Illness behaviour and health needs in migrants characterised by low satisfaction with healthcare

Background

Previous research shows inequalities in access to and quality of health care for migrants. We aimed to explore in what way individuals with a migrant background, who report different levels of satisfaction with healthcare, differ in terms of illness behaviour, health needs and sociodemographic characteristics.

Methods

In the rural Southwest of Germany, we conducted a survey with individuals who have a Turkish (n = 217) or Russian (n = 101) background and whom we could contact via cultural centres. Data were analysed using SPSS.

Results

In the total sample, 47,5% (Turks 53%, Russians 37%) reported always being satisfied with healthcare, 46,9% were sometimes and 5,7% never satisfied. Turks who were not always satisfied with healthcare significantly more often did not have a regular GP, and rarely visited GPs and consultants. They more often reported the need for culture sensitive print material, assistance in applying for ambulant care and culture sensitive treatment in matters such as intimacy and death and dying. Also, they more often demanded accessibility to healthcare providers with the same cultural background compared to Turks who reported more satisfaction with healthcare. Among Russians, not always being satisfied with healthcare was associated with demanding culture sensitive information on ambulant nursing care and demanding more cultural competence in providers regarding the treatment of particular diseases. Gender was not related to satisfaction with healthcare in either group.

Conclusions

In this sample of migrants from a rural area culture sensitive treatment was reported to be lacking especially in ambulant nursing care and end of life treatment. In view of the increasing heterogenization of society, it is necessary to address the socio-cultural needs of migrants in a home as well as in a hospital context. Therefore, culture-sensitive materials and workshops for health professionals may be useful to complement their own expertise.

Key messages

A low level of satisfaction with healthcare may be related to low levels of utilization. In this underserved rural area concerns regarding culture sensitive care need to be addressed.

Elderly drivers with dementia – how do experts and relatives assess their safety risk?

Background

Demographic change increases the proportion of car drivers over the age of 70. With increasing age, the likelihood of developing a form of dementia increases. In Germany, about 1.6 million people suffer from dementia. Surveys among dementia patients showed that about two-thirds said they held a valid driving licence and just under half reported still actively driving. We explored whether and to what extent motorists with dementia are putting road safety at risk and how relatives deal with the driving behaviour of their elders.

Methods

Semi-structured qualitative interviews were conducted with seven experts from the fields of police, gerontology and geriatrics as well as with 16 relatives of patients with different stages of dementia. All interviews were then transcribed. The analyses based on the qualitative content analysis (Mayring 2015) with MAXQDA.

Results

The experts regarded elderly drivers with dementia as a public health relevant safety risk. Among those elders who are affected by dementia the awareness of the problem often is limited and not rarely they are characterized by an unsafe driving style. Experts from Austria and Switzerland supported the concept of a mandatory dementia assessment for elderly drivers while experts from Germany did not. Relatives reported very similar descriptions of their elderly’s driving characteristics. Furthermore, the cognitive and motor limitations associated with dementia often are not noticed by both patients themselves and their relatives.

Conclusions

Representative studies are needed to test which measures, such as a mandatory dementia check from retirement age, are likely to improve the safety of older drivers with dementia. Family doctors and GPs should address and educate dementia patients in relation to their risk of accidents. Relatives should receive information material on how to communicate with their elderlys on this topic to maximize safety while avoiding conflict.

Key messages

The prevalence of elderly drivers with dementia is unknown. Representative studies are needed to test best practice appoaches for harm reduction in drivers with dementia.

High-speed fixed-target serial virus crystallography

We report a method for serial X-ray crystallography at X-ray free-electron lasers (XFELs), which allows for full use of the current 120-Hz repetition rate of the Linear Coherent Light Source (LCLS). Using a micropatterned silicon chip in combination with the high-speed Roadrunner goniometer for sample delivery, we were able to determine the crystal structures of the picornavirus bovine enterovirus 2 (BEV2) and the cytoplasmic polyhedrosis virus type 18 polyhedrin, with total data collection times of less than 14 and 10 min, respectively. Our method requires only micrograms of sample and should therefore broaden the applicability of serial femtosecond crystallography to challenging projects for which only limited sample amounts are available. By synchronizing the sample exchange to the XFEL repetition rate, our method allows for most efficient use of the limited beam time available at XFELs and should enable a substantial increase in sample throughput at these facilities.

X-ray Crystallography at Beamline P11 at PETRA III

The bio-imaging and diffraction beamline P11 at PETRA III is dedicated to structure determination of periodic (crystalline) and aperiodic biological samples. The beamline features two experimental endstations: an X-ray microscope and a crystallography experiment. Basis of design was to provide an extremely stable and flexible setup ideally suited for micro and nano beam applications. The X-ray optics consist of a HHL double crystal monochromator, followed by two horizontal deflecting and one vertical deflecting X-ray mirrors. All mirrors are dynamically bendable and used to generate an intermediate focus at 65.5 m from the source with a size of 37 × 221 µm2FWHM (v × h). All experiments are installed on an 8 m long granite support which provides a very stable setup for micro beam experiments. The crystallography endstation is located at the end of the granite at 72.9 m from the source. The experiment is equipped with a high precision single axis goniostat with a combined sphere of confusion of less than 100 nm. X-ray energies are tunable between 5.5 and 30 keV. A second focusing bendable KB mirror system can be used for further demagnification of the secondary source. In this way the beam size can be freely adjusted between 4 × 9 µm2and 300 × 300 µm2FWHM (v × h) with 1013ph/s at 12 keV. Smaller beam sizes down to 1 × 1 µm2with more than 2 × 1011ph/s in the focus can be realized by slitting down the secondary source at the cost of flux. The crystallography endstation is equipped with a Pilatus 6M-F detector which allows fast data collection with up to 25 Hz. Due to the very small beam divergence of the X-ray beam P11 is ideally suited to measure large unit cell systems, such as viruses or large molecular complexes. In addition, the beamline is capable of high-throughput crystallography and fast crystal screening. Crystals can be mounted in less than 10 s using an automatic sample changer. The large sample dewar provides space for 368 crystals.

[Predictors for low birth weight--an epidemiological case-control study with women in childbed in the federal state Saarland, Germany]

BACKGROUND AND AIMS

Low birth weight is associated with elevated health-care costs and adverse conditions for the newborn's start to life. A variety of health problems and an impaired potential for the infant's development are known long-term effects. Only few studies have examined the role of psychosocial and socioeconomic determinants for the incidence of low birth weight, especially in Germany. The aim of our study was to test the impact of maternal socioeconomic and psychosocial characteristics as well as health behaviour on the infant's birth weight.

METHODS

In an exploratory case-control study we tested whether the before mentioned potential determinants of low birth weight were observed more often among cases (birth weight <2,500 g) than among controls. Standardised interviews were conducted with maternal cases and controls.

RESULTS

The results show that mothers in the control group more often were married or cohabiting (100% vs. 77%; p<0.05) and that they had a higher occupational status (83% non-manual vs. 54%; p<0.05). Level of education was not significantly related to birth weight. Mothers in the case group more often reported exhaustion (p<0.05) and marital problems [M=1.8 (1.1) vs. M=1.3 (0.5); p<0.05). They were characterised by a higher burden of work-strain in terms of weather conditions, heat or infiltration [M=1.7 (1.0) vs. M=1.1 (0.4); p<0.05). The available living space was slightly smaller in the case group [M=96.5 m(2) (31.5 m(2)) vs. M=118.5 m(2) (46.8 m(2)); p<0.1).

DISCUSSION AND CONCLUSIONS

Our results confirm international studies showing differences regarding the social context of women who give birth to a child with normal or low birth weight. Apart from vertical status characteristics, marital conditions and resulting psychosocial stressors seem to have an impact.

A fast X-ray chopper for single-bunch extraction at synchrotron sources

A new X-ray chopper system based on air-bearing technology was developed in a joint project between the Paul Scherrer Institut and DESY. The X-ray chopper wheel of 150 mm diameter has a slit width of 50 µm, which corresponds to an opening time of 230 ns at 30 000 r min−1. The wheel is equipped with either one or two slits at slightly different radii, resulting in repetition frequencies of 500 and 1000 Hz. To reduce air friction the wheel is operated in a reduced-pressure environment. The chopper is controlled by a specially developed phase lock loop controller, which is synchronized to the master bunch clock of the synchrotron. The very small and constant friction of the bearing and the high mechanical accuracy of all mechanical components in combination with the high-precision controller resulted in a very small long-term jitter of less than 3 ns. The chopper is capable of isolating X-rays generated from a single bunch of the future PETRA III storage ring at DESY operated in 40-bunch mode.

Digital in-line holography with femtosecond VUV radiation provided by the free-electron laser FLASH

Femtosecond vacuum ultraviolet (VUV) radiation provided by the free-electron laser FLASH was used for digital in-line holographic microscopy and applied to image particles, diatoms and critical point dried fibroblast cells. To realize the classical in-line Gabor geometry, a 1 microm pinhole was used as spatial filter to generate a divergent light cone with excellent pointing stability. At a fundamental wavelength of 8 nm test objects such as particles and diatoms were imaged at a spatial resolution of 620 nm. In order to demonstrate the applicability to biologically relevant systems, critical point dried rat embryonic fibroblast cells were for the first time imaged with free-electron laser radiation.

Coherent-pulse 2D crystallography using a free-electron laser x-ray source

Coherent diffractive imaging for the reconstruction of a two-dimensional (2D) finite crystal structure with a single pulse train of free-electron laser radiation at 7.97 nm wavelength is demonstrated. This measurement shows an advance on traditional coherent imaging techniques by applying it to a periodic structure. It is also significant that this approach paves the way for the imaging of the class of specimens which readily form 2D, but not three-dimensional crystals. We show that the structure is reconstructed to the detected resolution, given an adequate signal-to-noise ratio.

Qualitative evaluation of titanium implant integration into bone by diffraction enhanced imaging

Diffraction enhanced imaging (DEI) uses refraction of x-rays at edges, which allows pronounced visualization of material borders and rejects scattering which often obscures edges and blurs images. Here, the first evidence is presented that, using DEI, a destruction-free evaluation of the quality of integration of metal implants into bone is possible. Experiments were performed in rabbits and sheep with model implants to investigate the option for DEI as a tool in implant research. The results obtained from DEI were compared to conventional histology obtained from the specimens. DE images allow the identification of the quality of ingrowth of bone into the hydroxyapatite layer of the implant. Incomplete integration of the implant with a remaining gap of less than 0.3 mm caused the presence of a highly refractive edge at the implant/bone border. In contrast, implants with bone fully grown onto the surface did not display a refractive signal. Therefore, the refractive signal could be utilized to diagnose implant healing and/or loosening.

X-ray detection of structural orientation in human articular cartilage

OBJECTIVE

To determine the feasibility of detecting the structural orientation in cartilage with Diffraction Enhanced X-Ray Imaging.

DESIGN

Human tali and femoral head specimens were Diffraction Enhanced X-Ray Imaged (DEI) at the SYRMEP beamline at Elettra at various energy levels to detect the architectural arrangement of collagen within cartilage. DEI utilizes a monochromatic and highly collimated beam, with an analyzer crystal that selectively weights out photons according to the angle they have been deviated with respect to the original direction. This provides images of very high contrast, and with the rejection of X-ray scatter.

RESULTS

DEI allowed the visualization of articular cartilage and a structural orientation, resembling arcades, within.

CONCLUSION

Our diffraction enhanced images represent the first radiographic detection of the structural orientation in cartilage. Our data are in line with previous studies on the structural organization of joint cartilage. They confirm the model of a vaulting system of collagen fiber bundles interrupted by proteoglycan aggregates.

Comparison of intravenous coronary angiography using synchrotron radiation with selective coronary angiography

Intravenous coronary angiography with synchrotron radiation is a novel and minimally invasive technique for coronary imaging. At the Hamburger Synchrotronstrahlungslabor HASYLAB at DESY, a dedicated angiography system has been developed, which has been shown to provide detailed images of coronary artery segments. For each scan, two monochromatic X-ray images below and above the K-edge of iodine were recorded simultaneously. The two images were subtracted logarithmically to produce a maximal contrast enhancement of the iodine. To date, the procedure has been carried out on 379 outpatients. No complications occurred during or after the angiographic procedure, and hospitalization was not required in any subject. The acceptance by patient is extremely high. Five outside reviewers, blinded as to the clinical data or prior angiographic interpretation, reviewed the images for the presence or absence of 70% or more occlusion of a vessel. They reached a sensitivity of 79% and a specificity of 99%. The study has demonstrated that the synchrotron method has satisfactory sensitivity and very high specificity for severe stenoses. The new method has several advantages over magnetic resonance imaging (MRI), electron beam computed tomography (EBCT), and multi-slice computed tomography (MSCT). Neither vascular calcification (CT) nor the presence of metal stents (MRI) impairs the evaluation of perfusion of segments of the coronary arteries. Furthermore, the spatial resolution is three or four times higher using synchrotron angiography, and problems due to respiratory motion are eliminated.

[Burned-out or depressive? An empirical study regarding the construct validity of burnout in contrast to depression]

Our study tested the discriminant validity of burnout in contrast to depression using the Maslach Burnout Inventory (MBI, Maslach u. Jackson 1986) and the Allgemeine Depressionsskala (ADS, Hautzinger u. Bailer 1993). Furthermore the relationships between burnout and depression to social support, occupational and health variables were examined. Pre-school teachers (n = 101), physician-assistants (n = 81) and their intimates were asked to complete a self-administered questionnaire. Spearman-correlations and factor analysis were conducted with SPSS. The results indicate validity for the burnout construct.

Eating habits, health status, and concern about health: a study among 1641 employees in the German metal industry

BACKGROUND

Nutrition has been found to be associated with sociodemographic characteristics and concern about health. There is limited knowledge, however, of associations between blue-collar worker's diet, morbidity, and health care utilization.

METHODS

We conducted a survey on eating habits, physical symptoms, health care utilization, health status, and concern about health in two German metal companies. A self-administered questionnaire was mailed to employees of whom 1641 participated in the study (response rate 54. 7%).

RESULTS

Most employees were characterized by a combination of healthy and unhealthy eating elements. Using linear regression analyses adjusted for age, gender, and occupational status, healthy eating was negatively associated with stomach aches and headaches, but not with cardiovascular disease. Restricted activity days and days in hospital were associated with healthy eating, but self-assessed health status and physician consultations were not. Using stepwise multiple regression analysis, age, gender, and concern about health were strongly and morbidity was weakly related to diet. Occupational status, marital status, and number of children were not associated with nutrition.

CONCLUSIONS

Health promotion programs should motivate younger and male employees to participate in and aim toward increasing concern about health.

[Attitudes and health status as determinants of participation in individually oriented health promotion]

In a cross-sectional health survey among employees of a large German metal company with 974 study participants, attitudes and aspects of the individual health status were identified which predispose employees to take part in individual health promotion activities. Apart from higher participation rates in women and white collar employees, participants reported on average a less favourable subjective health status, more complaints and diseases, better health related behaviours, and a more intensive utilization of curative and preventive medical services than nonparticipants. Among men, participation in all types of courses increased from the youngest to the oldest group, among women only until the middle-aged groups with a consequent decline thereafter. In men, the image of a person living health-consciously showed the strongest positive association with participation, and not the degree of internal control and responsibility with respect to the maintenance of health or the acquisition and overcoming of disease. The low participation of blue collar workers compared to white collar employees could be attributed to group specific differences in individual health consciousness only to a very small extent. Blue collar participants reported a positive image of a person living health-consciously that was more similar to that of white collar participants than to that of nonparticipants of their own occupational group. Advertisement for health promoting activities should place more emphasis on increasing the image of personal health promotion than on internal control and responsibility for health.

[Need adjustment of utilization of occupational health promotion for reducing back pain? Results of an employee survey of the metal industry]

We analysed data of a cross-sectional survey of 974 employees in the German metal industry to determine the degree to which worksite health promotion matches the needs of employees. 27% of study participants have already taken part in individually oriented health promotion, and another 48% want to participate most readily in activities aiming at preventing and reducing musculo-skeletal complaints. Recent participation (within a fourteen-month period) in these classes was low among male blue collar workers (7%) compared to male and female white collar employees (18 and 26%). Among blue collar workers the percentage of subjects who suffered from chronic back pain and did not recently participate in the relevant classes of the company health insurance plan (unserved prevalence) was 30%, compared to 17 and 26% in male and female white collar employees. Participants were less exposed to work-related predictors of chronic back pain than non-participants. Participants were, however, more often afflicted with chronic back pain than non-participants. In addition, the intention to participate was strongly associated with this type of complaint. Shift work was the most important single explanation for the low participation rates of blue collar workers. Suggestions are advanced to neutralise the adverse effects of shift work on participation, to strengthen the primary preventive functions of individual worksite health promotion, and to integrate it with structural measures of health and safety at work.

[Eating habits of employees in the metal industry: determinants and patterns]

We conducted a survey on chances and barriers of occupational health promotion and health behaviour including diet in two South German metal companies. Only a small percentage of the 1641 participants consumed healthy food each day, but many avoided eating unhealthy food. Most employees are characterized by a combination of healthy and unhealthy elements. The group of "healthy eaters" consists of more women than men, more older than younger people and more non-manual than manual workers. The level of education and number of children have not been associated with eating habits. Healthy eaters consumed less alcohol and tobacco and were more engaged in sports and in health promotion programmes than unhealthy eaters.

[Back pain in industry: prevalence, correlation with work conditions and requests for reassignment by employees]

Using data from a cross-sectional survey of 974 employees of a metal company in Germany, we analysed the frequency of chronic back pain, ist associations with working conditions, and the requests for workplace modifications, expressed by persons afflicted with chronic back pain. With a prevalence of 32% chronic back pain was the most common health problem. Physical work exposures, such as lifting and carrying as well as working in an awkward position, were strongly (multivariable odds ratios > or = 2.8) associated with chronic back pain, whereas environmental factors were moderately (multivariable odds ratios = 1.6) associated. Most psychosocial stressors, such as time pressure, and conflicts with co-workers and superiors, were moderately associated with chronic back pain as well (age-adjusted odds ratios between 1.4 and 1.8). Stress symptoms, such as irritation and strain, are rated as mediators by possibly linking psychosocial stressors to chronic back pain. If the individual subject is compelled to perform monotonous or repetitive work, he feels underrated, and this has proved to be a risk factor in its own right. Prolonged exposure to physical stressors (> 7 years) was associated with a strongly elevated risk for chronic back pain (age-adjusted odds ratios > or = 4.0 compared to the nonexposed). Blue collar workers afflicted with chronic back pain requested a reduction of their physical work load significantly more often than their non-afflicted colleagues. In contrast, female white collar employees with chronic back pain layed most emphasis on more physical exercise at work. Worksite health promotion programmes should consider these differences in order to meet the specific needs and preferences of different occupational groups.

Intravenous coronary angiography with dichromography using synchrotron radiation

Dichromography represents a digital subtraction angiography mode based on energy substraction which allows imaging of fast moving subjects like the heart. For logarithmic subtraction 2 images with X-rays just below and above the iodine K-edge (33.17 keV) are simultaneously obtained in a line scan mode. Monochromatic X-rays of sufficient intensity to visualize coronary arteries of 1 mm diameter with extremely low iodine concentrations (1 mg/cm2) after venous injection is only provided by synchrotron radiation. The system NIKOS (non-invasive coronary arteriography with synchrotron radiation) at the Deutsches Elektronen Synchrotron (DESY) consists of 6 components: a wiggler, a monochromator, a safety system, a scanning device, a detector and a computer system. After experimental studies in dogs patients are imaged since 1990. Initial results demonstrate feasibility and safety of synchrotron radiation coronary angiography. Large scale studies are designed to further evaluate sensitivity and specificity. When compact synchrotron radiation sources become available, this technique could be used for follow-up studies and for evaluation of certain high coronary risk populations.