study was to investigate motivation and stress factors related to the COVID-19 vaccination campaign among outpatient physicians and medical assistants in Germany. METHODS: In a quantitative, non-representative online survey, a total of 514 physicians and MFAs from different or the same practice were asked about reasons for and barriers to participation in the vaccination campaign, organizational conditions - including vaccine supply and availability - and workload. RESULTS: 70.3% of the respondents were physicians and 28.8% were medical assistants. In both occupational groups, the majority were from North Rhine-Westphalia (73.7% in total). The main motivations for participating in the vaccination campaign were to contribute to the fight against the pandemic (92.3%) and to advance the vaccination campaign (90.1%). For 94.6% of respondents, workload had increased since the vaccination campaign began in April 2021. Key stress factors were increased bureaucratic workload (92.5%), scheduling appointments for vaccinations (91%), patient inquiries (90.3%), and extra work/overtime (83%). Too much bureaucracy (69.6%) was the most frequently cited reason for not participating in the vaccination campaign. CONCLUSION: A large number of practices are making a key contribution to combating the pandemic by participating in the COVID-19 vaccination campaign, but this is also associated with a high workload situation. This is exacerbated by the dynamics of the infectious event and frequently changing demands and policy requirements on vaccinating practices. There is a strong desire for a uniform and less bureaucratic approach.

[Experiences of people with refugee backgrounds in utilising healthcare in Germany-findings from a qualitative study]. / Erfahrungen von Menschen mit Fluchtgeschichte bei der Inanspruchnahme der Gesundheitsversorgung in Deutschland ­ Erkenntnisse einer qualitativen Studie.

BACKGROUND: Refugees and asylum seekers face a variety of legal, structural, administrative, cultural and linguistic barriers in accessing healthcare. However, there is currently a lack of available data on the health needs of refugees and asylum seekers. In particular, their subjective experience in accessing healthcare has not been considered sufficiently. AIM OF THE STUDY: This paper explores the subjective experiences of refugees and asylum seekers in accessing and using healthcare. Strategies for dealing with potential challenges are presented. METHODS: The recruitment of interview partners was based on a quantitative cross-sectional study collected as part of a study on the health of refugees (FlüGe health study). Persons who agreed to be contacted again were contacted by telephone. A heterogeneous sub-sample (n = 18) with regard to age, gender, nationality, health status and utilisation behaviour was interviewed using interpreter-supported problem-centred interviews. Data were analysed using a deductive-inductive approach. RESULTS AND DISCUSSION: The migration-insensitive healthcare for refugees and asylum seekers is characterised by language barriers, disorientation, experiences of rejection, mistreatment and structural barriers. Experiences of foreignness in the healthcare system can lead to delayed care seeking or underusage of healthcare systems. At the same time, individual strategies by refugees, asylum seekers and healthcare providers are used in order to meet these challenges.

[Health protection and climate change require ambitious limit values for air pollutants in Europe : Opinion on the revision of the Directive on Air Quality and Clean Air for Europe of the Environmental Public Health commission of the Robert Koch Institute and the Federal Environment Agency]. / Gesundheitsschutz und Klimawandel erfordern ambitionierte Grenzwerte für Luftschadstoffe in Europa : Stellungnahme zur Revision der Richtlinie über Luftqualität und saubere Luft für Europa der Kommission Environmental Public Health des Robert Koch-Instituts und des Umweltbundesamtes.

Based on scientific findings, the World Health Organization (WHO) has recommended stricter guideline values for air quality in 2021. Significant reductions in the annual mean values of particulate matter (particle size 2.5 µm or smaller, PM2.5) and long-term exposure to nitrogen dioxide (NO2) and ozone (O3) were put forward. The risk of mortality already increases above the WHO guideline values, as shown in studies investigating low concentrations of air pollutants. In Germany, the 2021 WHO guideline values for PM2.5 and NO2 were clearly exceeded in 2022.In this position paper we give the following recommendations for the European Air Quality Directive: (1) set binding limit values according to WHO 2021, (2) apply the limit values to the whole of Europe, (3) continue and expand the established country-based monitoring networks, (4) expand air quality measurements for ultrafine particles and soot particles, and (5) link air pollution control and climate protection measures.Stricter limits for air pollutants require societal and political changes in areas such as mobility, energy use and generation, and urban and spatial planning. Implementation according to WHO 2021 would lead to a net economic benefit of 38 billion euros per year.Ambitious limit values for air pollutants also have an impact on climate change mitigation and its health impacts. The Environmental Public Health commission concludes that more ambitious limit values are crucial to enable effective health protection in Germany and calls for air pollutant limit values in line with the 2021 WHO recommendations to become binding in Europe.

[Organizational Health Literacy of German Public Health Departments (OHL-PH): Development of a Conceptual Model Employing Expert Interviews]. / Organisationale Gesundheitskompetenz deutscher Gesundheitsämter (OGK-GA): Entwicklung eines theoretischen Modells mit Hilfe von ExpertInneninterviews.

OBJECTIVE: In addition to the users' individual health literacy (HL), the organizational health literacy (OHL) of health care organizations plays an important role as well in assuring the health of the poipulation. In Germany, public health departments are responsible for public health at population level. They should help their users to access, understand and navigate and use information and services in their health-related decisions. This study addresses the question of the best conceptual model of OHL of the German public health departments for the first time. METHODS: In this explorative study, eleven guideline-oriented interviews with experts from public health departments were conducted in three German federal states. Subsequently, the transcripts underwent qualitative content analysis. RESULTS: A new conceptual model consisting of twelve attributes was identified for OHL of public health departments in Germany. These twelve characteristics can be assigned to the aspects "leadership and organizational culture", "employees" and "development and implementation of information and services". CONCLUSIONS: This model for the OHL-PH lays the foundation for future research in this area. It enables the development of a self-assessment tool and therefore the measurement of the level of OHL as well as the identification of barriers. Increasing the OHL of German public health departments by overcoming these obstacles can make a significant contribution to improving public health.

[The COVID-19 Pandemic as an Opportunity for Teletherapy? - A Survey of non-medical therapy professionals in the health sector]. / Die COVID-19-Pandemie als Chance für Teletherapie? ­ Eine Umfrage bei Vertreter*innen von Gesundheitsfachberufen.

OBJECTIVE: The aim of the study was to investigate the use of teletherapy during the corona pandemic by three non-medical therapy professionals in the health sector. METHOD: As part of a questionnaire-based online survey, 282 participants from the field of ergotherapy, physiotherapy and speech therapy were asked about usage behavior, challenges, potentials, and general conditions of teletherapy. RESULTS: Especially ergo and speech therapists used teletherapy during the corona pandemic. From their point of view, teletherapy also had a potential to be used as an alternative form of therapy, regardless of the coronavirus pandemic, adding that there was a great need for further assistance and training in the field of teletherapy. CONCLUSION: To implement this form of therapy on a long-term basis, in addition to technical requirements and training opportunities, accounting formalities need to be clarified.

[Pneumology in the Model Degree Program of the Medical Faculty Ostwestfalen Lippe, Germany]. / Das Fach Pneumologie im Modellstudiengang der Medizinischen Fakultät Ostwestfalen-Lippe (OWL).

The specialist field of "pneumology" is still underrepresented in university clinics in Germany, but this is not the case at the newly founded medical faculty Ostwestfalen-Lippe (OWL) in Bielefeld. This is linked to representing pneumology and internal intensive care medicine in patient care, teaching and research across the board and the opportunity to actively help shape the development of the human medicine faculty in an exciting environment.The early anchoring of the subject "Pneumology" in the model degree program of medical school in OWL (begin winter semester 2021/22) contributes to further visibility and a university medical orientation. In this overview various issues of Pneumology in the Model Degree Program are explored by basic scientists, clinical teachers, members of the medical faculty and a student.In today's Evangelisches Klinikum Bethel (EvKB), pulmonary medicine has a long tradition. The hospital's first lung and infection center was opened in 1927. The EvKB's department for internal medicine, pneumology and intensive care medicine, which has been independent since 2009, is becoming a university clinic for pneumology within the medical faculty OWL. Relevant translational and interdisciplinary research can be intensified.There are 30 "Pneumology" teaching units in the model degree program, which are divided into two study sections using different formats, such as lectures, seminars, hands on courses and skills lab. It is represented in particular in the module complex "Circulation and Respiration". The content of the first phase of teaching was carried out by a module commission, with members representing the subjects involved in the module.Knowledge of the basics from, for example, physiology, pathophysiology, anatomy and pathology are taught to the students in the run-up to the pneumology course. Using the example of physiology, the presentation of the learning content of a basic subject is elaborated in this article.Half of all teaching units on pneumology of the entire course took place in the 2nd semester (in March and April 2022), so that students experienced the clinical relevance of the content at an early stage. There was a particular focus on obstructive airway and restrictive lung diseases. After imparting the basic knowledge of the physical examination of the lungs in the Skills Lab, the most important pathological findings in the above-mentioned diseases on inspection, palpation, auscultation and percussion are demonstrated and practised in patients as part of bedside teaching under supervision.Communication training is also longitudinally integrated into the modular teaching, with a total of more than 200 teaching hours and is performed interdisciplinary. In the "Circulation and Breathing" module eight hours are devoted to this with simulated patients, the anamnesis and therapy advice on classic cardiopulmonary diseases. For the students, integrating the teaching of basic theory and its clinical application for each organ systems represents a challenge in the model degree program, the advantages outweigh from today's perspective.

[Teleconsultation for vascular- and diabetes-associated chronic wounds : A systematic review of health-related and economic implications]. / Telekonsultation bei vaskulär und diabetisch bedingten chronischen Wunden : Eine systematische Übersicht der gesundheitlichen und ökonomischen Implikationen.

BACKGROUND: In addition to lowering the quality of life of those affected, long periods of treatment and high recurrence rates of chronic wounds cause major economic costs for health care systems. Furthermore, inadequate health care and undersupply of care can be observed in Germany. Thus, new forms of care such as teleconsultation are being discussed increasingly. Recent changes in the remuneration system and macerations in the ban of remote treatment support those trends. METHODS: A systematic review was conducted in July 2018 using PubMed and CENTRAL databases for randomized controlled trials between 2008 and 2018. Only randomized clinical trials in which patients with chronic wound who received treatment and follow-up by teleconsultation using information and communication technology to share data were included. In total, 6 international clinical trials were identified. RESULTS: Regarding the current state of research, there is no definite evidence that teleconsultation can improve the care of chronic wound patients. Most likely, wound healing time was positively influenced. No correlation was found between mortality and hospitalizations when teleconsultation was used. CONCLUSION: On the basis of the included studies, the evidence for the care of chronic wounds by teleconsultation is unclear. Further research is needed to examine the health-related and economic benefits of teleconsultation to support integration into health care systems.

[Online therapy for depressive disorders : An acceptance-based analysis from the perspective of therapists]. / Onlinetherapie bei depressiven Störungen : Eine Akzeptanzanalyse aus der Perspektive der Behandelnden.

BACKGROUND: The supply of online therapy options for mild to moderate depressive disorders has substantially risen both nationally and internationally in the past years. While the efficacy and efficiency of specific online-based therapeutic services were indicated within the framework of scientific evaluations, little is known about the acceptance of these new therapy options. METHODS: In a nationwide online survey of online-based therapy options for mild to moderate depressive disorders, the attitude and stance as well as the use intention and the subjectively perceived knowledge of 657 medical practitioners and therapists, active in psychotherapeutic and psychiatric treatment were collated. The impact of the potential predictors on the use intention of online-based therapies, based on the unified theory of acceptance and use of technology, was analyzed by means of a binary logistic regression model. RESULTS: Besides the perceived performance and expense expectations, the supportive framework conditions, the influence of the cooperative environment, the individual technical affinity as well as the evaluation of the prospective significance of online-based therapy proved to be significantly influential predictors on the user intention. Special predictability for a positive user intention was shown related to the perceived potential of online therapy. CONCLUSION: The results underline the relevance of further evidence-basing of online therapy for mild to moderate depressive disorders. A user-oriented, participatory technology development proves to be just as relevant as a comprehensive sensitization, elucidation and education of potential users for a successful implementation.

[Telematics in ambulatory care: Exploring the nurses' perspective]. / Telematische Anwendungen in der ambulanten Pflege: Die Perspektive von Pflegekräften.

Telematics in ambulatory care: Exploring the nurses' perspective Abstract. BACKGROUND: In the context of demographic change, the use of information and communications technology in home care has the aim of ensuring the quality of nursing care in the future. The acceptance of telematic applications by all users is crucial in this regard. AIM: The aim of this study was to assess the subjective attitudes and intentions of nursing staff on telematic applications in home care. METHODS: Based on the "Unified Theory of Acceptance and Use of Technology" (UTAUT), an online survey was conducted in which nursing staff as well as nursing students throughout Germany were surveyed. 371 questionnaires have been included in the analysis. RESULTS: Nursing students as well as nurses stated inadequate information and insufficient technical competence. Referring to performance expectations, both groups hope for improving care process transparency and communication inside and outside sectors. For effort expectancy, higher costs, training efforts and technology dependency were named. CONCLUSIONS: The results show the relevance of the attitudes and demands of users for a successful implementation. In the future, training and further education should increasingly promote the technological competence of nursing staff.

How adverse childhood experiences relate to single and multiple health risk behaviours in German public university students: a cross-sectional analysis.

BACKGROUND: Adverse childhood experiences (ACEs) have been shown to be linked to health risk behaviours (HRBs). This study aims to identify risk factors for ACEs and to examine the associations between ACEs and single and multiple HRBs in a sample of university students in Germany. METHODS: An online-based cross-sectional study was conducted among public university students (N = 1466). The widely applied ACE questionnaire was used and extended to operationalise 13 categories of childhood adversity. First, variables for each type of ACE and HRB were dichotomised (single ACEs and single HRBs), and then used for cumulative scores (multiple ACEs and multiple HRBs). Frequencies were assessed, and (multinomial) logistic regression analyses were performed. RESULTS: Prevalence rates of ACEs ranged from 3.9 to 34.0%, depending on the type of childhood adversity. Sociodemographic risk and protective factors for single/multiple ACEs varied strongly depending on the outcome. In particular, a high family socioeconomic status seemed to be a consistent protective factor for most ACEs. After adjusting for sociodemographic characteristics, both single and multiple HRBs were associated with single events of ACEs. Moreover, dose-response relationships between multiple ACEs and various single and multiple HRBs were found. CONCLUSIONS: The study provides strong evidence that ACEs are associated with HRBs. The number of ACEs may play a role in single or multiple HRBs. Reducing the number of ACEs could thus decrease HRBs, which account for many of the leading causes of morbidity and death. The findings highlight the importance of trauma-informed health interventions designed to prevent the occurrence of ACEs, and build capacity among children and adults.

[Acceptance of Online-based Therapy by Patients with Light to Moderate Depressive Disorders]. / Akzeptanz onlinebasierter Therapieangebote bei Patientinnen und Patienten mit leichten bis mittelgradigen depressiven Störungen.

OBJECTIVES: Over the past few years, there has been a considerable increase in online-based therapeutic services for people affected by depressive disorders. The efficacy and efficiency of these programmes is well documented by now. User acceptance is considered as a significant factor of success in establishing this new patient-centered care. Theory-based acceptance surveys can provide valuable scientific knowledge regarding long-term introduction. METHODS: A nationwide online survey was conducted to determine the attitude towards web-based psychotherapy services for depressive disorders, the current state of knowledge and the intention of 186 participants (124 female and 62 male participants; aged 21 and above) to use these services. The participants were recruited from support groups for depressive disorders. The determinants of the intention to use online therapy, which is included in the binary logistic regression, are based upon the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS: Nearly two-thirds of the respondents could conceive making use of online-based therapeutic services in the near future. The perceived performance and expected effort proved to be significantly influential predictors regarding the intention to use. Specifically, these included an evaluation of the use of E-Mental Health to assist disease management, and better assessment of the course of one's disease. CONCLUSION: The actual contribution of E-Mental Health is closely connected to technical and jurisprudential assessments. But also, it significantly depends on evidence-based issues as well as user orientation in research, development and implementation. The results offer an initial theory-based approach to an increased user-oriented technology research in health care, with further diversity criteria to be taken into account in the future.

[The Environmental Burden of Disease Concept]. / Das Konzept der umweltbedingten Krankheitslast.

GOAL OF THE STUDY: Environmental risk factors are of great importance for public health with a considerable but often unused potential for prevention. However, knowledge about the complex associations between the environment and health effects is limited for some risk factors. A concept, which is using the existing evidence on associations between the impact of environmental factors and health effects, is the environmental burden of disease (EBD) concept. The aim of this article is to present the quantification method of the EBD concept and to discuss the advantages and its points of criticism. METHODS: The EBD concept combines morbidity and mortality data in a single measure (Disability-Adjusted Life Year, DALY) to enable a comparative description of the burden of disease. Life years are used as measurement unit. The environmental share of the total DALYs is quantified by using the attributable fraction. RESULTS: Despite its increasing application especially in the international context, the method is still criticized, because by summarizing the complex construct of health in one single measurement unit, much important information about quality of life is lost. A further criticism refers to partly arbitrarily set social value choices. Additionally, missing or insufficient data can limit the quality and validity of EBD estimations. CONCLUSION: A scientific discourse is needed to decide to what extent the EBD approach can and should be used in Germany.

[Environmental justice as an approach to tackle environmental health inequalities]. / Umweltgerechtigkeit als Ansatz zur Verringerung sozialer Ungleichheiten bei Umwelt und Gesundheit.

Current international studies show that environment-related diseases disproportionately affect vulnerable people. This is a case of environmental injustice. Environmental justice goes beyond the mere description of environment- and health-related social inequalities by comprising two dimensions of justice as a normative approach: distributional and procedural justice. Attempts to explain the link between social circumstances, the environment and health deal with both the socially unequal distribution of environmental hazards and environmental resources (exposure variation) and social differences in vulnerability to the health effects of environmental exposures (effect modification). Integrated monitoring approaches provide the basis for deriving interventions under various aspects of environmental justice. Parting from public health research and embedded in the Health in All Policies (HiAP) concept, environmental justice has now been taken up in a number of fields, including politics, administration and practice. There are strategic considerations and attempts to anchor it in politics at the federal, state and the communal level, both by government and non-government groups. Health-promoting urban development is a core field for intervention. The Soziale Stadt (Social City) programme for promoting urban planning and construction as well as place oriented sectoral planning make an important contribution by helping to focus on urban spaces with multiple health hazards and to implement target group-oriented participation processes. There continues to be a need to develop methods and systematically implemented evaluations of political strategies and corresponding interventions regarding their effects on inequalities in health and environmental justice.

[Overview of indicators in the context of environment and health]. / Übersicht zu Indikatoren im Kontext Umwelt und Gesundheit.

BACKGROUND: Evidence-based political measures need reliable information about the health status of a population and the determinants affecting health. Here, environment and health indicators can provide helpful additional insights. AIM: This article provides an overview of existing indicators in the field of environment and health. MATERIALS: There are single indicators and indicator sets describing solely the environment or health as well as some indicators integrating both aspects. RESULTS: The indicator sets cover classical epidemiological indicators but also summary measures of population health, which combine mortality and morbidity as well as simple descriptions of the exposure towards environmental risks. The indicator sets mostly cover water and air quality related aspects. For some of the indicators their influence on health is also presented. Furthermore, environment related health indicators are part of sustainability indicator sets. There are indicators on the international, European, national, and municipal level. DISCUSSION: All indicator sets aim to support policy-making by advising on measures and setting priorities in the area of environment and health protection. However not all indicators reflect the effect of the environment on health adequately. Therefore, further development of the existing indicators is necessary to reflect current progress (e. g. political needs) and to include new scientific evidence in the field of environment and health. A continuous provision, review, and interpretation of meaningful indicators is required to identify trends and to react to these in order to protect the environment and health. This is necessary to adequately pursue the precautionary principle.

[Environmental burden of disease in Germany]. / Umweltbedingte Krankheitslasten in Deutschland.

BACKGROUND: Environmental risk factors can have a substantial impact on population health. With the environmental burden of disease (EBD) approach, the health losses attributable to environmental risk factors can be quantified using disability-adjusted life years (DALY). OBJECTIVES: The aim of this article is to present and discuss available EBD estimates with a focus on Germany. MATERIALS: Using current EBD studies, the share of the burden of disease attributable to environmental risk factors globally and DALYs for Germany are presented. Ambient particulate matter (PM), water-related risks and environmental noise are used as examples to emphasize the importance of availability and quality of input data for burden of disease assessments. RESULTS: The share of the global burden of disease attributable to environmental risk factors varies according to the available studies and lies between 13 and 22%. For Germany, EBD estimates are available for 12 environmental risk factors. Most estimates are available for particulate matter in ambient air, however, the estimated burden differs greatly. Nonetheless, according to current knowledge, particulate matter pollution is the environmental risk factor with the highest burden of disease in Germany. CONCLUSIONS: Differences in the estimated burden of disease for the considered risk factors are due to varying underlying assumptions, e. g. for life expectancy or counterfactual value and the input data used.

[Integration of sex/gender into environmental health research. Results of the interdisciplinary research network Sex/Gender-Environment-Health (GeUmGe-NET)]. / Integration von Geschlecht in die Forschung zu umweltbezogener Gesundheit. Ergebnisse des interdisziplinären Forschungsnetzwerks Geschlecht ­ Umwelt ­ Gesundheit (GeUmGe-NET).

The comprehensive consideration of sex/gender in health research is essential to increase relevance and validity of research results. Contrary to other areas of health research, there is no systematic summary of the current state of research on the significance of sex/gender in environmental health. Within the interdisciplinary research network Sex/Gender-Environment-Health (GeUmGe-NET) the current state of integration of sex/gender aspects or, respectively, gender theoretical concepts into research was systematically assessed within selected topics of the research areas environmental toxicology, environmental medicine, environmental epidemiology and public health research on environment and health. Knowledge gaps and research needs were identified in all research areas. Furthermore, the potential for methodological advancements by using gender theoretical concepts was depicted. A dialogue between biomedical research, public health research, and gender studies was started with the research network GeUmGe-NET. This dialogue has to be continued particularly regarding a common testing of methodological innovations in data collection and data analysis. Insights of this interdisciplinary research are relevant for practice areas such as environmental health protection, health promotion, environmental justice, and environmental health monitoring.