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Holz A, Obi N, Ahrens W, Berger K, Bohn B, Brenner H, Fischer B, Fricke J, Führer A, Gastell S, Greiser KH, Harth V, Heise JK, Holleczek B, Keil T, Klett-Tammen CJ, Leitzmann M, Lieb W, Meinke-Franze C, Michels KB, Mikolajczyk R, Nimptsch K, Peters A, Pischon T, Riedel O, Schikowski T, Schipf S, Schmidt B, Schulze MB, Stang A, Hellwig K, Riemann-Lorenz K, Heesen C, Becher H. Childhood and adolescence factors and multiple sclerosis: results from the German National Cohort (NAKO). BMC Neurol 2024; 24:123. [PMID: 38614986 PMCID: PMC11015562 DOI: 10.1186/s12883-024-03620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) represents the most common inflammatory neurological disease causing disability in early adulthood. Childhood and adolescence factors might be of relevance in the development of MS. We aimed to investigate the association between various factors (e.g., prematurity, breastfeeding, daycare attendance, weight history) and MS risk. METHODS Data from the baseline assessment of the German National Cohort (NAKO) were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between childhood and adolescence factors and risk of MS. Analyses stratified by sex were conducted. RESULTS Among a total of 204,273 participants, 858 reported an MS diagnosis. Male sex was associated with a decreased MS risk (HR 0.48; 95% CI 0.41-0.56), while overweight (HR 2.03; 95% CI 1.41-2.94) and obesity (HR 1.89; 95% CI 1.02-3.48) at 18 years of age compared to normal weight were associated with increased MS risk. Having been breastfed for ≤ 4 months was associated with a decreased MS risk in men (HR 0.59; 95% CI 0.40-0.86) compared to no breastfeeding. No association with MS risk was observed for the remaining factors. CONCLUSIONS Apart from overweight and obesity at the age of 18 years, we did not observe considerable associations with MS risk. The proportion of cases that can be explained by childhood and adolescence factors examined in this study was low. Further investigations of the association between the onset of overweight and obesity in childhood and adolescence and its interaction with physical activity and MS risk seem worthwhile.
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Affiliation(s)
- Anja Holz
- Institute of Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany.
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- University Bremen, Bremen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Beate Fischer
- Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sylvia Gastell
- NAKO Study Center, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | | | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Carolina J Klett-Tammen
- Department for Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Michael Leitzmann
- Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Karin B Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Katharina Nimptsch
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tobias Pischon
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tamara Schikowski
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
- School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
| | - Kerstin Hellwig
- Katholisches Klinikum Bochum, Neurology Clinic, Clinic of Ruhr-Universität Bochum, Bochum, Germany
| | - Karin Riemann-Lorenz
- Center for Molecular Neurobiology Hamburg (ZMNH), Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christoph Heesen
- Center for Molecular Neurobiology Hamburg (ZMNH), Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Heiko Becher
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
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Führer A, Pacolli-Tabaku L, Kompa P, Yılmaz-Aslan Y, Brzoska P. [Management Of Covid-19 Pandemic In Shelters For Asylum Seekers: Results From A Mixed Methods Study.]. Gesundheitswesen 2024; 86:315-321. [PMID: 37816384 PMCID: PMC11003248 DOI: 10.1055/a-2144-5841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
BACKGROUND Refugees in Germany are often housed in shelters, where their influence on the organization of everyday life is severely limited. During the COVID-19 pandemic, these shelters therefore had a special responsibility to take measures to protect the health of their residents. The aim of this research project was to examine how this task was managed and how the pandemic affected daily life in refugee shelters, with the aim to formulate recommendations for practice. METHODS Using a mixed-methods study, the first step was a scoping review of the literature on the management of infectious disease outbreaks in refugee shelters. Building on the findings of the review, management of the pandemic was then explored in an online survey and in interviews with experts and residents of shelters. In a third step, the results of the preceding steps were summarized and discussed with a panel of experts. Recommendations for practice were developed with the expert panel in two discussion rounds two months apart. RESULTS The refugee shelters included in the study were inadequately prepared for the pandemic and often did not develop contingency plans until the pandemic was underway. In many cases, the contingency plans included the establishment of crisis teams, but the interests and perspectives of facility residents were generally not represented by these teams. This subsequently led to problems: Pandemic measures were often not communicated in a timely or sufficiently understandable manner, gaps in care resulting from measures were not identified or addressed, and psychosocial stresses associated with the pandemic and quarantine measures were not adequately mitigated. CONCLUSION • Refugee shelters should establish mechanisms to integrate residents' interests and perspectives into decision-making processes in a structured manner, regardless of the pandemic.• Depending on the type of shelter, this should be realized through resident involvement in decision-making bodies or other appropriate representation of interests. • Measures introduced during the pandemic that may have a negative impact on the psychosocial situation of residents should be terminated as soon as the epidemic justification for the measures no longer applies.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und
Informatik, Profilzentrum Gesundheitswissenschaften,
Martin-Luther-Universität Halle-Wittenberg, Halle (Saale),
Germany
- Lehrstuhl für Versorgungsforschung, Fakultät
für Gesundheit, Department für Humanmedizin, Universität
Witten/Herdecke, Witten, Germany
| | - Latife Pacolli-Tabaku
- Lehrstuhl für Versorgungsforschung, Fakultät
für Gesundheit, Department für Humanmedizin, Universität
Witten/Herdecke, Witten, Germany
| | - Paula Kompa
- Institut für Medizinische Epidemiologie, Biometrie und
Informatik, Profilzentrum Gesundheitswissenschaften,
Martin-Luther-Universität Halle-Wittenberg, Halle (Saale),
Germany
| | - Yüce Yılmaz-Aslan
- Lehrstuhl für Versorgungsforschung, Fakultät
für Gesundheit, Department für Humanmedizin, Universität
Witten/Herdecke, Witten, Germany
- Fakultät für Gesundheitswissenschaften,
Universität Bielefeld, Bielefeld, Germany
| | - Patrick Brzoska
- Lehrstuhl für Versorgungsforschung, Fakultät
für Gesundheit, Department für Humanmedizin, Universität
Witten/Herdecke, Witten, Germany
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Wiessner C, Licaj S, Klein J, Bohn B, Brand T, Castell S, Führer A, Harth V, Heier M, Heise JK, Holleczek B, Jaskulski S, Jochem C, Koch-Gallenkamp L, Krist L, Leitzmann M, Lieb W, Meinke-Franze C, Mikolajczyk R, Moreno Velásquez I, Obi N, Pischon T, Schipf S, Thierry S, Willich SN, Zeeb H, Becher H. Health Service Use Among Migrants in the German National Cohort-The Role of Birth Region and Language Skills. Int J Public Health 2024; 69:1606377. [PMID: 38510525 PMCID: PMC10952844 DOI: 10.3389/ijph.2024.1606377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
Objective: To compare health service use (HSU) between migrants and non-migrants in Germany. Methods: Using data from the population-based German National Cohort (NAKO), we compared the HSU of general practitioners, medical specialists, and psychologists/psychiatrists between six migrant groups of different origins with the utilization of non-migrants. A latent profile analysis (LPA) with a subsequent multinomial regression analysis was conducted to characterize the HSU of different groups. Additionally, separate regression models were calculated. Both analyses aimed to estimate the direct effect of migration background on HSU. Results: In the LPA, the migrant groups showed no relevant differences compared to non-migrants regarding HSU. In separate analyses, general practitioners and medical specialists were used comparably to slightly more often by first-generation migrants from Eastern Europe, Turkey, and resettlers. In contrast, the use of psychologists/psychiatrists was substantially lower among those groups. Second-generation migrants and migrants from Western countries showed no differences in their HSU compared to non-migrants. Conclusion: We observed a low mental HSU among specific migrant groups in Germany. This indicates the existence of barriers among those groups that need to be addressed.
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Affiliation(s)
- Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sara Licaj
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Klein
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research, Brunswick, Germany
| | - Amand Führer
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Jana-Kristin Heise
- Department of Epidemiology, Helmholtz Center for Infection Research, Brunswick, Germany
| | | | - Stefanie Jaskulski
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Lena Koch-Gallenkamp
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Faculty of Medicine, University of Kiel, Kiel, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ilais Moreno Velásquez
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Sigrid Thierry
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Augsburg University Hospital, Augsburg, Germany
| | - Stefan N. Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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4
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Klinger-König J, Erhardt A, Streit F, Völker MP, Schulze MB, Keil T, Fricke J, Castell S, Klett-Tammen CJ, Pischon T, Karch A, Teismann H, Michels KB, Greiser KH, Becher H, Karrasch S, Ahrens W, Meinke-Franze C, Schipf S, Mikolajczyk R, Führer A, Brandes B, Schmidt B, Emmel C, Leitzmann M, Konzok J, Peters A, Obi N, Brenner H, Holleczek B, Moreno Velásquez I, Deckert J, Baune BT, Rietschel M, Berger K, Grabe HJ. Childhood Trauma and Somatic and Mental Illness in Adulthood. Dtsch Arztebl Int 2024; 121:1-8. [PMID: 37876295 PMCID: PMC10916765 DOI: 10.3238/arztebl.m2023.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Childhood trauma is associated with somatic and mental illness in adulthood. The strength of the association varies as a function of age, sex, and type of trauma. Pertinent studies to date have mainly focused on individual diseases. In this study, we investigate the association between childhood trauma and a multiplicity of somatic and mental illnesses in adulthood. METHODS Data from 156 807 NAKO Health Study participants were analyzed by means of logistic regressions, with adjustment for age, sex, years of education, and study site. The Childhood Trauma Screener differentiated between no/minor (n = 115 891) and moderate/severe childhood trauma (n = 40 916). The outcome variables were medical diagnoses of five somatic and two mental health conditions as stated in the clinical history. RESULTS Persons with childhood trauma were more likely to bear a diagnosis of all of the studied conditions: cancer (odds ratio [OR] = 1.10; 95% confidence interval: [1.05; 1.15]), myocardial infarction (OR = 1.13 [1.03; 1.24]), diabetes (OR = 1.16, [1.10; 1.23]), stroke (OR = 1.35 [1.23; 1.48]), chronic obstructive pulmonary disease (OR = 1.45 [1.38; 1.52]), depression (OR = 2.36 [2.29; 2.43]), and anxiety disorders (OR = 2.08 [2.00; 2.17]). All of these associations were stronger in younger persons, regardless of the nature of childhood trauma. Differences between the sexes were observed only for some of these associations. CONCLUSION Childhood trauma was associated with a higher probability of developing mental as well as somatic illness in adulthood. As childhood trauma is an element of individual history that the victim has little to no control over, and because the illnesses that can arise in adulthood in association with it are a heavy burden on the affected persons and on society, there is a need for research on these associations and for the development of preventive measures.
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Affiliation(s)
- Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maja P. Völker
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- State Institute of Health I, Bavarian State Office for Health and Food Safety, Erlangen, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research (HZI), Braunschweig, Germany
| | - Carolina J. Klett-Tammen
- Department of Epidemiology, Helmholtz Center for Infection Research (HZI), Braunschweig, Germany
| | - Tobias Pischon
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Henning Teismann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Karin B. Michels
- Institute for Prevention and Tumor Epidemiology, Medical Center—University of Freiburg, Medical Faculty, Albert Ludwigs University of Freiburg, Freiburg, Germany
| | - K. Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Claudia Meinke-Franze
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sabine Schipf
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Rafael Mikolajczyk
- IInstitute of Medical Epidemiology, Biometry and Informatics, Profile Center Health Sciences, Medical School, Martin Luther University Halle-Wittenberg, Halle, Germany
- German Center for Mental Health (DZPG), Jena-Magdeburg-Halle Site, Halle, Germany
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Halle, Germany
| | - Amand Führer
- IInstitute of Medical Epidemiology, Biometry and Informatics, Profile Center Health Sciences, Medical School, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Berit Brandes
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Börge Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Medicine Essen, Essen, Germany
| | - Carina Emmel
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Medicine Essen, Essen, Germany
| | - Michael Leitzmann
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Julian Konzok
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Anette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, LMU—Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Mental Health (DZPG), Munich site, Munich, Germany
| | - Nadia Obi
- Central Institute for Occupational Medicine and Maritime Medicine (ZfAM,) University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Saarbrücken, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Saarbrücken, Germany
| | | | - Ilais Moreno Velásquez
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - Bernhard T. Baune
- Department of Psychiatry, University Hospital Münster, Münster, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
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5
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Michel Z, Krayl N, Götz K, Wienke A, Mikolajczyk R, Führer A. Increasing social disparities in obesity among 15 000 pre-schoolers in a German district from 2009 to 2019. Eur J Public Health 2023; 33:757-763. [PMID: 37322569 PMCID: PMC10567254 DOI: 10.1093/eurpub/ckad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Although childhood obesity prevalence has stagnated in many high-income regions after decades of increase, it continues to be a major public health problem with adverse effects. The objective was to examine obesity trends as a function of parental social status to identify obesity disparities among children. METHODS Data from school entry examinations from 2009 to 2019 of 14 952 pre-schoolers in one German district were used. Logistic regression models (obesity/overweight as dependent variable) and a linear regression [BMI z-score (BMIz) as dependent variable] were performed adjusted for social status and sex to investigate time trends in overweight and obesity. RESULTS Overall, we found an increase of obesity over time [odds ratio (ORs): 1.03 per year, 95% CI: 1.01-1.06]. Children with low social status had an OR of 1.08 per year (95% CI: 1.03-1.13), while the trend was less expressed in children with high social status (OR: 1.03 per year, 95% CI: 0.98-1.08). The mean BMIz decreased per year (regression coefficient -0.005 per year, 95% CI: -0.01 to 0.0) when considering all children. This decrease was more pronounced in children with high social status (regression coefficient: -0.011 per year, 95% CI: -0.019 to -0.004), compared with a slight increase of 0.014 (95% CI: -0.003 to 0.03) per year among children with low social status. Also, children with low parental social status were heavier and smaller than their peers with high social status. CONCLUSIONS Although the mean BMIz decreased among pre-schoolers, obesity prevalence and status-related inequity in obesity prevalence increased from 2009 to 2019 in the region studied.
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Affiliation(s)
- Zora Michel
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburgerstraße 8, 06112 Halle (Saale), Germany
| | - Nele Krayl
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburgerstraße 8, 06112 Halle (Saale), Germany
- Department of Operative Dentistry and Periodontology, School of Dental Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Katja Götz
- Department of Public Health, Child and Youth Medical Service, Saalekreis, Germany
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburgerstraße 8, 06112 Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburgerstraße 8, 06112 Halle (Saale), Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburgerstraße 8, 06112 Halle (Saale), Germany
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Führer A. [Determinants of asylum seekers' health and medical care in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1083-1091. [PMID: 37707509 PMCID: PMC10539189 DOI: 10.1007/s00103-023-03762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023]
Abstract
Asylum seekers in Germany are exposed to a variety of health-related stressors, while their access to medical care is impaired. This review explains some of the determinants that structure this situation, for example by elaborating on how the Asylum Seekers' Benefits Act (ASBA), billing via treatment vouchers, and accommodation in refugee shelters affect asylum seekers' health and healthcare utilization. Hereby, it becomes clear that the exclusion of asylum seekers from the welfare system is detrimental to their health, is expensive, and raises ethical and legal questions. In particular, the huge discretionary scope of the social welfare offices in the assumption of costs as well as the different models for billing medical services for asylum seekers are potentially unjust and lead to a plurality of care, which lacks legal and ethical justification.The second part of the article shows that asylum seekers generally suffer from the same health problems as people with statutory health insurance-with the exception of mental illnesses, which are substantially more common among asylum seekers, but are often undiagnosed and frequently inadequately treated.This leads to three practical conclusions: (1) asylum seekers should be integrated into statutory health insurance, (2) from a public health point of view, accommodation in refugee shelters should be avoided in favor of decentralized accommodation, and (3) to ensure diversity-sensitive care for all patients, the healthcare system must make adjustments to its structures and practices.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Deutschland.
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Führer A, Taché S, Riemenschneider H, Bozorgmehr K, Diaz-Monsalve S, Knipper M, Mews C, Schwienhorst-Stich EM, Siebert U, Strelow KU, Ziegler S. [The Migration and Health Teaching Network: consolidating and developing education and training]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1130-1134. [PMID: 37737318 PMCID: PMC10539183 DOI: 10.1007/s00103-023-03765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
Patients with migration history often encounter barriers to accessing healthcare in Germany, which lowers the quality of care available to them and can affect their overall health. These barriers in access to healthcare are due to both adverse health policies and a lack of migration-related - and diversity-sensitive - content in medical and other health profession teaching. Although most healthcare professionals regularly care for patients with individual or generational migration experience in Germany, teaching content relevant to the healthcare of these patients has not yet been anchored in the curriculum. At best, it is taught in the form of electives or other optional courses.To address this gap, the Teaching Network Migration and Health was created with the goal of promoting the development of human rights-based, diversity-sensitive, and equity-oriented curricula at medical and healthcare professions schools. It aims to (1) connect individuals active in teaching and promote the exchange and collaborative development of teaching materials, (2) use this collective knowledge and experience to develop a model course on migration and health, and (3) develop strategies for the longitudinal implementation of this course into the regular medical and other health professional school curricula. These efforts are flanked by evaluative accompanying research. Anyone interested in joining the network is invited to join and strengthen the network by contacting the authors.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Stephanie Taché
- Bereich Allgemeinmedizin, Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Henna Riemenschneider
- Bereich Allgemeinmedizin, Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Kayvan Bozorgmehr
- Sektion Health Equity Studies & Migration, Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- AG Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Sonia Diaz-Monsalve
- Zentrum für Medizin und Gesellschaft, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Michael Knipper
- Professur für Global Health, Migration und Kulturwissenschaften in der Medizin, Institut für Geschichte, Theorie und Ethik der Medizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Claudia Mews
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Eva-Maria Schwienhorst-Stich
- Institut für Allgemeinmedizin und Lehrklinik der Medizinischen Fakultät, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Ute Siebert
- Projekt "Empowerment für Diversität - Allianz für Chancengleichheit in der Gesundheitsversorgung", Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kai-Uwe Strelow
- Rudolf Frey Lernklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Sandra Ziegler
- Sektion Health Equity Studies & Migration, Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Vonneilich N, Becher H, Bohn B, Brandes B, Castell S, Deckert A, Dragano N, Franzke CW, Führer A, Gastell S, Greiser H, Keil T, Klett-Tammen C, Koch-Gallenkamp L, Krist L, Leitzmann M, Meinke-Franze C, Mikolajczyk R, Moreno Velasquez I, Obi N, Peters A, Pischon T, Reuter M, Schikowski T, Schmidt B, Schulze M, Sergeev D, Stang A, Völzke H, Wiessner C, Zeeb H, Lüdecke D, von dem Knesebeck O. Associations of Migration, Socioeconomic Position and Social Relations With Depressive Symptoms - Analyses of the German National Cohort Baseline Data. Int J Public Health 2023; 68:1606097. [PMID: 37533684 PMCID: PMC10391163 DOI: 10.3389/ijph.2023.1606097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives: We analyze whether the prevalence of depressive symptoms differs among various migrant and non-migrant populations in Germany and to what extent these differences can be attributed to socioeconomic position (SEP) and social relations. Methods: The German National Cohort health study (NAKO) is a prospective multicenter cohort study (N = 204,878). Migration background (assessed based on citizenship and country of birth of both participant and parents) was used as independent variable, age, sex, Social Network Index, the availability of emotional support, SEP (relative income position and educational status) and employment status were introduced as covariates and depressive symptoms (PHQ-9) as dependent variable in logistic regression models. Results: Increased odds ratios of depressive symptoms were found in all migrant subgroups compared to non-migrants and varied regarding regions of origins. Elevated odds ratios decreased when SEP and social relations were included. Attenuations varied across migrant subgroups. Conclusion: The gap in depressive symptoms can partly be attributed to SEP and social relations, with variations between migrant subgroups. The integration paradox is likely to contribute to the explanation of the results. Future studies need to consider heterogeneity among migrant subgroups whenever possible.
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Affiliation(s)
- Nico Vonneilich
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Barbara Bohn
- NAKO e.V., Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Berit Brandes
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Nico Dragano
- Institute for Medical Sociology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Claus-Werner Franzke
- Institute for Prevention and Cancer Epidemiology, University of Freiburg Medical Center, Freiburg, Baden-Württemberg, Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Sylvia Gastell
- NAKO Study Center, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
| | - Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, Faculty of Medicine, University of Würzburg, Würzburg, Bavaria, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Carolina Klett-Tammen
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Lena Koch-Gallenkamp
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Leitzmann
- Deptartment of Epidemiology and Preventive Medicine, University Medical Center Regensburg, Regensburg, Bavaria, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Ilais Moreno Velasquez
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
| | - Nadia Obi
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Center München, Helmholtz Association of German Research Centres (HZ), Neuherberg, Germany
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
- Berlin Institute of Health (BIH), Charité University Medicine Berlin, Berlin, Germany
| | - Marvin Reuter
- Subject Sociology, University of Bamberg, Bamberg, Bavaria, Germany
| | - Tamara Schikowski
- Leibniz-Institut für Umweltmedizinische Forschung (IUF), Dusseldorf, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Matthias Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
- Institute of Nutrition Science, Faculty of Mathematics and Natural Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Dmitry Sergeev
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Streit F, Völker MP, Klinger-König J, Zillich L, Frank J, Reinhard I, Foo JC, Witt SH, Sirignano L, Becher H, Obi N, Riedel O, Do S, Castell S, Hassenstein MJ, Karch A, Stang A, Schmidt B, Schikowski T, Stahl-Pehe A, Brenner H, Perna L, Greiser KH, Kaaks R, Michels KB, Franzke CW, Peters A, Fischer B, Konzok J, Mikolajczyk R, Führer A, Keil T, Fricke J, Willich SN, Pischon T, Völzke H, Meinke-Franze C, Loeffler M, Wirkner K, Berger K, Grabe HJ, Rietschel M. The interplay of family history of depression and early trauma: associations with lifetime and current depression in the German national cohort (NAKO). Front Epidemiol 2023; 3:1099235. [PMID: 38523800 PMCID: PMC10959537 DOI: 10.3389/fepid.2023.1099235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/28/2023] [Indexed: 03/26/2024]
Abstract
Introduction Family history of depression and childhood maltreatment are established risk factors for depression. However, how these factors are interrelated and jointly influence depression risk is not well understood. The present study investigated (i) if childhood maltreatment is associated with a family history of depression (ii) if family history and childhood maltreatment are associated with increased lifetime and current depression, and whether both factors interact beyond their main effects, and (iii) if family history affects lifetime and current depression via childhood maltreatment. Methods Analyses were based on a subgroup of the first 100,000 participants of the German National Cohort (NAKO), with complete information (58,703 participants, mean age = 51.2 years, 53% female). Parental family history of depression was assessed via self-report, childhood maltreatment with the Childhood Trauma Screener (CTS), lifetime depression with self-reported physician's diagnosis and the Mini-International Neuropsychiatric Interview (MINI), and current depressive symptoms with the depression scale of the Patient Health Questionnaire (PHQ-9). Generalized linear models were used to test main and interaction effects. Mediation was tested using causal mediation analyses. Results Higher frequencies of the childhood maltreatment measures were found in subjects reporting a positive family history of depression. Family history and childhood maltreatment were independently associated with increased depression. No statistical interactions of family history and childhood maltreatment were found for the lifetime depression measures. For current depressive symptoms (PHQ-9 sum score), an interaction was found, with stronger associations of childhood maltreatment and depression in subjects with a positive family history. Childhood maltreatment was estimated to mediate 7%-12% of the effect of family history on depression, with higher mediated proportions in subjects whose parents had a depression onset below 40 years. Abuse showed stronger associations with family history and depression, and higher mediated proportions of family history effects on depression than neglect. Discussion The present study confirms the association of childhood maltreatment and family history with depression in a large population-based cohort. While analyses provide little evidence for the joint effects of both risk factors on depression beyond their individual effects, results are consistent with family history affecting depression via childhood maltreatment to a small extent.
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Affiliation(s)
- Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maja P. Völker
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Lea Zillich
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jerome C. Foo
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stephanie H. Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lea Sirignano
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heiko Becher
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Riedel
- Leibniz-Institut für Präventionsforschung und Epidemiologie – BIPS, Bremen, Deutschland
| | - Stefanie Do
- Leibniz-Institut für Präventionsforschung und Epidemiologie – BIPS, Bremen, Deutschland
| | - Stefanie Castell
- Department for Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Max J. Hassenstein
- Department for Epidemiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
- PhD Programme “Epidemiology”, Braunschweig-Hannover, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Tamara Schikowski
- IUF—Leibniz Institute for Environmental Medicine, Düsseldorf, Germany
| | - Anna Stahl-Pehe
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research, University of Düsseldorf, Düsseldorf, Germany
| | - Hermann Brenner
- Network Ageing Research (NAR), Heidelberg University, Heidelberg, Germany
- Division of Clinical Epidemiology & Ageing Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Laura Perna
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Karin Halina Greiser
- German Cancer Research Centre (DKFZ) Heidelberg, Div. of Cancer Epidemiology, Heidelberg, Germany
| | - Rudolf Kaaks
- German Cancer Research Centre (DKFZ) Heidelberg, Div. of Cancer Epidemiology, Heidelberg, Germany
| | - Karin B. Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Claus-Werner Franzke
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum Munchen, German Research Centre for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Beate Fischer
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Julian Konzok
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
- German Center for Mental Health, Site Jena-Magdeburg-Halle, Jena, Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan N. Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Pischon
- Max-Delbrueck-Centre for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max-Delbrueck-Centre for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
- Leipzig Research Center for Civilization Diseases (LIFE), University of Leipzig, Leipzig, Germany
| | - Kerstin Wirkner
- Leipzig Research Center for Civilization Diseases (LIFE), University of Leipzig, Leipzig, Germany
| | - Klaus Berger
- Institute of Epidemiology & Social Medicine, University of Muenster, Muenster, Germany
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Wagner K, Wienke A, Gröger C, Klusmann JH, Führer A. Segregated by Wealth, Health, and Development: An Analysis of Pre-School Child Health in a Medium-Sized German City. Children (Basel) 2023; 10:children10050865. [PMID: 37238412 DOI: 10.3390/children10050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/17/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
The School Entry Examination (SEE) can be used to identify children with current health issues, developmental delays, and risk factors for later diseases. This study analyzes the health status of preschool children in a German city with considerable socio-economic differences among its quarters. We used secondary data from SEEs 2016-2019 from the entire city (8417 children), which we divided into quarters with low (LSEB), medium (MSEB), and high socioeconomic burden (HSEB). In HSEB quarters, 11.3% of children were overweight as opposed to 5.3% in LSEB quarters. In HSEB quarters, 17.2% of children had sub-par cognitive development in contrast to 1.5% in LSEB quarters. For overall sub-par development, LSEB quarters had a prevalence of 3.3%, whereas, in HSEB quarters, 35.8% of children received this result. Logistic regression was used to determine the influence of the city quarter on the outcome of overall sub-par development. Here, considerable disparities among HSEB and LSEB quarters remained after adjustment for parents' employment status and education. Pre-school children in HSEB quarters showed a higher risk for later disease than children in LSEB quarters. The city quarter had an association with child health and development that should be considered in the formulation of interventions.
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Affiliation(s)
- Karoline Wagner
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany
| | | | | | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany
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11
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Machmud PB, Führer A, Gottschick C, Mikolajczyk R. Barriers to and Facilitators of Hepatitis B Vaccination among the Adult Population in Indonesia: A Mixed Methods Study. Vaccines (Basel) 2023; 11:398. [PMID: 36851280 PMCID: PMC9967628 DOI: 10.3390/vaccines11020398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
To reach the goals of the Global Hepatitis Elimination 2030 program, Indonesia is now preparing a new regulation for hepatitis B vaccinations for adult population. This study aimed to determine the factors influencing vaccine uptake for hepatitis B in the adult population, and identify barriers to, and facilitators of, hepatitis B vaccination programmes. An explanatory sequential mixed methods design was implemented in this study. We conducted a survey involving 893 participants in the general population followed by 14 in-depth interviews with health providers. The survey found that only 15% (95% confidence interval 13-18%) of participants received at least one dose of the hepatitis B vaccine. Factors associated with vaccine uptake were, living in Yogyakarta compared to living in Aceh, having secondary and higher education compared to primary education, working as a health worker compared to working in other sectors, and having health insurance that covered hepatitis B vaccination compared to not having such health insurance. Our qualitative study also identified several barriers to the adult hepatitis B vaccination programme in Indonesia such as the high cost of vaccination, lack of vaccine availability in certain areas, limited human resources to implement the hepatitis B vaccination programme, and the ineffective dissemination of hepatitis B vaccination. This study highlights that accessibility and affordability of vaccinations are important determinants of vaccination uptake that should be taken into account when planning vaccination campaigns.
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Affiliation(s)
- Putri Bungsu Machmud
- Institute of Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany
- Department of Epidemiology, Public Health Faculty, Universitas Indonesia, Jl. Prof Dr Bahder Djohan, Depok 16424, Jawa Barat, Indonesia
| | - Amand Führer
- Institute of Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany
| | - Cornelia Gottschick
- Institute of Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany
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Führer A, Pacolli L, Yilmaz-Aslan Y, Brzoska P. COVID-19 Vaccine Acceptance and Its Determinants among Migrants in Germany-Results of a Cross-Sectional Study. Vaccines (Basel) 2022; 10:1350. [PMID: 36016238 PMCID: PMC9413826 DOI: 10.3390/vaccines10081350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccinations are a core element of infection control. Migrants have been reported to have low vaccination rates for many infectious diseases, including COVID-19. Still, determinants of migrants' uptake of COVID-19 vaccinations are not sufficiently clear. The present study addresses this gap and examines the respective influence of three potential determinants: barriers to access, attitude towards vaccinations in general, and towards COVID-19 vaccines. The study uses a cross-sectional online survey among migrants in Germany. The questionnaire assessed the aforementioned determinants using standardized tools. Information on 204 individuals was available. The vaccination rate in the sample was 80%. Vaccinated as compared to unvaccinated respondents reported more often the absence of financial barriers (71% (95%CI: 64-73%) vs. 45% (95%CI: 28-63%)), short waiting times (51% (95%CI: 43-59%) vs. 22% (95%CI: 5-38%)), and the presence of a vaccination center close-by (91.5% (95%CI: 87-96%) vs. 69.7% (95%CI: 54-85%)). Concerning COVID-19 vaccine acceptance, the majority of respondents (68%) agreed that the vaccine is important. Unvaccinated respondents more often feared side effects, were convinced that the vaccine is not safe, and assumed that COVID-19 is not dangerous. Correspondingly, acceptance of vaccinations in general was higher among vaccinated respondents. In line with findings from previous studies, our survey found that all three determinants seem to influence migrants' vaccination status while their overall vaccination rate was comparable to the general population. Hence, migration background per se does not sufficiently explain vaccine acceptance and further research is needed to identify subgroups of migrants that should be specifically addressed to increase their vaccination rate.
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Affiliation(s)
- Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Latife Pacolli
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Yüce Yilmaz-Aslan
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- Deptartment of Health Services Research and Nursing, Faculty of Health Sciences, Bielefeld University, 33615 Bielefeld, Germany
| | - Patrick Brzoska
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
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Führer A, Özer Erdogdu I, Kompa P, Yilmaz-Aslan Y, Brzoska P. COVID-19 pandemic in shelters for asylum seekers: a scoping review of preventive measures. BMJ Open 2022; 12:e058076. [PMID: 35477871 PMCID: PMC10098256 DOI: 10.1136/bmjopen-2021-058076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate which measures are recommended by guidelines on prevention and management of infectious disease outbreaks in refugee shelters, how outbreaks have been dealt with in these facilities in the past and how measures taken compare with the recommendations identified in the literature. DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA The review comprised German and English language literature on refugees residing in shelters located in high-income countries, published between 1990 and 2021. We searched PubMed, CINAHL and Web of Science. DATA EXTRACTION AND SYNTHESIS We extracted information concerning the characteristics of the setting and the study population, measures for outbreak prevention and reported difficulties with implementing these measures. The findings were evaluated using descriptive statistics and were narratively summarised. RESULTS Of a total of 1162 publications, 36 were included in the review, of which 19 were original research articles and 17 were guidelines/commentaries. In the guidelines, 37 different measures of infection control were mentioned. Among those, social distancing and isolation or quarantine were mentioned most frequently. In the outbreak reports, 27 different measures were reported, of which testing was reported most often. Different reasons why recommendations are difficult to implement in shelters were described, which are related to space, equipment, staff and financial constraints. Discrepancies between recommendations and actual practice mostly relate to the lack of preparation for outbreaks and the lack of appropriate measures to ensure intersectoral cooperation. CONCLUSIONS Recommendations on infection control and outbreak management and the measures actually taken in refugee shelters differ considerably. Among others, this results from a lack of intersectoral cooperation between state ministries, municipal health offices and the administration of the facilities as well as from guidelines not sufficiently tailored to the characteristics of refugee shelters.
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Affiliation(s)
- Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Ilknur Özer Erdogdu
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Paula Kompa
- Institute for Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Yüce Yilmaz-Aslan
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- Department of Health Services Research and Nursing, Bielefeld University, Bielefeld, Germany
| | - Patrick Brzoska
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Schildmann J, Nadolny S, Führer A, Frese T, Mau W, Meyer G, Richter M, Steckelberg A, Mikolajczyk R. [Reasons and Influencing Factors for the Willingness to Document Preferences Regarding Organ Donation: Results of an Online Survey]. Psychother Psychosom Med Psychol 2022; 72:354-361. [PMID: 35213903 DOI: 10.1055/a-1718-3896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Different options to regulate decisions about organ transplantation were subjected to discussions prior to parliamentary decision on 16.01.2020. The goal of this study was the description of citizens' attitudes towards organ donation and investigation of predictors of (documentation of) willingness to donate. METHODS Cross sectional online survey in Berlin and Saxony-Anhalt between 25.11.2019 till 16.01.2020. Descriptive, statistical analysis. We report absolute and relative frequencies. We conducted logistic regression analysis for the influence of age, income and gender on knowledge, willingness to donate and possession of an organ donor card. RESULTS Of 20 020 invited citizens, 676 (3.4%) participated in the online survey; 54.9% were in favour of an opt-out regulation, 49.4% supported an opt-in regulation, 63.3% of respondents were willing or rather willing to donate an organ and 43.2% possessed an organ donor card. Willingness to donate and possession of an organ donor card decreased with increasing age. A Higher educational level was associated with having an organ donor card. Gender, income, education and knowledge about organ donation were not associated with the willingness to donate an organ. Of those who were willing to donate but who had not a donor card, 45.7% had communicated their will to relatives. Reasons indicated for lack of documentation included practical reasons as also fears related to medical care in case of critical health state. DISCUSSION None of the discussed legislative regulations on organ donation has been supported by a clear majority of respondents. Distinct population-based surveys can serve as starting point for developing targeted initiatives to increase the documentation of citizens' will regarding organ donation following brain death.
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Affiliation(s)
- Jan Schildmann
- Institut für Geschichte und Ethik der Medizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Stephan Nadolny
- Institut für Geschichte und Ethik der Medizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.,Stabsstelle Pflegewissenschaft, Franziskus-Hospital Harderberg, Niels-Stensen-Klinken, Georgsmarienhütte, Germany
| | - Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Thomas Frese
- Institut für Allgemeinmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Wilfried Mau
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Matthias Richter
- Institut für Medizinische Soziologie, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Anke Steckelberg
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Führer A, König M, Kluth W. [The Asylum Seekers' Benefit Act in the German Medical Literature: A Scoping Review]. Gesundheitswesen 2021; 84:664-673. [PMID: 33461238 DOI: 10.1055/a-1327-2642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medical care of asylum seekers in Germany is complicated by laws -predominantly the Asylum Seekers' Benefit Act (ASBA) - that regulate the billing of services. Physicians need to be familiar with these regulations to ensure that these regulations do not hamper the medical care this vulnerable group of patients receives. This article investigates how the ASBA is presented in the medical literature and to what extent the descriptions in the literature meet physicians' information needs. METHODS A scoping review of the German language medical literature published between 01.01.2015 and 14.04.2020 on asylum seekers' medical care in Germany was carried out. RESULTS The analysis included a total of 55 articles. The majority of articles (80%, n=44) mentioned the ASBA as an important determinant of asylum seekers' medical care. The definition of the ASBA's recipients and the benefit period was mostly correct, while explanations concerning the scope of benefits covered by ASBA were correct and complete in only 16% (n=9) of the articles. The administrative details connected with the ASBA were mentioned only rarely; 23% (n=10) of the articles falsely portrayed the ASBA as a normative guide for medical practice. CONCLUSIONS Often, the presentation of the ASBA in the medical literature seems to be unsuitable to guide physicians through the practical problems that often come up when treating asylum seekers. To achieve this, a more nuanced engagement with the topic would be necessary that also pays attention to the legal literature.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Maximiliane König
- Martin-Luther-Universität Halle-Wittenberg, Interdisziplinäres Zentrum Medizin - Ethik - Recht, Halle, Deutschland
| | - Winfried Kluth
- Lehrstuhl für Öffentliches Recht, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
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Führer A, Korn M, Brzoska P. [The usability of information material for refugees. An exemplary evaluation of Saxony-Anhalt's "Health Booklet for Asylum Seekers"]. Z Evid Fortbild Qual Gesundhwes 2020; 158-159:1-9. [PMID: 33239253 DOI: 10.1016/j.zefq.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS In response to the large number of asylum seekers coming to Germany since 2015, lots of informational materials, translation aids, leaflets, etc. have been developed. However, hardly any of these materials have been evaluated with respect to their acceptance and usability in clinical practice. The aim of the present study was to exemplarily evaluate the 'Health Booklet for Asylum Seekers' that has been in use in Saxony-Anhalt since 2017. METHODS A cross-sectional survey was combined with qualitative interviews in an explanatory sequential mixed methods design. The survey included general practitioners (n=41), nursing staff (n=7), refugees (n=19) and other stakeholders (n=30); the Systems Usability Scale (SUS) was used to assess the usability of the booklet. The qualitative part of the study involved 35 interviews with the above-mentioned participants and two focus group discussions with physicians and refugees; the aim was to better understand the different actors' perception of usability. RESULTS Most general practitioners did not know the booklet and had never used it before, but were eager to make use of it in the future. Overall, the booklet was rated as highly usable by 65 % of all respondents, while the median score in the SUS was above the threshold value for good usability. Respondents explained that the booklet improved patient care, helped patients to better understand the health care system and their health issues, increased patient autonomy and has symbolic value as an expression of diversity management. DISCUSSION The different stakeholders predominantly perceived the health booklet to be a useful tool and assumed that its application in clinical practice would help alleviate some of the practical problems in providing medical care for asylum seekers.
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Affiliation(s)
- Amand Führer
- Martin-Luther-Universität Halle-Wittenberg, Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Halle (Saale), Deutschland.
| | - Marie Korn
- Martin-Luther-Universität Halle-Wittenberg, Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Halle (Saale), Deutschland
| | - Patrick Brzoska
- Lehrstuhl für Versorgungsforschung, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland
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Führer A, Brzoska P. [The Importance of Language Interpretation in the Health Care System]. Gesundheitswesen 2020; 84:474-478. [PMID: 33184807 DOI: 10.1055/a-1276-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many people in German-speaking countries have a limited proficiency in the German language. In the health care system, this may result in barriers to accessing and utilization of health services. The aim of this review was to present the current state of research on the relevance of language barriers in medical care and to explain strategies used to address language-related communication problems. METHODS The review is based on a synthesis of German- and English-language systematic reviews on the topic of 'language interpretation in the health care sector', including also all original papers from Germany published since 2015. RESULTS The most common method used in hospitals for language problems was interpretation by relatives of patients or by bilingual staff of the hospital. The quality of this language mediation by untrained laypersons was often limited, which can affect health care outcomes. Using professional interpreters was associated with significantly better health care outcomes and, particularly in the form of interpretation via telephone, was a flexible and cost-effective approach. CONCLUSION Language-based communication is an important prerequisite for patient-centered care and must be ensured by the health care system for ethical, social and legal reasons. In this context, professional interpretation solutions should be used, for which the required financial resources and infrastructure must also be made available.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle
| | - Patrick Brzoska
- Lehrstuhl für Versorgungsforschung, Fakultät für Gesundheit/Department für Humanmedizin Universität Witten/Herdecke
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Niedermaier A, Freiberg A, Tiller D, Wienke A, Führer A. Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data. BMC Health Serv Res 2020; 20:961. [PMID: 33081775 PMCID: PMC7576695 DOI: 10.1186/s12913-020-05811-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background Asylum seekers are a vulnerable group with special needs in health care due to their migration history and pre-, peri- and postmigratory social determinants of health. However, in Germany access to health care is restricted for asylum seekers by law and administrative regulations. Methods Using claims data generated in the billing process of health care services provided to asylum seekers, we explore their utilization of health care services in the outpatient sector. We describe the utilization of outpatient specialties, prevalences of diagnoses, prescribed drugs and other health care services, as well as total costs of health care provision. Results The estimated prevalence for visiting an ambulatory physician at least once per year was 67.5% [95%-Confidence-Interval (CI): 65.1–69.9%], with a notably higher prevalence for women than men. The diagnoses with the highest one-year prevalence were “Acute upper respiratory infections” (16.1% [14.5–18.0%]), “Abdominal and pelvic pain” (15.6% [13.9–17.4%]) and “Dorsalgia” (13.8% [12.2–15.5%]). A total of 21% of all prescriptions were for common pain killers. Women received more diagnoses across most diagnosis groups and prescribed drugs from all types than men. Less than half (45.3%) of all health care costs were generated in the outpatient sector. Conclusion The analysis of claims data held in a municipal social services office is a novel approach to gain better insight into asylum seekers’ utilization of health services on an individual level. Compared to regularly insured patients, four characteristics in health care utilization by asylum seekers were identified: low utilization of ambulatory physicians; a gender gap in almost all services, with higher utilization by women; frequent prescription of pain killers; and a low proportion of overall health care costs generated in the outpatient sector. Further research is needed to describe structural and individual factors producing these anomalies.
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Affiliation(s)
- Andreas Niedermaier
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| | - Anna Freiberg
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Tiller
- IT-Department, Data Integration Center, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Amand Führer
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Führer A, Niedermaier A, Kalfa V, Mikolajczyk R, Wienke A. Serious shortcomings in assessment and treatment of asylum seekers' mental health needs. PLoS One 2020; 15:e0239211. [PMID: 33027307 PMCID: PMC7540848 DOI: 10.1371/journal.pone.0239211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of psychological complaints is known to be very high in populations of asylum seekers. Despite this, data on the health care system's ability to adequately meet these high-risk populations' mental health needs are scarce. This article investigates how well the German outpatient health care system is able to detect and adequately treat them. METHODS To this end, we combined data from a cross-sectional survey with billing data from the local social welfare office from the year 2015. Using descriptive statistics, the data of the cross-sectional study are used to quantify the psychological health care needs of asylum seekers while the secondary data analysis indicates the actual access to and extent of psychological treatment. RESULTS In the cross-sectional study, 54% of patients were screened positive for symptoms of depression, 41% for symptoms of anxiety disorder and 18% for symptoms of Posttraumatic Stress Disorder. In total, 59% were screened positive for at least one of these three disorders. However, when contrasting these screening-based prevalences with the prevalences based on data from the health care system, a mismatch becomes apparent: According to the social welfare office's billing data, only 2.6% of asylum seekers received the diagnosis of depression, 1.4% were diagnosed with anxiety disorder and 2.9% with Posttraumatic Stress Disorder (PTSD). In combination, 4.9% were diagnosed with at least one of these three disorders. Overall, less than one tenth of asylum seekers with symptoms of depression, anxiety or PTSD received the corresponding diagnosis by the health care system. Among those who were diagnosed, about 45% received no treatment at all, while 38% were treated with drugs alone. Only 1% of all patients received psychotherapy. CONCLUSIONS Psychological complaints are very common among asylum seekers, yet only a small proportion of this population receives the corresponding diagnoses and treatment. While various factors can contribute to these shortcomings, there is an urgent need to systematically address this deficit and introduce measures to improve mental health care for this high-risk population.
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Affiliation(s)
- Amand Führer
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Niedermaier
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Vivian Kalfa
- Psychosocial Centre for Refugees and Victims of Torture (PSZ), Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Führer A, Frese T, Karch A, Mau W, Meyer G, Richter M, Schildmann J, Steckelberg A, Wagner K, Mikolajczyk R. [COVID-19: Knowledge, risk perception and strategies for handling the pandemic]. Z Evid Fortbild Qual Gesundhwes 2020; 153-154:32-38. [PMID: 32601024 PMCID: PMC7294294 DOI: 10.1016/j.zefq.2020.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/04/2022]
Abstract
Hintergrund Für den Erfolg der Bemühungen zur Eindämmung einer Epidemie sind die großflächige Umsetzung der Maßnahmen und ihre Akzeptanz in der Bevölkerung wichtig. Diese Studie untersucht daher den Wissensstand und die Risikowahrnehmung in der frühen Phase der COVID-19-Pandemie und analysiert, wie empfohlene und vorgeschriebene Maßnahmen umgesetzt bzw. eingehalten wurden. Methode Im März 2020 wurden die im HeReCa-Online-Panel registrierten Teilnehmer/-innen aus Sachsen-Anhalt, Berlin und Schleswig-Holstein eingeladen, einen Fragebogen mit 65 Fragen zu beantworten. Ergebnisse 1048 Teilnehmer/-innen beantworteten den Fragebogen. Dies entspricht einer Rücklaufquote von 3,5%. 83% der Befragten fühlten sich gut oder sehr gut über COVID-19 und das ursächliche Virus informiert. Die meisten Befragten gaben an, vor allem in Bezug auf die Gesundheit von Familienangehörigen (60%) und der Bevölkerung als Ganzes (45%) Angst vor der Pandemie zu haben und fürchteten negative Folgen für die Wirtschaft (79%). 79% der Befragten haben in Reaktion auf die Pandemie individuelle Maßnahmen ergriffen, z. B. das Einhalten von Mindestabständen zu anderen im öffentlichen Raum und Kontaktreduktion. Die staatlich verordneten Maßnahmen wurden überwiegend als sinnvoll und der Situation angemessen wahrgenommen. Schlussfolgerung In der Frühphase der Pandemie hat sich ein Großteil der Bevölkerung gezielt mit COVID-19 beschäftigt und setzte individuelle Maßnahmen zur Risikoreduktion um. Die Akzeptanz für die staatlichen Maßnahmen zur Eindämmung der Pandemie war hoch.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Thomas Frese
- Institut für Allgemeinmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Andre Karch
- Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - Wilfried Mau
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Matthias Richter
- Institut für Medizinische Soziologie, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Jan Schildmann
- Institut für Geschichte und Ethik der Medizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Anke Steckelberg
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Karoline Wagner
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Freiberg A, Wienke A, Bauer L, Niedermaier A, Führer A. Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study. Int J Environ Res Public Health 2020; 17:ijerph17082672. [PMID: 32295091 PMCID: PMC7215588 DOI: 10.3390/ijerph17082672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022]
Abstract
Background: The growing immigration to Germany led to more patients whose medical needs are divergent from those of the domestic population. In the field of dental health care there is a debate about how well the German health system is able to meet the resulting challenges. Data on asylum-seekers' dental health is scarce. This work is intended to reduce this data gap. Methods: We conducted this retrospective observational study in Halle (Saale), Germany. We included all persons who were registered with the social welfare office (SWO) in 2015 and received dental treatments. From the medical records, we derived information such as complaints, diagnoses, and treatments. Results: Out of 4107 asylum-seekers, the SWO received a bill for 568 people. On average, there were 1.44 treatment cases (95%-CI: 1.34-1.55) and 2.53 contacts with the dentist per patient (95%-CI: 2.33-2.74). Among those, the majority went to the dentist because of localized (43.2%, 95%-CI: 38.7-47.7) and non-localized pain (32.0%, 95%-CI: 27.8-36.2). The most widespread diagnosis was caries (n = 469, 98.7%, 95%-CI: 97.7-99.7). Conclusion: The utilization of dental care is lower among asylum-seekers than among regularly insured patients. We assume that the low prevalence rates in our data indicate existing access barriers to the German health care system.
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Wiessner C, Keil T, Krist L, Zeeb H, Dragano N, Schmidt B, Ahrens W, Berger K, Castell S, Fricke J, Führer A, Gastell S, Greiser H, Guo F, Jaeschke L, Jochem C, Jöckel KH, Kaaks R, Koch-Gallenkamp L, Krause G, Kuss O, Legath N, Leitzmann M, Lieb W, Meinke-Franze C, Meisinger C, Mikolajczyk R, Obi N, Pischon T, Schipf S, Schmoor C, Schramm S, Schulze MB, Sowarka N, Waniek S, Wigmann C, Willich SN, Becher H. [Persons with migration background in the German National Cohort (NAKO)-sociodemographic characteristics and comparisons with the German autochthonous population]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:279-289. [PMID: 32034443 DOI: 10.1007/s00103-020-03097-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persons with a migration background (PmM) as a population group usually differ from the autochthonous population in terms of morbidity, mortality, and use of the health care system, but they participate less frequently in health studies. The PmM group is very heterogeneous, which has hardly been taken into account in studies so far. OBJECTIVES Sociodemographic characteristics of PmM in the NAKO health study (age, sex, time since migration, education) are presented. In addition, it is examined through an example whether migration background is related to the use of cancer screening for colorectal cancer (hemoccult test). METHODS Data of the first 101,816 persons of the NAKO were analyzed descriptively and cartographically. The migration background was assigned on the basis of the definition of the Federal Statistical Office, based on nationality, country of birth, year of entry, and country of birth of the parents. RESULTS Overall, the PmM proportion is 16.0%. The distribution across the 18 study centers varies considerably between 6% (Neubrandenburg) and 33% (Düsseldorf). With 153 countries of origin, most countries are represented in the NAKO. All variables show clear differences between the different regions of origin. In the hemoccult test, persons of Turkish origin (OR = 0.67) and resettlers (OR = 0.60) have a lower participation rate. PmM born in Germany do not differ in this respect from the autochthonous population (OR = 0.99). CONCLUSION PmM in the NAKO are a very heterogeneous group. However, due to the sample size, individual subgroups of migrants can be studied separately with respect to region of origin.
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Affiliation(s)
- Christian Wiessner
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland.
| | - Thomas Keil
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg, Deutschland.,Landesinstitut für Gesundheit, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Bad Kissingen, Deutschland
| | - Lilian Krist
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland.,Health Sciences Bremen, Universität Bremen, Bremen, Deutschland
| | - Nico Dragano
- Institut für Medizinische Soziologie, Centre for Health and Society, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Börge Schmidt
- Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Wolfgang Ahrens
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland.,Institut für Statistik, Fachbereich Mathematik und Informatik, Universität Bremen, Bremen, Deutschland
| | - Klaus Berger
- Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Deutschland
| | - Stefanie Castell
- Abteilung für Epidemiologie, Helmholtz-Zentrum für Infektionsforschung (HZI), Braunschweig, Deutschland
| | - Julia Fricke
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik (IMEBI), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Sylvia Gastell
- NAKO Studienzentrum, Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Nuthetal, Deutschland
| | - Halina Greiser
- Abteilung Epidemiologie von Krebserkrankungen, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Feng Guo
- Abteilung Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Lina Jaeschke
- Forschergruppe Molekulare Epidemiologie, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC), Berlin, Deutschland
| | - Carmen Jochem
- Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Regensburg, Deutschland
| | - Karl-Heinz Jöckel
- Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Rudolf Kaaks
- Abteilung Epidemiologie von Krebserkrankungen, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Lena Koch-Gallenkamp
- Abteilung Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Gérard Krause
- Abteilung für Epidemiologie, Helmholtz-Zentrum für Infektionsforschung (HZI), Braunschweig, Deutschland.,Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - Oliver Kuss
- Institut für Biometrie und Epidemiologie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Nicole Legath
- Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Deutschland
| | - Michael Leitzmann
- Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Regensburg, Deutschland
| | - Wolfgang Lieb
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Claudia Meinke-Franze
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Christa Meisinger
- SFG Klinische Epidemiologie, Helmholtz Zentrum München, Neuherberg, Deutschland.,Lehrstuhl für Epidemiologie am UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Deutschland.,NAKO Studienzentrum, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik (IMEBI), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Nadia Obi
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
| | - Tobias Pischon
- Forschergruppe Molekulare Epidemiologie, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC), Berlin, Deutschland.,Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Partnerstandort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,MDC/BIH Biobank, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC) und Berlin Institute of Health (BIH), Berlin, Deutschland
| | - Sabine Schipf
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Claudia Schmoor
- Zentrum Klinische Studien, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Sara Schramm
- Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Matthias B Schulze
- Abteilung Molekulare Epidemiologie, Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Nuthetal, Deutschland
| | - Nicole Sowarka
- NAKO Studienzentrum, Universitätsklinikum Augsburg, Augsburg, Deutschland.,Institut für Epidemiologie, Helmholtz Zentrum München, Neuherberg, Deutschland
| | - Sabina Waniek
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Claudia Wigmann
- IUF-Leibniz Institut für umweltmedizinische Forschung, Düsseldorf, Deutschland
| | - Stefan N Willich
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Heiko Becher
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
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Führer A, Tiller D, Brzoska P, Korn M, Gröger C, Wienke A. Health-Related Disparities among Migrant Children at School Entry in Germany. How does the Definition of Migration Status Matter? Int J Environ Res Public Health 2019; 17:E212. [PMID: 31892226 PMCID: PMC6981556 DOI: 10.3390/ijerph17010212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/02/2022]
Abstract
Background: Migration background is known to be an important risk factor for a number of medical outcomes. Still, relatively little is known about the epidemiologic relevance of different definitions of migration status. Methods: Data from 5250 school entry examinations spanning three consecutive years (2015-2017) were gathered from the Public Health Department in Halle, Germany. Data were stratified according to six different migration statuses and evaluated for differences in health service utilization and developmental outcomes. Results: Compared to non-migrant children, migrant children have a lower utilization of preventative services, and higher frequencies of developmental delays. Children with first-generation migration background consistently show results worse than all others, while children with one-sided second-generation migration background show results similar to those of their non-migrant peers. These findings are not substantially altered by adjustment for social status. Conclusions: Children with first-generation migration background should receive special attention in school entry examinations, since they constitute a group with consistently higher health risks compared to other groups of preschoolers.
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Affiliation(s)
- Amand Führer
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics and Informatics, 06112 Halle (Saale), Germany; (D.T.); (M.K.); (A.W.)
| | - Daniel Tiller
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics and Informatics, 06112 Halle (Saale), Germany; (D.T.); (M.K.); (A.W.)
| | - Patrick Brzoska
- Health Services Research Unit, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany;
| | - Marie Korn
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics and Informatics, 06112 Halle (Saale), Germany; (D.T.); (M.K.); (A.W.)
| | - Christine Gröger
- Public Health Department, City of Halle (Saale), 06112 Halle, Germany;
| | - Andreas Wienke
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics and Informatics, 06112 Halle (Saale), Germany; (D.T.); (M.K.); (A.W.)
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Führer A. „Da muss sich jemand anders kümmern“ – Die medizinische Versorgung von Asylsuchenden als Herausforderung für eine bio-psycho-soziale Medizin. Gesundheitswesen 2019; 82:151-156. [DOI: 10.1055/a-1026-6190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ZUSAMMENFASSUNG
Ziel der Studie Die Medizin wird verschiedentlich dafür kritisiert, die biologischen Facetten von Gesundheit und Krankheit gegenüber gesellschaftlichen Einflüssen zu privilegieren. Gegen diesen Vorwurf hat sich in den letzten Jahrzehnten ein medizintheoretischer Ansatz etabliert, der ein bio-psycho-soziales Krankheitskonzept vertritt. Dieser Artikel nutzt ethnografische Perspektiven auf die medizinische Versorgung von Asylsuchenden, um zu untersuchen, inwiefern die Prinzipien der bio-psycho-sozialen Medizin in Bezug auf die wissenschaftlich fundierte Berücksichtigung gesellschaftlicher Einflüsse auf die Gesundheit und Krankheit dieser Patientengruppe verwirklicht werden.
Methoden Dabei findet ein ethnografisches Methodenrepertoire mit narrativen Interviews, Leitfadeninterviews und teilnehmender Beobachtung Anwendung.
Ergebnisse Anhand des Umgangs mit den rechtlichen Rahmenbedingungen der medizinischen Versorgung von Asylsuchenden und mit Sprachinkongruenz wird gezeigt, dass es Ärzt/-innen regelmäßig nicht gelingt, die gesundheitsbezogene Lebenswelt dieser Patientengruppe adäquat und wissenschaftlichen Standards entsprechend in Diagnostik und Therapie zu berücksichtigen. Stattdessen rekurrieren sie im klinischen Alltag häufig auf improvisierte Lösungsansätze oder verschieben die Verantwortung auf andere, oft unbenannte Akteure.
Schlussfolgerung Sozialwissenschaftliche Ansätze, v. a. aus der Medizinanthropologie, könnten diese zu Versorgungsdefiziten führenden Schwierigkeiten beheben und sollten daher vermehrt in die ärztliche Aus- und Weiterbildung integriert werden. Dadurch könnten zudem theoretische und methodische Lücken geschlossen werden, die möglicherweise auch in der Versorgung anderer Patientengruppen bedeutsam sind.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle
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25
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Führer A, Wienke A, Wiermann S, Gröger C, Tiller D. Risk-based approach to school entry examinations in Germany - a validation study. BMC Pediatr 2019; 19:448. [PMID: 31744487 PMCID: PMC6862836 DOI: 10.1186/s12887-019-1825-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/07/2019] [Indexed: 11/12/2022] Open
Abstract
Background In Germany, all preschoolers undergo a school entry examination (SEE). While most children are sufficiently served with standardized developmental tests only, for a small group of otherwise underserved children, the SEE should also include a subsidiary health checkup. The aim of the study was to validate selection criteria to differentiate these two groups of children. Methods Secondary data from the SEEs of 2016 and 2017 that contained information on 3513 children were analyzed. Of these children, a subset was selected in which no severe developmental disorders were diagnosed prior to the SEE (n = 2744). The selection criteria identified in an earlier study (low or medium social status, missed the last pediatric routine check-up, migration background, three or more siblings, and raised by a single mother) were then applied to this subset to estimate their effectiveness in finding children at risk for a newly diagnosed severe developmental disorder. The sensitivity, specificity and positive and negative predictive values of the selection criteria were calculated. Results The tested selection criteria identified children who would likely benefit from a subsidiary checkup in the context of SEEs with a sensitivity of 96% (95% CI: 94.5–98.9%). The negative predictive value and specificity of the criteria were 99% (98.6–99.7%) and 34% (32.1–35.8%), respectively. By using this approach, the number of children seen by a physician could be reduced to 53% of the age cohorts. Conclusion The tested selection criteria are a viable way to differentiate children for whom SEEs should include a subsidiary health checkup from those who do not need it. Therefore, the time that physicians spend with SEEs could be reduced. Using the selection criteria to establish a stepped procedure in SEEs therefore offers a valid way to focus physicians’ resources on the children who need them most.
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Affiliation(s)
- Amand Führer
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics and Informatics, Halle (Saale), Germany.
| | - Andreas Wienke
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics and Informatics, Halle (Saale), Germany
| | - Snezhina Wiermann
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics and Informatics, Halle (Saale), Germany
| | | | - Daniel Tiller
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics and Informatics, Halle (Saale), Germany
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27
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Hofmann J, Meier M, Enders M, Führer A, Ettinger J, Klempa B, Schmidt S, Ulrich RG, Kruger DH. Hantavirus disease in Germany due to infection with Dobrava-Belgrade virus genotype Kurkino. Clin Microbiol Infect 2014; 20:O648-55. [PMID: 24438436 DOI: 10.1111/1469-0691.12543] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/19/2013] [Accepted: 01/13/2014] [Indexed: 01/10/2023]
Abstract
Members of the Dobrava-Belgrade virus (DOBV) species are hantaviruses carried by different Apodemus mice as reservoir hosts and causing haemorrhagic fever with renal syndrome (HFRS) in humans. In Central Europe, the Kurkino genotype of DOBV, associated with the striped field mouse, Apodemus agrarius, is prevalent. This paper presents the first extensive study of the serological and molecular diagnostics, epidemiology and clinics of DOBV-Kurkino infections in Central Europe. Serum samples from 570 German patients living in the habitat of A. agrarius (north and northeast Germany) and exhibiting febrile disease, were analysed. All samples were tested by ELISA, subsets of samples were also analysed by immunoblot, neutralization assay, and RT-PCR. A group of 86 individuals was confirmed as DOBV-infected. The virus neutralization assay allowed a reliable identification of DOBV antibodies during both acute and convalescent phases of infection. However, differentiation of relevant DOBV genotypes was not possible by neutralization test but required molecular analysis. Whereas DOBV IgM antibodies tend to persist in the infected organism, RNAaemia seems to be short. Nucleotide sequences were amplified from four patients, and their analysis demonstrated infection by DOBV-Kurkino. With respect to the initial results, the high degree of identity of local patient-derived and A. agrarius-derived virus sequences may allow a closer allocation of the geographical place where the human infection occurred. In contrast to moderate/severe HFRS caused by the DOBV genotypes Dobrava or Sochi, all available data showed a mild clinical course of HFRS caused by DOBV-Kurkino infection without lethal outcomes.
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Affiliation(s)
- J Hofmann
- Institute of Medical Virology, Helmut-Ruska-Haus, Charité Medical School, Berlin, Germany; Division of Virology, Labor Berlin Charité-Vivantes GmbH, Berlin, Germany
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Boršo D, Löbermann M, Fritzsche C, Hemmer C, Führer A, Zettl U, Reisinger EC. [Vaccinations in patients with immunodeficiency or immunosuppressive therapy]. Dtsch Med Wochenschr 2013; 138:145-50. [PMID: 23322428 DOI: 10.1055/s-0032-1327401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Patients with immunodeficiency and patients under immunosuppressive therapy have an increased risk of infectious diseases. Vaccination strategies are needed to protect them from preventable diseases. The underlying disease and severity of the immune impairment may have influence on indications and contra-indications of vaccines. Inactivated vaccines can be administered safely according to the current recommendations of the Permanent Commission on Vaccinations of the Robert-Koch-Institut in Berlin, Germany (STIKO). Depending on the severity of the immune dysfunction, antibody response to vaccinations varies. Where possible, the antibody response following vaccinations should be tested. Previously, attenuated live vaccines were considered to be strictly contra-indicated in immunocompromised patients. Today, the administration of attenuated live vaccines is thought to be possible, depending on the degree and type of immunodeficiency or immunosuppression of the individual.
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Affiliation(s)
- D Boršo
- Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock
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Führer A, Bolz M, Hofmann J. [Hantavirus infection due to Dobrava-Belgrade virus in a third trimester pregnant woman]. Dtsch Med Wochenschr 2012; 137:2369-72. [PMID: 23132155 DOI: 10.1055/s-0032-1327261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 20-year-old woman was admitted to our hospital because of acute renal failure. She was pregnant in the third trimester. She reported on nausea, feeling of sickness, vomiting, abdominal pain and consecutively gross hematuria and sinustachycardia. Under suspicion of premature labour the patient was admitted to an external hospital. An antibiotic therapy with intravenous ampicillin/sulbactam was initiated. Because of acute kidney injury the patient was transferred firstly to the university women's hospital and finally to the department of nephrology. Obesity, the clinical signs of pregnancy, dehydration and small edema of the lower legs were the main medical findings on examination. INVESTIGATIONS Laboratory tests revealed hyperuricemia, virological tests detected an acute infection with Dobrava-Belgrade virus. The ultrasonography demonstrated a pregnancy in good condition and a dilated (physiological) renal pelvis but otherwise normal renal morphology. DIAGNOSIS, TREATMENT AND COURSE A Hantavirus associated acute kidney failure due to infection with the Dobrava-Belgrade virus was diagnosed. The course of the acute renal failure was characterised by remission of all symptoms. Intermittent evaluation by an obstetrician and a nephrologist were done to diagnose maternal and/or fetal complications. A renal replacement therapy was not necessary. At the 41st week of gestation a healthy male infant was born. The development of the newborn was age-appropriate. CONCLUSION Hantavirus infections should be considered in cases of pregnancy-associated acute kidney injury.
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Affiliation(s)
- A Führer
- Zentrum für Innere Medizin, Universitätsmedizin Rostock, Medizinische Klinik II, Sektion für Nephrologie.
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Braun G, Führer A, Breitenstein E, Tariku W, Abdelbaghi O, Hauptmann S, Bogale S, Kantelhardt E. Cancer in Africa: AORTIC 8th International Cancer Conference 'Entering the 21st Century for Cancer Control in Africa' 30.11.-2.12.2011. ACTA ACUST UNITED AC 2012; 7:177-179. [PMID: 22740807 DOI: 10.1159/000188335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- G Braun
- Department of Gynecology, Martin-Luther-University Halle/Wittenberg, Germany
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Koball S, Hickstein H, Führer A, Heller T, Stange J, Mitzner S. Atypical electrolyte kinetics during an emergency dialysis session in a patient with Leriche syndrome. Clin Nephrol 2010; 74:471-473. [PMID: 21084051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
A hemodialysis patient suffered from circulation failure due to a low output syndrome caused by a hyperkalemia (9.9 micromol/l) with typical ecg signs. An emergency hemodialysis was started. After 2 h ecg signs of hypokalemia (2.1 micromol/l) were detectable. Hemodialysis was stopped. 2 h later, serum potassium rose to 6.2 micromol/l. An obturation of the aorta and the inferior caval vein with perfusion through collateral vessels of the lower body side was obvious, resulting into a faster electrolyte correction in the upper and a delayed correction in the lower body side with a rebound in the upper compartment. Dialysis time and dialysate potassium (4.0 micromol/l) were increased. Furthermore no potassium problems occurred.
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Affiliation(s)
- S Koball
- Department of Internal Medicine and Nephrology, University of Rostock, Rostock, Germany.
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Edelmann J, Klein-Hitpass L, Carpinteiro A, Führer A, Sellmann L, Stilgenbauer S, Dührsen U, Dürig J. Bone marrow fibroblasts induce expression of PI3K/NF-kappaB pathway genes and a pro-angiogenic phenotype in CLL cells. Leuk Res 2008; 32:1565-72. [PMID: 18407351 DOI: 10.1016/j.leukres.2008.03.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 02/29/2008] [Accepted: 03/03/2008] [Indexed: 11/16/2022]
Abstract
Microarray-based gene expression profiling (GEP) was used to study how stroma modulates the survival of CLL cells in an in vitro coculture model employing the murine fibroblast cell line M2-10B4. CLL cells cultured in direct contact with the stromal layer (STR) showed a significantly better survival than cells cultured in transwell (TW) inserts above the M2-10B4 cells. STR as compared to TW conditions induced a significant up-regulation of PI3K/NF-kappaB pro-survival pathway genes and mediated a pro-angiogenetic switch in the CLL cells by up-regulation of vascular endothelial growth factor (VEGF) and osteopontin (OPN) and down-regulation of the anti-angiogenetic molecule thrombospondin-1 (TSP-1).
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Affiliation(s)
- J Edelmann
- Department of Hematology, University Hospital, University of Duisburg-Essen, Essen, Germany
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Hüttmann A, Klein-Hitpass L, Thomale J, Deenen R, Carpinteiro A, Nückel H, Ebeling P, Führer A, Edelmann J, Sellmann L, Dührsen U, Dürig J. Gene expression signatures separate B-cell chronic lymphocytic leukaemia prognostic subgroups defined by ZAP-70 and CD38 expression status. Leukemia 2006; 20:1774-82. [PMID: 16932341 DOI: 10.1038/sj.leu.2404363] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
B-cell chronic lymphocytic leukaemia (B-CLL) is a heterogenous disease with a highly variable clinical course and analysis of zeta-associated protein 70 (ZAP-70) and CD38 expression on B-CLL cells allowed for identification of patients with good (ZAP-70-CD38-) and poor (ZAP-70+CD38+) prognosis. DNA microarray technology was employed to compare eight ZAP-70+CD38+ with eight ZAP-70-CD38- B-CLL cases. The expression of 358 genes differed significantly between the two subgroups, including genes involved in B-cell receptor signaling, angiogenesis and lymphomagenesis. Three of these genes, that is, immune receptor translocation-associated protein 4 (IRTA4)/Fc receptor homologue 2 (FcRH2), angiopoietin 2 (ANGPT2) and Pim2 were selected for further validating studies in a cohort of 94 B-CLL patients. IRTA4/FcRH2 expression as detected by flow cytometry was significantly lower in the poor prognosis subgroup as compared to ZAP-70-CD38- B-CLL cells. In healthy individuals, IRTA4/FcRH2 protein expression was associated with a CD19+CD27+ memory cell phenotype. ANGPT2 plasma concentrations were twofold higher in the poor prognosis subgroup (P<0.05). Pim2 was significantly overexpressed in poor prognosis cases and Binet stage C. Disease progression may be related to proangiogenic processes and strong Pim2 expression.
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MESH Headings
- ADP-ribosyl Cyclase 1/genetics
- ADP-ribosyl Cyclase 1/metabolism
- Aged
- Aged, 80 and over
- Angiopoietin-2/genetics
- Angiopoietin-2/metabolism
- B-Lymphocytes/pathology
- B-Lymphocytes/physiology
- Cell Differentiation
- Cohort Studies
- Female
- Flow Cytometry
- Gene Expression Regulation, Leukemic
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/classification
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Male
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/metabolism
- Middle Aged
- Neovascularization, Pathologic/genetics
- Oligonucleotide Array Sequence Analysis
- Prognosis
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/metabolism
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/metabolism
- Proto-Oncogene Proteins c-bcr/metabolism
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Risk Factors
- Signal Transduction/genetics
- ZAP-70 Protein-Tyrosine Kinase/genetics
- ZAP-70 Protein-Tyrosine Kinase/metabolism
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Affiliation(s)
- A Hüttmann
- Clinic of Hematology, University Hospital, University of Duisburg-Essen, Essen, Germany
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Dürig J, Nückel H, Cremer M, Führer A, Halfmeyer K, Fandrey J, Möröy T, Klein-Hitpass L, Dührsen U. ZAP-70 expression is a prognostic factor in chronic lymphocytic leukemia. Leukemia 2004; 17:2426-34. [PMID: 14523469 DOI: 10.1038/sj.leu.2403147] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
B-cell chronic lymphocytic leukemia (B-CLL) is a heterogenous disease with a highly variable clinical course. Recent studies have shown that expression of the protein tyrosine kinase ZAP-70 may serve as a prognostic marker in B-CLL. Employing a semiquantitative RT-PCR assay, we examined purified leukemia B cells of 39 CLL patients for the expression of ZAP-70 mRNA transcripts. Significant ZAP-70 mRNA levels exceeding those found in control samples with 5% T cells were detected in 36% of the CLL cases. Patients in the ZAP-70 positive cohort were characterized by an unfavorable clinical course with a significantly shorter progression-free survival as compared to the ZAP-70-negative patients (64%). These results were confirmed by flow-cytometric analysis of the ZAP-70 protein, and expanded to a larger patient cohort (n=67). A combined statistical analysis of 79 patients showed that the two patient subgroups also differed with regard to overall survival and a panel of known clinical prognostic factors including LDH, thymidine kinase serum levels and expression of the CD38 surface antigen by the leukemic cell clone. The level of ZAP-70 expression did not change over time in the majority of patients where sequential samples were available for analysis.
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MESH Headings
- ADP-ribosyl Cyclase/metabolism
- ADP-ribosyl Cyclase 1
- Antigens, CD/metabolism
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/genetics
- Clone Cells
- Flow Cytometry
- Gene Expression Regulation, Enzymologic
- Gene Expression Regulation, Leukemic
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Membrane Glycoproteins
- Prognosis
- Protein-Tyrosine Kinases/genetics
- Retrospective Studies
- Reverse Transcriptase Polymerase Chain Reaction
- Risk Factors
- Thymidine Kinase/blood
- Treatment Outcome
- ZAP-70 Protein-Tyrosine Kinase
- beta 2-Microglobulin/blood
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Affiliation(s)
- J Dürig
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Germany
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Abstract
HepatoConsult is a publicly available knowledge-based second opinion and documentation system aiding in the diagnosis of liver diseases. The positive results of a prospective diagnostic evaluation study encouraged its use in clinical routine, although the available hardware infrastructure was not optimal. The comments of the physicians who used the system confirmed the results of the study and showed that the time for data entering is acceptable and the implicit standardization of terminology and documentation is welcome. Suggestions for improvement included the interface to enter data more easily, the scope to be usable for more patients and the additional capability to generate medical reports from the data.
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Affiliation(s)
- H P Buscher
- Clinic for Internal Medicine II, DRK-Kliniken Berlin-Köpenick, Salvador Allende Strasse 2-8, 12559 Berlin, Germany.
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Buscher HP, Führer A, Kirschke S, Galland D, Spangenberg HC, Blum HE. [The evaluation of HepatoConsult, a hepatological expert system--the initial results and trends]. Dtsch Med Wochenschr 1999; 124:989-92. [PMID: 10488325 DOI: 10.1055/s-2007-1024462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE HepatoConsult (HC) is a medical expert system, based on the expert system building block D3, designed to aid in the diagnosis of liver and biliary tract disease. It was the aim of this study to evaluate its diagnostic competence in clinical cases prospectively. PATIENTS AND METHODS The diagnostic accuracy of HC was tested prospectively in 106 consecutive patients with the main diagnosis of liver disease. 57 were ambulant, 49 were in-patients. The data were obtained and stored at defined phases of the diagnosis. The diagnoses put forward by HC were compared with the final clinical diagnosis and, on the basis of the data, checked for plausibility by four experienced physicians. RESULTS After history taking and physical examination HC put forward the main diagnosis, as established by the doctors in charge, in 60% of patients. After addition of the results of basic laboratory tests and sonography, HC provided the correct diagnosis in 85% and, after inclusion of all the findings, in 93%. In almost all cases HC put forward diagnoses that were, on the basis of the supplied data, considered correct by the four physicians experienced in liver disease. In 56% of cases HC provided more differentiated diagnoses or items in the differential diagnosis than the attending doctors. In the opinion of the four assessors HC had not put forward any seriously wrong diagnoses. CONCLUSION HC can be useful in solving diagnostic problems and thus in ensuring the quality of medical diagnoses.
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Affiliation(s)
- H P Buscher
- Medizinische Klinik II, DRK-Kliniken Köpenick
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