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The objective of this analysis was to record the social and epidemiological characteristics of a specific sample population, as well as to identify any associations between a previous commitment to a public facility on legal grounds and subsequent assessments of an individual's fitness to drive as per the National Health Service (or "ÖGD").For the retrospective data analysis, the documents of 87 subjects were evaluated who had been committed to public psychiatric institutions on legal grounds between 2015 and 2019. Using the SAS software package, frequency distributions and statistical relationships were identified between specific features of the commitment to accommodation and the assessment of fitness to drive by means of Chi-squared testing.The average age of the study cohort was 43.5 years (range: 16-82 years; male: 59%). The most frequent grounds for commitment to a facility were suicidal intentions expressed by the person in question. In one third of the cases, these individuals were under the influence of alcohol at the time of commitment to the facility, and drug use was documented in 3 of the 87 cases. In 74% of cases, confinement was solely due to an individual's risk to themselves; in 26% a risk to others was (additionally) identified; and in 20% of those affected, there was verbal and/or physical resistance to commitment to the accommodation facility. In 57% of cases, the medical evaluation raised doubts about the individual's fitness to drive, resulting in the matter being referred on to the driving license authority. Statistically significant associations were demonstrated between: a) the grounds for commitment to a facility; the type of risk; and resistance to commitment being enforced, and b) the results of a fitness-to-drive assessment carried out by the ÖGD.The data available on individuals committed to public facilities on legal grounds in connection with driving-related medical issues should be optimised to improve quality, whereby the anonymous registration system, introduced on the basis of the Bavarian Mental Health Act ("BayPsychoKHG"), can make a contribution in this regard. In addition, further qualification measures for effective quality management are necessary for all actors involved.

For alcohol withdrawal during hospitalization, often a medication as means for withdrawal needs to be chosen. Modern, score-controlled processes that can be used by the nursing staff after instruction by physicians are frequently not used and even unknown in hospitals. One reason for this is that some of the scores require checking several criteria and are therefore more time-consuming and complicated than use of a fixed-dosage strategy. The SAB-P and HAES are short with only 6 items that can be checked by the nursing staff.Safety of the Hamburg Alcohol Withdrawal Scale (Hamburger Alkoholentzugs-Skala (HAES)) was analyzed retrospectively and prospectively with regard to score-controlled alcohol-withdrawal treatment after rating by the nurse staff (Scoregesteuerte Alkoholentzugsbehandlung nach Rating durch das Pflegepersonal (SAB-P)).Incidence of complications in patients treated with SAB-P and HAES was nearly similar with 1% start of delirium and 3% seizures (SAB-P) and 0.5 to 1.5% start of delirium and 0 to 0.5% seizures in the HAES group. With both scales it was possible to start medical treatment while still under falling alcohol levels (0.93 and 0.91%, respectively). Medication dosage was initially higher using the HAES, so that the time needed to monitor withdrawal symptoms could be reduced (3.8 vs. 3.1 days).Using a score-controlled strategy for alcohol withdrawal leads to a lower complication rate than found in literature. The structured procedure was helpful for the nursing staff as well as for the physicians. SAB-P as well as HAES made withdrawal for the patients more comfortable and led to fewer complaints. Because of rapid reaction and faster symptom reduction of HAES, there was less time necessary for monitoring. Simple handling, clomethiazol, oxazepam or diazepam as applicable medication and clear documentation are the advantages of HAES.

The climate crisis and its consequences represent the greatest challenge facing human health and health care system in the 21st century. It threatens to undermine the last decades of health gains. Rising temperatures, fires, floods and droughts can directly and indirectly cause human pathologies, that are physical and mental. Extreme weather events lead to loss of life, basic life resources and cause severe mental burden. More intense and frequent heat waves due to global warming impact human health and increase mortality, especially for those most vulnerable. The heat-related health risk depends on individual state of health as well as environmental and socioeconomic characteristics of residential areas. Increasing exposure to air pollutants, due to wildfires and anthropogenic emissions, raises respiratory and cardiovascular mortality. Climate warming changes ecosystems and enhances biological invasions that can better adapt to warm environments. Pathogen profiles are changing, transmission and spread of vector-borne diseases as Malaria or Dengue are increasing. Further, rising temperatures and air pollution increase the production and allergenicity of pollen, associated with higher prevalence of allergic diseases. Protective environmental factors, as biodiversity or diverse microbiome, should be given greater consideration in future research.Health sector has the central responsibility as the fifth-largest greenhouse gas emitter to transform in a climate-neutral and sustainable way, e. g. by efficient use of resources. Further education and training in this area should be intensified and included in curricula for medical staff. Furthermore, medical professionals must educate patients about the burden of climate change, climate resilience, and the benefits of CO2 reduction - for human but also for planetary health.

Alcohol dependent patients represent a high-risk group for vitamin deficiency, which could lead to variable cognitive dysfunctions and, as an extreme example, to an amnestic-confabulatory syndrome. In this case report, we report about an alcohol dependent 58-year-old patient without focal neurological symptoms with an amnestic-confabulatory syndrome. After substitution of thiamine, vitamin B12 and folic acid, cognitive symptoms completely vanish within a 22-month period of observation.

Various factors are involved in the pathogenesis of alcoholic liver disease (ALD) and ethanol-mediated carcinogenesis. In addition to genetic, epigenetic and immunologic mechanisms, acetaldehyde-associated toxicity, oxidative stress as well as cytokine-mediated inflammation are of major importance. Oxidative stress, with the generation of reactive oxygen species (ROS), develops either in inflammation (alcoholic hepatitis) or during oxidation of ethanol via cytochrome P4502E1 (CYP2E1). CYP2E1 is induced by ethanol, oxidizes ethanol to acetaldehyde, and generates ROS during this process. ROS results in protein damage, enhanced fibrogenesis and DNA lesions. Furthermore, CYP2E1 induction results in an enhanced activation of various procarcinogens and an increased degradation of retinol and retinoic acid (RA), a compound responsible for cell differentiation and proliferation. An inhibition of CYP2E1 results in an improvement of ALD and chemically induced carcinogenesis in animal experiments. In humans, CYP2E1 is induced following the consumption of 40 grams of ethanol per day after one week. However, the induction varies inter-individually. The mechanism for this is still unclear. Patients with ALD show a significant correlation between CYP2E1, the occurrence of highly carcinogenic etheno DNA adducts and the severity of fibrosis. First results on the effect of CYP2E1 inhibition by chlormethiazole, a specific CYP2E1 inhibitor on ALD, can be expected soon.

Climate change is a threat to health and social security of billions of people. Health and quality of life are increasingly affected in many ways due to the climate crisis. Rising global temperatures are resulting in increasingly frequent and severe extreme weather events, contributing to further increase in inequality, discrimination, and injustice overall and in health care specifically. Furthermore, climatic conditions are also becoming increasingly suitable for the transmission of infectious diseases and their spread into new regions. Socio-economically disadvantaged regions with weak health infrastructure (e.g. Global South) will be hardly able to cope without specific support. The overriding imperative is to achieve reductions in greenhouse gas emissions from transport, energy and food production at global, national and regional levels to mitigate negative health impacts. The 2015 Paris Agreement must also be seen as crucial health agreement. Our paper aims to highlight ethical aspects of climate change in the health sector.

The City of Dresden has no data on the perception of climate change and the associated increase in the average temperature during summer times yet. The data are needed to develop targeted action for vulnerable groups.To close this gap, a representative survey of the population was carried out in Dresden in 2017. Two urban districts, which differ from one another both in terms of urban planning and social structure, were compared, in particular, regarding the question of whether there was a fair distribution or procedural justice concerning the effects of subjective heat burden and influencing factors.The results showed that especially inhabitants of the urban area with predominantly prefabricated buildings, less green space and an increased proportion of socially disadvantaged felt more exposed to the summer heat and had fewer opportunities to adapt to the high temperature.In addition to urban development measures, the results can be used to derive measures for the prevention of heat-related illnesses. These require, for example, increased advice and health education locally to reach people.

Surgical treatment of patients with alcohol use disorder can lead to disturbances (withdrawal syndrome, delirium) which require intensive care treatment. In a surgical ward, the diagnosis of an alcohol related disorder is not always simple. Oftentimes patients conceal or trivialize the issue and as a result are admitted to the hospital in a non-abstinent or unstable state. It is risky to assume that patients with alcohol use disorder will successfully be supplied with alcohol in general hospitals. The risk can be reduced through presurgical identification and alcohol withdrawal of such patients. A literature review concludes that there is no secured evidence for the application of alcohol as prophylaxis or therapy of alcohol withdrawal syndrome in a surgical intensive care unit. The use of intravenous and oral alcohol in intensive care is an unnecessary risk to patients. There are more secure alternatives.