Noise annoyance due to different sources is associated with tinnitus presence and distress in the general population.

BACKGROUND: The pathophysiology of tinnitus is not yet fully understood. Although there is a large amount of evidence associating traffic noise exposure with non-auditory health outcomes, there is no evidence regarding the impact of noise annoyance on auditory disorders such as tinnitus. OBJECTIVE: Thus, we aimed to investigate the association between noise annoyance due to different sources and tinnitus presence and distress in the general population. METHODS: Data of 6813 participants from a large German population-based cohort were used (Gutenberg Health Study). Participants were asked about the presence of tinnitus and how much they were bothered by it. In addition, information on annoyance from road traffic, aircraft, railways, industrial, and neighborhood noise during the day and sleep was collected through validated questionnaires. RESULTS: The prevalence of tinnitus was 27.3%, and the predominant sources of noise annoyance in these subjects were aircraft, neighborhood, and road traffic noise. Overall, logistic regression results demonstrated consistent positive associations between annoyance due to different noise sources and prevalent risk of tinnitus with increases in odds ratios ranging from 4 to 11% after adjustment for sex, age, and socioeconomic status. Likewise, consistent increases in odds ratios were observed for tinnitus distress in subjects with prevalent tinnitus. For instance, neighborhood noise annoyance during the sleep was associated with a 26% increase in tinnitus distress (OR 1.26, 95% CI 1.13; 1.39). IMPACT: This is the first study investigating the association between noise annoyance and tinnitus presence and distress in a large cohort of the general population. Our results indicate consistent and positive associations between various sources of noise annoyance and tinnitus. These unprecedented findings are highly relevant as noise annoyance and tinnitus are widespread. The precise etiology and locus of tinnitus remain unknown, but excessive noise exposure is thought to be among the major causes. This study suggests that transportation and neighborhood noise levels thought merely to contribute to annoyance and non-auditory health effects may be sufficient to cause or exacerbate tinnitus.

[Wind days in Taranto (Southern Italy): a public health intervention between technical and social contradictions. Lessons learned]. / Wind days a Taranto: un intervento di sanità pubblica tra contraddizioni tecniche e sociali. Lezioni imparate.

Public health interventions in the context of environmental crisis are necessary and desirable for the protection of public health. This manuscript highlights the critical aspects and potentials of a public health intervention by reconstructing the most relevant stages of the case study called 'Precautionary measures during wind days in Taranto'. Under particular weather conditions, the 'wind days' intervention includes prescriptions to companies and recommendations to the public. The latter has been found to be scientifically inconsistent, as highlighted by studies published over the years. The case-study analysis showed that any public health measure must include: a timed evaluation of the measure effectiveness and consider the possibility of its revision; involvement of the population at all stages.

Health risks of titanium dioxide (TiO2) dust exposure in occupational settings - A scoping review.

Titanium dioxide (TiO2) is an inorganic compound with many applications, for example in paint, sunscreen or as food coloring. There have been concerns regarding its safety and according to IARC, the existing evidence is not substantial enough to rule them out, leading to the substance being classified as possibly carcinogenic to humans (2B). This work aims to provide a comprehensible overview about epidemiological studies on occupational health risks and methodological aspects. A literature search was conducted in two databases (MEDLINE and Web of Science). The search focused on occupational exposure since this setting provides the highest amounts of TiO2 exposure. Of 443 unique search results, ten were included in this study, with publication dates ranging from 1988 to 2022. Seven of them are retrospective cohort studies and three have a case-control study design. Main outcomes of most studies were all-cause mortality and lung cancer mortality. For all-cause mortality, most cohort studies reported no association with TiO2 exposure. For lung cancer mortality, a significantly increased risk was found in a study population from Europe. The analysis results of working cohorts from the US comparing exposed workers' mortality rates with those of the general population were unobtrusive. However, one US cohort found an elevated mortality risk for all causes and lung cancer based on a reference population of company workers unexposed to TiO2. Case-control studies did not indicate an increased risk for cancer related to TiO2. Recent publications partly questioned the validity of those earlier findings, claiming insufficient confounder analysis, most notably for smoking, as well as the presence of the healthy worker effect, masking a potential health risk. In conclusion, the associations between occupational TiO2 exposure and mortality are unclear, but concerns regarding possible health risks recently re-emerged based on new analytical approaches, highlighting methodological difficulties that could have limited the inferential value of previously conducted studies.

Effects of care of multimorbid patients in general practices by advanced practice nurses (FAMOUS): study protocol for a nonrandomized controlled trial.

BACKGROUND: Multimorbidity is a common phenomenon among patients treated in general practices. Key challenges within this group include functional difficulties, polypharmacy, treatment burden, fragmentation of care, reduced quality of life and increased health care utilization. These problems cannot be solved in the short consultation time of a general practitioner (GP) since there is an increasing shortage of GPs. In many countries, advanced practice nurses (APNs) are successfully integrated into primary health care for multimorbid patients. The objective of this study is to examine whether the integration of APNs in the primary care of multimorbid patients in Germany leads to optimized care of the target group and to a reduction in the workload of the GPs. METHODS: The intervention includes the integration of APNs into the care for multimorbid patients in general practice for twelve months. Qualifications for APNs include a master's level academic degree and 500 hours of project-specific training. Their tasks include in-depth assessment, preparation, implementation, monitoring and evaluation of a person-centred and evidence-based care plan. In this nonrandomized controlled trial, a prospective multicentre mixed methods study will be performed. The main inclusion criterion was the cooccurrence of three chronic diseases. For data collection in the intervention group (n = 817), routine data from health insurance companies and association of statutory health insurance physicians (ASHIP) will be used, as well as qualitative interviews. In addition, the intervention will be assessed through documentation of the care process and standardized questionnaires using a longitudinal design. The control group (n = 1634) will receive standard care. For the evaluation, routine data from health insurance companies are matched at a ratio of 1:2. Outcomes will be measured using emergency contacts and GP visits, treatment costs, health status of the patients and the satisfaction of parties involved. The statistical analyses will include Poisson regression to compare outcomes between the intervention and control groups. Descriptive and analytical statistical methods will be used in the longitudinal analysis of the intervention group data. Cost analysis will compare total costs and subgroup costs between the intervention and control groups. Qualitative data will be analysed using content analysis. DISCUSSION: Challenges to this protocol could include the political and strategic environment as well as the planned number of participants. TRIAL REGISTRATION: DRKS00026172 on DRKS.

Habitual physical activity in patients born with oesophageal atresia: a multicenter cross-sectional study and comparison to a healthy reference cohort matched for gender and age.

Oesophageal atresia (EA) is associated with life-long gastrointestinal and respiratory morbidity and other associated malformations. The aim of this study is to compare physical activity (PA) levels of children and adolescents with and without EA. A validated questionnaire (MoMo-PAQ) was used to evaluate PA in EA patients EA (4-17 years), who were randomly matched for gender and age (1:5) with a representative sample of the Motorik-Modul Longitudinal Study (n = 6233). Sports activity per week (sports index) and minutes of moderate to vigorous physical activity per week (MVPA minutes) were calculated. Correlations between PA and medical factors were analysed. In total, 104 patients and 520 controls were included. Children with EA were significantly less active at higher intensities (mean MPVA minutes 462; 95% confidence interval (CI): 370-554) compared to controls (626; 95% CI: 576-676), although there was no statistically significant difference in the sports index (187; 95% CI: 156-220 versus 220; 95% CI: 203-237). A lower mean weight-for-age and height-for-age, additional urogenital (r = - 0.20, p = 0.04) or anorectal malformation (r = - 0.24, p = 0.01) were associated with fewer MVPA minutes. For other medical factors (prematurity, type of repair, congenital heart disease, skeletal malformation or symptom load), no statistically significant association with PA was found.  Conclusion: EA patients participated in PA at a similar level but lower intensities compared to the reference cohort. PA in EA patients was largely independent of medical factors. TRIAL REGISTRATION: German Clinical Trials Register (ID: DRKS00025276) on September 6, 2021. WHAT IS KNOWN: • Oesophageal atresia is associated with a low body weight and height, delayed development of motor skills and impaired lung function and exercise capacity. WHAT IS NEW: • Patients with oesophageal atresia have a similar amount of sports activity per week but engage significantly less in moderate to vigorous physical activities compared to peers. • Physical activity was  associated with weight-for-age and height-for-age, but largely independent of symptom load and other medical factors.

Sex-specific percentiles for bodyweight and height in children born with esophageal atresia: a registry-based analysis 2001-2021.

BACKGROUND: Esophageal atresia (EA) is a rare malformation with a wide range of co-morbidity and associated malformations impairing weight gain and growth. The aim of this study was to calculate specific percentiles for body weight and height for children born with esophageal atresia according to sex from birth to the age of 6 years, accounting for prematurity and presence of congenital heart disease (CHD). METHODS: Data was extracted from an anonymized voluntary national registry for patients born with esophageal atresia between 2001 and 2021, from birth until the age of six years. Missing values were imputed using a multiple imputation approach. In premature infants, chronological age was corrected for gestational week until the age of one year. The impact of sex and additional congenital heart disease on weight gain and growth was analysed using quartile regression models. RESULTS: In total, 1812 examinations of 485 patients were considered and 1232 examinations of 301 patients were finally included. Most data was available for children at birth and during the first year of life. Body weight was imputed for 3.3% and height for 12.5% of examinations. The mean body weight-for-age and length-for-age at birth according to gestational age was lower in EA patients and median body weight developed along the tenth percentile compared to the general population. Median height-for-age was at the 50th percentile during the first months of life, before crossing to lower percentiles before the age of one year. CHD had an additional negative impact on growth and weight gain, especially during the first year of life. CONCLUSIONS: Children with EA had a reduced bodyweight and -height compared to the general population. Therefore, specific percentile curves are helpful to evaluate growth and development. Especially during the first year of life, particular attention is necessary and complications leading to a reduced calorie intake should be treated without delay to promote timely development and growth. Cardiac co-morbidities may further compromise weight gain in these patients, implying that such patients should be under even closer surveillance.

Incidence of childhood leukemia before and after shut down of nuclear power plants in Germany in 2011: A population-based register study during 2004 to 2019.

The association between leukemia and proximity to nuclear-power-plants (NPPs) has been assessed in several countries with inconsistent results. A case-control study from Germany had shown an increased risk for childhood leukemia (diagnoses 1980-2003) near NPPs. Germany began shutting down nuclear reactors in 2011, following the Fukushima disaster. We tested whether the previously observed association between leukemia and proximity to NPP persisted despite the shutdown. We used an ecological study design to investigate the incidence of leukemia during 2004 to 2019 in children aged 0 to 14 years living near NPPs where at least one reactor was shut down in 2011. We defined study and control areas as municipalities whose surface area was at least 75% within 10 km or between 10 and 50 km of NPPs, respectively. We calculated age-standardized rates and incidence rate ratios (IRR) using control-areas as the reference. We also computed standardized incidence ratios (SIR) separately for each NPP using incidence rates of the German population as a reference. IRR decreased from 1.20 (95% confidence interval: 0.81-1.77) in 2004 to 2011 to 1.12 (0.75-1.68) in 2012 to 2019. Analyses of single plants showed an excess of childhood leukemia during 2004 to 2019 for the Unterweser-NPP, based only on three cases, and the Krümmel-NPP (n = 14; SIR: 1.98, 1.17-3.35). We found slightly decreasing of leukemia incidence rate ratios after the shutdown of nuclear reactors in 2011. Due to the small number of cases, risk estimates have large uncertainty. Further research including a longer follow-up is warranted. The consistent excess of incidence cases around Krümmel may require analytical epidemiological analysis.

What do bereaved relatives of cancer patients dying in hospital want to tell us? Analysis of free-text comments from the International Care of the Dying Evaluation (i-CODE) survey: a mixed methods approach.

PURPOSE: We conducted an international survey of bereaved relatives of cancer patients dying in hospitals in seven countries, with the aim to assess and improve the quality of care. The survey used the i-CODE (International Care of the Dying Evaluation) questionnaire. Here, we report findings from the free-text comments submitted with the questionnaires. We explored for topic areas which would potentially be important for improving the quality of care. Further, we examined who reported free-texts and in what way, to reduce bias without ignoring the function the free-texts may have for those contributing. METHODS: We used a combined qualitative-quantitative approach: logistic regression analysis to study the effect of respondents' socio-demographic characteristics on the probability of free-texts contributions and thematic analysis to understand the free-text meaning. The primary survey outcomes, (1) how frequently the dying person was treated with dignity and respect and (2) support for the relative, were related to free-text content. RESULTS: In total, 914 questionnaires were submitted; 457/914 (50%) contained free-text comments. We found no socio-demographic differences between the respondents providing free-texts and those who did not. We discovered different types of free-texts ("feedback," "narrative," "self-revelation") containing themes of which "continuity of care," "the one person who can make a difference," and "the importance of being a companion to the dying" represent care dimensions supplementing the questionnaire items. A free-text type of grateful feedback was associated with well perceived support for the relative. CONCLUSION: Bereaved relatives used the free-texts to report details related to i-CODE items and to dimensions otherwise not represented. They highlighted the importance of the perceived support from human interaction between staff and the dying patient and themselves; and that more than professional competence alone, personal, meaningful interactions have profound importance.

Noise annoyance and risk of prevalent and incident atrial fibrillation-A sex-specific analysis.

Background: While chronic exposure to high levels of noise was demonstrated to increase the risk of various cardiovascular diseases, the association between noise annoyance and risk of cardiovascular disease remains still inconsistent. Recently, we showed that noise annoyance is associated with prevalent atrial fibrillation in the general population. However, the association between noise annoyance and risk of incident atrial fibrillation as well as potential sex-differences remain still elusive. Methods and results: 15,010 subjects from a German population-based cohort were examined at baseline (2007 to 2012) and follow-up five years later (2012 to 2017) to investigative the association between noise annoyance due to multiple sources and prevalent and incident atrial fibrillation. After multivariable adjustment, the results from logistic regression analyses revealed overall consistent and positive associations between noise annoyance and prevalent and incident atrial fibrillation in men, whereas this association was weaker in women, in particular with respect to incident atrial fibrillation. For instance, industrial noise annoyance was associated with 21% (95% confidence interval (CI) 9-34%) and 18% (8-29%) higher odds of prevalent atrial fibrillation in men and women, respectively. In prospective analysis, this association remained stable in men (odds ratio (OR) 1.25, 1.07-1.44), while in women no association was observed (OR 1.03, 0.89-1.18). Conclusions: The findings suggest that noise annoyance can increase the risk of incident atrial fibrillation in a large population-based cohort and that men may be more sensitive to the adverse effects of noise annoyance with regard to the risk of atrial fibrillation.

Self-Reported Reactogenicity After Different COVID-19 Vaccination Regimens.

BACKGROUND: In Rhineland-Palatinate, most COVID-19 vaccinations are centrally registered by the Rhineland-Palatinate Division of Vaccine Documentation, which includes self-reported vaccination reactions (SRVR) and their level of perceived intensity. We analyzed the occurrence of SRVR reported between 12/2020 and 12/2021 in relation to the different vaccination regimens involving BioNTech/Pfizer (BNT) and Moderna (m1273) mRNA vaccines and AstraZeneca (ChAd) and Johnson & Johnson (Ad26) viral vector vaccines. METHODS: Using sex-specific logistic regression models, we analyzed the occurrence of all local and systemic SRVR, as well as the occurrence of local and systemic SRVR that were self-rated as "severe" by the vaccinated persons, in relation to the vaccine of the first vaccination and the vaccination regimen of the second vaccination (BNT/BNT, ChAd/ChAd, m1273/m1273, ChAd/ BNT, ChAd/m1273). Vaccination with BNT or the BNT/BNT regimen formed the reference category for the estimated odds ratios (OR) with respective 95% confidence intervals. RESULTS: Of all those vaccinated, 40.7% provided valid information on SRVR after the first vaccination and 33.8% after the second vaccination. As a result, 887 052 individuals were included in the analyses. Their median age was 60 years, and 58% were women. The most common vaccination regimen was BNT/BNT (67.3%). The most common SRVR were pain at the injection site and fatigue. Self-reported reactogenicity after the first vaccination was lowest for BNT. Self-reported systemic reactogenicity was notably higher after vaccination with a vector vaccine. After the second vaccination, self-reported reactogenicity was lowest after a ChAd/ChAd regimen and highest after an m1273 second vaccination. CONCLUSION: With overall acceptable tolerability, differences in self-reported reactogenicity were evident depending on the particular COVID-19 vaccines and vaccination regimens in question.

Telementoring in Minimally Invasive Esophageal Atresia Repair: Results of a Case-Control Study and Lessons Learned from the TIC-PEA Study (Telemedical Interdisciplinary Care for Patients with Esophageal Atresia).

Minimally invasive esophageal atresia (EA) repair is deemed one of the most demanding procedures in pediatric surgery. Open repair is considered the gold standard and learning opportunities for minimally invasive repairs remain scarce. "Telemedical Interdisciplinary Care for Patients with Esophageal Atresia (TIC-PEA)" offers free access to an interdisciplinary network of experts for telemedical consultation (telementoring). The aim of this study was to determine the frequency of minimally invasive surgery (MIS) in TIC-PEA patients compared to the general population. TIC-PEA patients were matched and compared to controls regarding the use of MIS, patient characteristics, and complications. Patients (n = 31) were included at a mean age of 62.8 days (95%-CI: 41.4-84.3, 77% after the primary esophageal repair). The odds-ratio to have MIS was 4.03 (95%-confidence interval: 0.79-20.55) for esophageal anastomosis and 4.60 (95%-confidence interval: 0.87-24.22) for tracheoesophageal fistula-repair in the TIC-PEA group. Telementoring offered the chance to select the ideal candidate for MIS, plan the procedure, and review intraoperative images and videos with the expert. Telementoring as offered is ideal to promote MIS for EA and helps to address the individual learning curve. In order to maximize benefits, patients need to be included prior to the first esophageal procedure.

Patterns of coronary heart disease mortality in Italy from 1931 to 2015 and a focus on a region with highly industrialized areas.

BACKGROUND: Coronary Heart Disease (CHD) is associated with various risk factors, including environmental stressors. The aim of our paper is to study the mortality patterns in Italy with a focus on provinces of the Apulia Region from 1931 to 2015 to analyze the burden of the disease over time. METHODS: We conducted an ecological analysis of mortality from all causes and from CHD in main Italian geographical areas and in the Apulian provinces, from 1931 to 2015. Sex-specific mortality and population data were obtained from the Italian National Institute of Statistics since 1969. Direct standardized mortality rates (SDRs) per 10,000 inhabitants with 90% confidence intervals (90%CI) were calculated from 1969, using the European population as standard. The standardized mortality ratios (SMRs%) were calculated with 90%CI and the Italian population as reference. RESULTS: The SDRs indicate a decline in mortality from CHD in all geographical Italian areas and in the Apulian provinces for both sexes. However, this decline slowed over time, particularly in the South. The highest values of SMRs% were observed in the industrialized areas of Taranto and especially Brindisi, in both sexes. CONCLUSIONS: The historical reconstruction over about 80 years highlighted critical issues for CHD at the start of the industrial development in the provinces of Brindisi and Taranto. This might suggest environmental pollution as risk factor for cardiovascular diseases. Furthermore, it would be necessary to verify how much other risk factors (eg. diabetes and obesity) affect the slowdown in the CHD mortality decline over the last decade.

The Gutenberg health study: a five-year prospective analysis of psychosocial working conditions using COPSOQ (Copenhagen psychosocial Questoinnaire) and ERI (effort-reward imbalance).

BACKGROUND: Psychosocial working conditions were previously analyzed using the first recruitment wave of the Gutenberg Health Study (GHS) cohort (n = 5000). We aimed to confirm the initial analysis using the entire GHS population at baseline (N = 15,010) and at the five-year follow-up. We also aimed to determine the effects of psychosocial working conditions at baseline on self-rated outcomes measured at follow-up. METHODS: At baseline, working GHS participants were assessed with either the Effort-Reward-Imbalance questionnaire (ERI) (n = 4358) or with the Copenhagen Psychosocial Questionnaire (COPSOQ) (n = 4322); participants still working after five years received the same questionnaire again (ERI n = 3142; COPSOQ n = 3091). We analyzed the association between working conditions and the outcomes job satisfaction, general health, burnout, and satisfaction with life at baseline, at follow-up and also prospectively from baseline to follow-up using linear regression models. We examined the outcome variance explained by the models (R2) to estimate the predictive performance of the questionnaires. RESULTS: The models' R2 was comparable to the original baseline analyses at both t0 and t1 (R2 range: ERI 0.10-0.43; COPSOQ 0.10-0.56). However, selected scales of the regression models sometimes changed between assessment times. The prospective analysis showed weaker associations between baseline working conditions and outcomes after five years (R2 range: ERI 0.07-0.19; COPSOQ 0.07-0.24). This was particularly true for job satisfaction. After adjusting for the baseline levels of the outcomes, fewer scales still explained some of the variance in the distribution of the outcome variables at follow-up. The models using only data from t0 or t1 confirmed the previous baseline analysis. We observed a loss of explained variance in the prospective analysis models. This loss was greatest for job satisfaction, suggesting that this outcome is most influenced by short-term working conditions. CONCLUSIONS: Both the COPSOQ and ERI instruments show good criterion validity and adequately predict contemporaneously measured self-reported measurements of health and (occupational) well-being. However, the COPSOQ provides a more detailed picture of working conditions and might be preferable for improvment strategies in workplaces. Additional prospective research with shorter follow-up times would be beneficial for estimating dose-response relationships.

Multi-household social gatherings contribute to the second SARS-CoV-2 wave in Rhineland-Palatinate, Germany, August to November 2020.

BACKGROUND: Although the private household setting is considered a major driver of viral spread, only little is known about the contextual details of SARS-CoV-2 household transmission, thus hampering political decision-making. MATERIALS AND METHODS: We analyzed individual case and cluster data from statutory notifications from August to November 2020 in Rhineland-Palatinate - the period preceding the second SARS-CoV-2 wave. We also conducted an into-depth survey on contextual details of household transmission in a representative sample of 149 private household clusters that had occurred during this period. RESULTS: During the study period, 18,695 PCR-confirmed SARS-CoV-2 cases were notified, 3,642 of which occurred in 911 clusters (private households (67.3%), the workplace (7.8%), elderly homes (1.8%), others (23.2%). Demographically, clustered cases were representative of all notified cases. Two-thirds (77/113, 68%) of sample response clusters involved more than one private household. These caused on average more close contact persons (mean 13.5, ±SD 15.8) and secondary cases (3.9, ±SD 0.4) than clusters involving one household only (5.1 ± 13.8 and 2.9 ± 0.2). About one in six multi-household clusters in the private setting (13/77) followed a social gathering (e.g. birthday party). Breaches of one or more of the three major barrier concepts (mask, ventilation, and distance) were identified in most (10/13) of these social gatherings. SARS-CoV-2 clusters following social gatherings were overrepresented during the second half of the study period. CONCLUSION: In times of increasing infectious pressure in a given population, multi-household social gatherings appear to be an important target for reducing SARS-CoV-2 transmission.

Esophageal Interventions in Infants Born with Esophageal Atresia: A Comprehensive Analysis of a National Database.

INTRODUCTION: Esophageal atresia (EA) is a rare malformation that often requires a series of procedures, including surgical primary anastomosis, staged repair, and endoscopic procedures. Actual numbers and trends in interventions and variety in treatment strategies remain unclear. MATERIALS AND METHODS: Data from the German federal bureau of statistics containing all EA-related inpatient procedures encoded from 2005 until 2018 were analyzed for children during the first year of life. The sum of esophageal anastomoses and replacements was used to calculate an estimate of incidence of EA. RESULTS: Over 14 years, 12,627,888 inpatient cases were recorded in infants in Germany. The mean incidence of EA was 1 per 4,217 live births. On average, 163.3 (95% confidence interval [CI]: 150.8-176.1) esophageal anastomoses, 11.2 (95% CI: 8.7-13.7) esophageal lengthening procedures, and 6.7 (95% CI: 5.42-8.00) esophageal replacements were recorded annually. Overall, 187.8 (95% CI: 147.1-200.4) endoluminal treatments (ballon dilatation, bougienage, stent placement, or injection) were performed per 100 anastomoses. Over the years, bougienage was increasingly replaced by ballon dilatation as primary treatment. Boys had a significantly higher number of esophageal procedures than girls, but the incidence of endoscopic treatments in relation to anastomoses was the same for both genders. CONCLUSION: The low incidence of EA in relation to a relatively large number of units treating those patients in Germany may pose challenges for maintaining competency and training of all specialists involved. The number of esophagoscopic treatments for esophageal stricture per anastomosis is lower than previously estimated.

[Explaining the age-adjusted excess mortality with COVID-19-attributed deaths from January 2020 to July 2021]. / Erklärbarkeit der altersadjustierten Übersterblichkeit mit den COVID-19-attribuierten Sterbefällen von Januar 2020 bis Juli 2021.

BACKGROUND: Estimating COVID-19 mortality is impeded by uncertainties in cause of death coding. In contrast, age-adjusted excess all-cause mortality is a robust indicator of how the COVID-19 pandemic impacts public health. However, in addition to COVID-19 deaths, excess mortality potentially also reflects indirect negative effects of public health measures aiming to contain the pandemic. OBJECTIVES: The study examines whether excess mortality in Germany between January 2020 and July 2021 is consistent with fatalities attributed to COVID-19 or may be partially due to indirect effects of public health measures. METHODS: Excess mortality trends for the period from January 2020 to July 2021 were checked for consistency with deaths attributed to COVID-19 in both the German federal states and districts of Rhineland-Palatinate. The expected monthly mortality rates were predicted based on data from 2015-2019, taking into account the population demographics, air temperature, seasonal influenza activity, and cyclic and long-term time trends RESULTS: COVID-19-attributed mortality was included in the 95% prediction uncertainty intervals for excess mortality in 232 of 304 (76.3%) month-state combinations and in 607 of 684 (88.7%) month-district combinations. The Spearman rank correlation between excess mortality and COVID-19-attributed mortality across federal states was 0.42 (95% confidence interval [0.31; 0.53]) and 0.21 (95% confidence interval [0.13; 0.29]) across districts. CONCLUSIONS: The good agreement of spatiotemporal excess mortality patterns with COVID-19 attributed mortality is consistent with the assumption that indirect adverse effects from public health interventions to contain the COVID-19 pandemic did not substantially contribute to excess mortality in Germany between January 2020 and July 2021.

[Noise annoyance in the German general population : Prevalence and determinants in the Gutenberg Health Study]. / Lärmbelästigung in der deutschen Allgemeinbevölkerung : Prävalenz und Determinanten in der Gutenberg-Gesundheitsstudie.

BACKGROUND: Noise annoyance, especially from traffic noise, is a massive problem in the population and is associated with impaired health. OBJECTIVE: Based on data from the population representative Gutenberg Health Study (GHS), the prevalence of noise annoyance from different sources and relevant determinants were identified. MATERIAL AND METHODS: The GHS is a population-based, prospective cohort study in Germany that included subjects aged 35-74 years. In the study 15,010 participants from the city of Mainz and the district of Mainz-Bingen were asked from 2007 to 2012 to what extent they had recently felt annoyed by aircraft, road, rail, industrial and neighborhood noise (answers ranged from not at all to extremely). A distinction was made between noise annoyance during the day and during sleep. To examine the relationships between sociodemographic variables, cardiovascular risk factors as well as diseases and noise annoyance, multivariable logistic regression models were used. RESULTS: Approximately 80% of the participants felt annoyed by noise. Aircraft noise annoyance during the day was the predominant source of noise annoyance with the highest prevalence of strongly (9.6%) and extremely annoyed participants (5.4%), followed by road traffic (strongly 4.0% and extremely 1.6%) and neighborhood noise annoyance (strongly 3.5% and extremely 1.3%). Noise annoyance tended to decrease with increasing age. Relevant determinants of noise annoyance included gender, age, socioeconomic status, depression, anxiety disorder, sleep disorder and atrial fibrillation. CONCLUSION: Noise annoyance is common in the population and is associated with sociodemographic variables, cardiovascular risk factors and diseases.