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Introduction: Climate change is a paramount global health threat with multifaceted implications. Societal change is required to mitigate the negative effects of climate change, as well as help people adapt to the associated health risks. This requires situation-specific, large-scale data to help scientists and policymakers understand public perceptions and behaviours and identify the levers to increase public readiness to act against climate change and protect health. The Planetary Health Action Survey (PACE) assesses this readiness to act as a regular monitoring of representative samples in Germany. The ongoing monitoring seeks to develop and refine an integrated conceptual model of the trait-like readiness to act, comprising policy acceptance, political participation and individual behaviours as indicators of the trait. It also proposes as set of determinants to explain different levels of readiness to act. This study protocol provides newly developed valid measurement instruments and the methodological details of the monitoring., Method and Analysis: PACE assesses indicators of the readiness to act and a set of sociocognitive factors predicting the readiness to act in continuous cross-sectional data collections. The latter comprise climate change knowledge, trust in institutions, perceived health risks, self-efficacy, social norms and perceived effectiveness of policy measures. The online questionnaire is updated regularly. Data collection involves non-probabilistic quota samples from Germany (n≈1000 at each collection)., Ethics and Dissemination: The project adheres to the ethical guidelines of the University of Erfurt and the German Research Foundation. Ethical clearance was granted by the University's Institutional Review Board (No #20220525/No #2024-01). Participants are guaranteed confidentiality and anonymity, and informed consent is obtained before participation. Results will be published in peer-reviewed journals. Additionally, we aim to inform and empower the public and support stakeholders (media, policymakers, climate protection organisations) in preparing climate communication and assisting policymakers through the project website including an interactive tool, detailed reports and short summaries for practitioners., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objective: Acitretin has long-lasting teratogenic properties. Therefore, pregnancies must be avoided during and within 3 years after acitretin treatment. We aimed to describe (i) acitretin use in women of childbearing age in Germany, (ii) the occurrence of acitretin-exposed pregnancies, and (iii) malformations among children exposed in utero., Methods: Using 2004-2019 data from the German Pharmacoepidemiological Research Database (GePaRD-claims data from ~ 20% of the German population), we determined annual age-standardized prevalence of acitretin use among girls and women aged 13-49 years. In longitudinal analyses, we estimated the number of exposed pregnancies by assessing whether the exposure window assigned to the last dispensation before pregnancy (days covered by dispensation plus 3 years) overlapped the onset of pregnancy or whether there was a dispensation in the first eight weeks of pregnancy. Data of live-born children with in utero exposure to acitretin were reviewed to assess the presence of congenital malformations., Results: The age-standardized prevalence of acitretin use per 1000 girls and women was 0.04 in 2019. We identified 35 acitretin-exposed pregnancies; 94.3% of these pregnancies were classified as exposed because they occurred within 3 years after stopping acitretin treatment. Among 18 live-born children linked to their mother, four children (22.2%) had congenital malformations (three children with a major malformation)., Conclusions: We observed 35 acitretin-exposed pregnancies mainly because treatment ended too late before pregnancy. Approximately one in five children born from these pregnancies had malformations, highlighting the importance of drawing more attention to the long-lasting teratogenicity of this drug., (© 2023. The Author(s).)