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Objective: According to the WHO, anthropogenic climate change poses the greatest threat to human health in the 21st century. However, the link between climate change and human health is not an integral part of medical education in Germany. Within a student-led project, an elective clinical course was designed and successfully implemented, which has been made accessible to undergraduate medical students at the Universities of Giessen and Marburg. The implementation and didactic concept are explained in this article.Methodology: In a participatory format, knowledge is imparted using an action-based, transformative approach. Topics discussed are, amongst others, interactions of climate change and health, transformative action, and health behavior, as well as "green hospital" and the simulation of a "climate-sensitive health counselling". Lecturers from different disciplines within and beyond medicine are invited as speakers.Results: Overall, the elective was evaluated positively by the participants. The fact that there is a high demand among students for participation in the elective, as well as for the transfer of concepts underlines the need for including this topic into medical education. The implementation and further development of the concept at two universities with different study regulations demonstrates its adaptability.Conclusion: Medical education can raise awareness of the multiple health consequences of the climate crisis, can have a sensitizing and transformative effect on various levels, and can promote climate-sensitive action ability in patient care. In the long term, however, these positive consequences can only be guaranteed by including mandatory education on climate change and health in medical curricula. Zielsetzung: Der anthropogene Klimawandel ist laut der WHO die größte Gefahr für die menschliche Gesundheit im 21. Jahrhundert. Dennoch stellen die Zusammenhänge zwischen Klimawandel und Gesundheit keinen festen Bestandteil der ärztlichen Ausbildung dar. Im Rahmen einer studentischen Initiative wurde ein klinisches Wahlfach konzipiert und durchgeführt, welches für Studierende der Universitäten Gießen und Marburg zugänglich ist. Durchführung und didaktisches Konzept sollen in diesem Beitrag erläutert werden.Methodik: In einem partizipativen Format werden Inhalte mit einem praktischen, transformativen Ansatz besprochen. Es werden zunächst die Zusammenhänge zwischen Klimakrise und Gesundheit aufgezeigt, dann u.a. das transformative Handeln und Gesundheitsverhalten behandelt, die anschließend im Bereich Green Hospital und der Simulation einer "Klimasprechstunde" münden. Dazu werden Dozierende unterschiedlicher Fachrichtungen aus der Medizin sowie aus anderen Bereichen eingeladen.Ergebnisse: Das Wahlfach wird insgesamt positiv bewertet. Der Umstand, dass die Nachfrage sowohl zur Teilnahme am Wahlfach als auch zur Weitergabe von Konzepten hoch ist, unterstreicht den Bedarf an Lehre zur Thematik. Die Durchführung und Weiterentwicklung des Konzepts an zwei Universitäten mit verschiedenen Studienordnungen zeigt dessen Adaptivität auf.Schlussfolgerung: Medizinische Lehre kann Bewusstsein für die mit der Klimakrise zusammenhängende Gesundheitsrisiken schaffen, transformativ wirken, sowie einen präventiven Ansatz der Gesundheitsversorgung fördern. Langfristig können diese positiven Effekte allerdings nur durch eine Aufnahme des Themenkomplexes Klimawandel und Gesundheit in die Curricula gewährleistet werden. Das Projekt zeigt, dass entsprechende Angebote realisierbar sind und gut angenommen werden.

The complex mechanism by which stress can affect sensory processes such as hearing is still poorly understood. In a previous study, the mineralocorticoid (MR) and/or glucocorticoid receptor (GR) were deleted in frontal brain regions but not cochlear regions using a CaMKIIα-based tamoxifen-inducible CreERT2/loxP approach. These mice exhibit either a diminished (MRTMXcKO) or disinhibited (GRTMXcKO) auditory nerve activity. In the present study, we observed that mice differentially were (MRTMXcKO) or were not (GRTMXcKO) able to compensate for altered auditory nerve activity in the central auditory pathway. As previous findings demonstrated a link between central auditory compensation and memory-dependent adaptation processes, we analyzed hippocampal paired-pulse facilitation (PPF) and long-term potentiation (LTP). To determine which molecular mechanisms may impact differences in synaptic plasticity, we analyzed Arc/Arg3.1, known to control AMPA receptor trafficking, as well as regulators of tissue perfusion and energy consumption (NO-GC and GC-A). We observed that the changes in PPF of MRTMXcKOs mirrored the changes in their auditory nerve activity, whereas changes in the LTP of MRTMXcKOs and GRTMXcKOs mirrored instead the changes in their central compensation capacity. Enhanced GR expression levels in MRTMXcKOs suggest that MRs typically suppress GR expression. We observed that hippocampal LTP, GC-A mRNA expression levels, and ABR wave IV/I ratio were all enhanced in animals with elevated GR (MRTMXcKOs) but were all lower or not mobilized in animals with impaired GR expression levels (GRTMXcKOs and MRGRTMXcKOs). This suggests that GC-A may link LTP and auditory neural gain through GR-dependent processes. In addition, enhanced NO-GC expression levels in MR, GR, and MRGRTMXcKOs suggest that both receptors suppress NO-GC; on the other hand, elevated Arc/Arg3.1 levels in MRTMXcKOs and MRGRTMXcKOs but not GRTMXcKOs suggest that MR suppresses Arc/Arg3.1 expression levels. Conclusively, MR through GR inhibition may define the threshold for hemodynamic responses for LTP and auditory neural gain associated with GC-A.

Neuronal hyperexcitability in the central auditory pathway linked to reduced inhibitory activity is associated with numerous forms of hearing loss, including noise damage, age-dependent hearing loss, and deafness, as well as tinnitus or auditory processing deficits in autism spectrum disorder (ASD). In most cases, the reduced central inhibitory activity and the accompanying hyperexcitability are interpreted as an active compensatory response to the absence of synaptic activity, linked to increased central neural gain control (increased output activity relative to reduced input). We here suggest that hyperexcitability also could be related to an immaturity or impairment of tonic inhibitory strength that typically develops in an activity-dependent process in the ascending auditory pathway with auditory experience. In these cases, high-SR auditory nerve fibers, which are critical for the shortest latencies and lowest sound thresholds, may have either not matured (possibly in congenital deafness or autism) or are dysfunctional (possibly after sudden, stressful auditory trauma or age-dependent hearing loss linked with cognitive decline). Fast auditory processing deficits can occur despite maintained basal hearing. In that case, tonic inhibitory strength is reduced in ascending auditory nuclei, and fast inhibitory parvalbumin positive interneuron (PV-IN) dendrites are diminished in auditory and frontal brain regions. This leads to deficits in central neural gain control linked to hippocampal LTP/LTD deficiencies, cognitive deficits, and unbalanced extra-hypothalamic stress control. Under these conditions, a diminished inhibitory strength may weaken local neuronal coupling to homeostatic vascular responses required for the metabolic support of auditory adjustment processes. We emphasize the need to distinguish these two states of excitatory/inhibitory imbalance in hearing disorders: (i) Under conditions of preserved fast auditory processing and sustained tonic inhibitory strength, an excitatory/inhibitory imbalance following auditory deprivation can maintain precise hearing through a memory linked, transient disinhibition that leads to enhanced spiking fidelity (central neural gain⇑) (ii) Under conditions of critically diminished fast auditory processing and reduced tonic inhibitory strength, hyperexcitability can be part of an increased synchronization over a broader frequency range, linked to reduced spiking reliability (central neural gain⇓). This latter stage mutually reinforces diminished metabolic support for auditory adjustment processes, increasing the risks for canonical dementia syndromes.

Background: Hyperacusis is intolerance of certain everyday sounds that causes significant distress and impairment in social, occupational, recreational, and other day-to-day activities. Objective: The aim of this report is to summarize the key findings and conclusions from the Third International Conference on Hyperacusis. Topics covered: The main topics discussed comprise (1) diagnosis of hyperacusis and audiological evaluations, (2) neurobiological aspect of hyperacusis, (3) misophonia, (4) hyperacusis in autism spectrum disorder, (5) noise sensitivity, (6) hyperacusis-related distress and comorbid psychiatric illness, and (7) audiologist-delivered cognitive behavioral therapy for hyperacusis. Conclusions: Implications for research and clinical practice are summarised.

Hintergrund und Fragestellung: Die Bedeutung von MOOC (Massive Open Online Course) für die Hochschulbildung wird kontrovers diskutiert. Im Rahmen dieser Pilotstudie wurden das didaktische Potential und die Praktikabilität der Integration eines MOOC in die Präsenzlehre zum Thema „Global[zum vollständigen Text gelangen Sie über die oben angegebene URL], Gemeinsame Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA) und des Arbeitskreises zur Weiterentwicklung der Lehre in der Zahnmedizin (AKWLZ)

Internationalizing higher education is considered to be a major goal for universities in Germany and many medical students aspire to include international experiences into their academic training. However, the exact meaning of “internationalizing” medical education is still poorly defined, just as is the possible pedagogic impact and effects. Against this background, this article presents the special track curriculum on global health (in German: Schwerpunktcurriculum Global Health, short: SPC) at Justus Liebig University Giessen, which was established in 2011 as a comprehensive teaching program to integrate international perspectives and activities systematically into the clinical years of the medical curriculum. The report of the structure, content, didactic principles and participants’ evaluations of the SPC is embedded into a larger discussion of the pedagogic value of a broad and interdisciplinary perspective on “global health” in medical education, that explicitly includes attention for health inequities, social determinants of health and the cultural dimensions of medicine and health abroad and “at home” (e.g. in relation to migration). We conclude that if properly defined, the emerging field of “global health” represents a didactically meaningful approach for adding value to medical education through internationalizing the curriculum, especially in regard to themes that despite of their uncontested value are often rather weak within medical education. The concrete curricular structures, however, have always to be developed locally. The “SPC” at Giessen University Medical School is only one possible way of addressing these globally relevant issues in one particular local academic setting., Internationalisierung gilt als Zukunftsaufgabe für die deutschen Hochschulen, und Auslandsaufenthalte sind unter Medizinstudierenden weit verbreitet. Eine systematische Verknüpfung internationaler Elemente in der medizinischen Ausbildung findet bisher jedoch kaum statt. Auch ist bislang nicht geklärt, was der Begriff „Internationalisierung“ im Medizinstudium konkret bedeutet und bewirken kann. Dieser Projektbericht stellt dazu das 2011 an der JLU Gießen etablierte „Schwerpunktcurriculum Global Health“ (SPC) vor: ein Lehrprojekt zur systematischen Integration internationaler Elemente im klinischen Abschnitt des Medizinstudiums. Das umfassende Themenfeld „Global Health“ wird aufgrund der explizit „globalen“ Perspektive, die auch die Medizin in Deutschland einschließt, als didaktisch sinnvoller Zugang für eine „Internationalisierung“ des Medizinstudiums zur Diskussion gestellt. Das Potential für die medizinische Ausbildung zeigt sich vor allem für disziplinübergreifende Themen und Kompetenzen, die im Regelstudium oft nur punktuell behandelt werden. Beispiele sind: soziale Determinanten von Gesundheit, Gesundheitssysteme und -politik, Medizinethik, Menschenrechte, kulturelle Kompetenz, sowie Reflexionsfähigkeit und ein differenziertes Verständnis der kulturellen, sozialen und historischen Bedingtheit von Medizin und ärztlichem Handeln in Deutschland und global., GMS Zeitschrift für Medizinische Ausbildung; 32(5):Doc52

Einleitung: Extrazelluläres Calcium und ATP sind an der Vermittlung lärminduzierter Schwerhörigkeit beteiligt, zum einen bei der Apoptoseinduktion über erk 1/2, zum anderen über die otoprotektive NO-cGMP-cGK Signalkaskade. Mögliche Kandidaten zur Regulation dieser[for full text, please go to the a.m. URL], 86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Lärm induzierter Hörverlust ist durch verändertes Freizeitverhalten parallel zu demographischen Veränderungen eine zunehmende Volkskrankheit. Hörverlust in jungen Jahren kann das Risiko für Altersschwerhörigkeit, Hyperakusis und Tinnitus erhöhen. Daher sind gebündelte[for full text, please go to the a.m. URL], 86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie