Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis

This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.

Interventions to promote health literacy among working-age populations experiencing socioeconomic disadvantage: systematic review

Background

Experiencing financial insecurity and being underserved is often associated with low health literacy, i.e., the ability to identify, obtain, interpret and act upon health information, which may result in poor health outcomes. Little is known about effective interventions for promoting health literacy among underserved populations. The objective of this systematic review is to summarize the literature on such interventions and identify characteristics that differentiate more effective interventions.

Methods

Following PRISMA guidelines we searched the databases SCOPUS, Pubmed, Web of Science core collection and CINAHL. We included primary studies with a quantitative study design and control groups testing interventions to increase health literacy or health knowledge in underserved populations between 18 and 65 years. Where possible, we converted effect sizes into Cohen's d and compared mean differences of intervention and control groups. Albatross plots were created to summarize the results according to different health literacy and health knowledge outcomes.

Results

We screened 3,696 titles and abstracts and 206 full texts. In total, 86 articles were analyzed, of which 55 were summarized in seven albatross plots. The majority of the studies (n = 55) were conducted in the United States and had a randomized controlled study design (n = 44). More effective intervention approaches assessed needs of participants through focus group discussions prior to conducting the intervention, used bilingual educational materials, and included professionals fluent in the first languages of the study population as intervention deliverers. Additionally, the use of educational materials in video and text form, fotonovelas and interactive group education sessions with role playing exercises were observed to be effective.

Discussion

Although the outcomes addressed in the included studies were heterogeneous, effective intervention approaches were often culturally sensitive and developed tailored educational materials. Interventions aiming to promote health literacy in underserved populations should hence consider applying similar approaches.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323801, PROSPERO registration ID: CRD42022323801.

Factors Contributing to Resilience Among First Generation Migrants, Refugees and Asylum Seekers: A Systematic Review

Objectives: We aimed at 1) collating and evaluating the current evidence on factors contributing to resilience of adult transnational migrants, 2) identifying methodological factors which contribute to the findings, 3) identifying and analyzing promotive and preventive factors contributing to the findings. Methods: A systematic search for relevant studies published until 2021 was conducted in PubMed, PsycINFO, PTSDPubs, and Web of Science. Both, quantitative and qualitative peer-reviewed observational studies reporting on resilience and wellbeing, sense of coherence, or post-traumatic growth outcomes among transnational migrants (aged 18+). Risk of Bias was assessed using the Critical Appraisal Skills Program for qualitative studies and the Appraisal Tool for cross-sectional studies. Due to the heterogeneity of studies we did a narrative review. Results: Database search yielded 3,756 unique records, of those n = 80 records, representing n = 76 studies met the inclusion criteria. The studies provided knowledge on resilience for n = 9,845 transnational migrants across 23 countries. All studies except two were cross sectional. N = 45 reported on resilience, n = 4 on Sense of Coherence and n = 15 on Post-Traumatic Growth. The study methods were not related to the findings. Future orientation, hope and religion/spirituality, caring for others and having opportunities were shown to be more pertinent to resilience outcomes than institutional care structures. Conclusion: Our findings highlight that mental health professionals and policymakers should try to support positive perspectives for the future and encourage policies tailored towards giving refugees opportunities to work, learn and care and to help others.

Cardiometabolic risk profile among children with migrant parents and role of parental education: the IDEFICS/I.Family cohort

BACKGROUND AND AIMS

Evidence shows that migrant children have a higher risk of developing obesity than those with native parents. We aimed to investigate the association between parental migration background and cardiometabolic health in children and adolescents in Europe.

METHODS AND RESULTS

We included 8745 children aged 2-17 from the second follow-up of the European IDEFICS/I.Family cohort. Linear regression models were used to investigate the association between parental migration background (one or two migrant parent(s) vs native parents) and body mass index (BMI), metabolic syndrome (MetS) score and its individual components. Outcome variables were parametrized as age and sex-specific z-scores. We adjusted for age, sex, country, and parental education, and additionally for parental income, lifestyle including dietary factors, and maternal BMI. On average, children with two migrant parents had higher z-scores of BMI (+0.24 standard deviation (SD)) and MetS score (+0.30 SD) compared to those with native parents, whereas no significant differences were seen for children with one migrant parent. Associations were attenuated when controlling for maternal BMI and sports club activity. Parental education modified the associations with BMI and MetS z-scores such that they were more pronounced in children with low parental education.

CONCLUSION

Children with two migrant parents were at higher risk for adverse cardiometabolic health compared to children with native parents, especially in families with low parental education. These associations were explained by lower physical activity and maternal body weight and encourages early intervention strategies by schools and communities.

Involving trained community health mediators in COVID-19 prevention measures. A process evaluation from Bremen, Germany

Objective

The objective was to assess the feasibility of incorporating trained community health mediators in COVID-19 prevention in a multicultural and disadvantaged setting in Bremen, Germany. Specifically, we aimed to develop and implement measures corresponding to the needs of the residents and to analyse the role of digital communication tools and sustainability factors of the health mediator approach.

Methods

A comprehensive process evaluation using 41 qualitative interviews with residents, mediator short surveys and group discussions, work documentation sheets, and a stakeholder workshop was carried out.

Results

Uncertainties due to changing regulations, a lack of trust and fear of potential side effects were major themes identified in the needs assessment. The eight mediators documented more than 1,600 contacts. Digital communication via Facebook was a useful tool, but personal contacts remained crucial for communicating with residents. The participatory approach, multilingualism and the flexibility to react to dynamic situations were identified as relevant factors for the success and sustainability of the health mediator approach.

Conclusion

Multilingual health mediators can facilitate contact with and dissemination of health information to different communities and also can play an important role in pandemic preparedness.

Modifiable predictors of health literacy in working-age adults - a rapid review and meta-analysis

Background

Health literacy comprises the ability to identify, obtain, interpret and act upon health information. Low health literacy is a major risk factor for hospitalizations, use of emergency care and premature mortality among others. Known risk factors for low health literacy such as lower educational attainment, migration history and chronic illnesses overlap with those for long-term unemployment – in itself a risk factor for low health literacy. These factors are difficult to address in interventions to support health literacy. Therefore, the objective of this review is to identify potentially modifiable predictors of HL in populations potentially affected by long-term unemployment.

Methods

A rapid review (PROSPERO registration number: 290873) was carried out in Pubmed and SCOPUS including quantitative studies on potentially modifiable predictors of health literacy in working-age populations following PRISMA guidelines for systematic reviews. Where possible, reported effect sizes were transformed into r, and random-effects meta-analyses were conducted where appropriate to pool effect sizes for the association between modifiable predictors and health literacy.

Results

In total, 4765 titles and abstracts were screened, 114 articles were assessed in full-text screening, and 54 were included in the review. Forty-one effect sizes were considered for 9 different meta-analyses. Higher language proficiency, higher frequency of internet use, using the internet as a source of health information more often, being more physically active, more oral health behaviours, watching more health-related TV and a good health status were significantly associated with higher health literacy. Significant heterogeneity suggests between-study differences.

Conclusions

Improving language proficiency and/or providing information in multiple and simplified languages, together with reliable and accessible health information on the internet and in linear media are potentially promising targets to improve health literacy levels in working-age populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13851-0.

Health Literacy Needs Among Unemployed Persons: Collating Evidence Through Triangulation of Interview and Scoping Review Data

Background

Unemployed persons are at high risk for low health literacy. Most studies addressing health literacy of unemployed persons focus on risk factors for low health literacy or correlates of health literacy, but studies on needs of unemployed persons regarding health literacy are scarce. We aimed to obtain better understanding of health literacy needs of unemployed adults by triangulating the results from a scoping review on health literacy needs in unemployed adults and additional in-depth qualitative interviews.

Methods

Scoping review: We searched six databases up to January 2021 as well as gray literature for relevant studies following PRISMA-ScR guidelines. Titles, abstracts, and full texts were screened independently by two researchers. Qualitative study: Ten participants of a job-reintegration program in Germany were interviewed following a guideline covering topics including health issues of interest to the participants, their sources of health-related information and the barriers/facilitators they experience when accessing health services.

Results

Scoping review: After screening 2,966 titles and abstracts, 36 full texts were considered, and five articles fulfilled the inclusion criteria. Four focused on mental health literacy and outcomes, while the fifth assessed information-seeking practices. One additional report on health literacy was identified via the gray literature search. Awareness of one's condition was identified as a facilitator for mental health help-seeking, while fear of harmful effects of medication prevented help-seeking. Qualitative study: Participants were interested in and were generally well-informed about health topics such as nutrition and physical activity. The main challenge perceived was translating the knowledge into practice in daily life. GPs and the social services providers played an important role as a source of health information and advice. Regarding mental health, similar barriers, facilitators and needs were identified through triangulation of findings of the scoping review with those of the interviews.

Conclusions

There is need to address health literacy needs of long-term unemployed persons that go beyond mental health literacy. Public health interventions should not only aim at improving health literacy scores, but also focus on how to help participants translate health literacy into practice. Population groups of interest should also be involved in all processes of designing interventions.

Health literacy needs among unemployed adults: Triangulating interview and scoping review data

 

Disadvantaged populations, including unemployed adults, often exhibit low levels of health literacy. Exploring subjectively perceived health literacy needs in these populations can serve as an entry point for participatory intervention development. We aimed to assess health literacy needs of unemployed adults by triangulating qualitative interviews data and a scoping review. Using a parallel approach, we combined results of an interview study with 10 participants of a job-reintegration program in Germany and a scoping review. The interviews, conducted in early 2021, focused on health topics of interest to the participants and their sources of health-related information. Data were analysed using thematic analysis. For the scoping review, we searched MEDLINE, CINAHL, PsycInfo and SCOPUS up to January 2021 for studies containing “unemployed” AND “health literacy” in titles/abstracts. Study selection and data extraction were done independently by two researchers. Nutrition and physical activity emerged as core themes during the interviews, with some participants referring to the importance of both for mental health. Doctors and the institution running the job-reintegration program were the sources of health-related information often mentioned. The Corona pandemic was reported to have limited physical activity and affected psycho-social well-being. Five out of 2696 studies were included in the review. Four focused on mental health literacy, the fifth assessed information seeking practices in unemployed adults. The qualitative analysis revealed that health literacy needs of unemployed adults go beyond mental health literacy. As nutrition and physical activity impact mental health, interventions targeting such topics might also improve mental health literacy in unemployed adults. Study findings will be discussed with unemployed persons and social workers in co-production workshops that aim to identify and prioritize health literacy needs for intervention development.

Key messages

Health literacy programs for unemployed adults should target nutrition and physical activity. Workforce re-integration programs play a pivotal role in improving health literacy of unemployed adults.

Exploring factors that contribute to human trafficking in Ethiopia: a socio-ecological perspective

Background

A number of individuals in Ethiopia are involved in illegal types of transnational migration, namely human trafficking and smuggling. The magnitude is not declining despite efforts to curb it. An in-depth understanding of the reasons for trafficking is needed to control human trafficking and its consequences.

Methods

The study included four focus group discussions and 44 in-depth interviews conducted in three border towns, five trafficking-stricken areas, and the IOM transit center for returnees in Addis Ababa. Participants were victims of trafficking, emigrants, community members, police, immigration personnel, and staff of labor and social affairs offices and non-government organizations. Based on the social-ecological model framework, content analysis was implemented using opencode-4.03 software.

Results

Factors identified as possibly encouraging acts of illegal migration included community attitudes such as having a child abroad being considered a measure of status, and the reluctance to do certain types of works associated with low social status when at home. There was, however, willingness to do similar work abroad, which was coupled with the belief that wages for such jobs were better abroad than at home and a lack of knowledge regarding differences in working conditions in the two settings. Further reasons given were poor government service provisions, ineffective immigration policies, political instability, government focus on reactive and poorly coordinated control rather than on sustainable prevention of human trafficking and corruption. Corruption was said to be the underlying factor for the poor coordination among government agencies, communities, and individuals. These factors, among others, led to the loss of trust and belief in local governance, resources, and opportunities to build one’s future at home, thereby creating fertile ground for illegal migration, including smuggling and possibly trafficking.

Conclusions

Individual lack of trust and belief in local governance, resources, and opportunities to build one’s future was the main reason why people resorted to migrate in a manner subjecting them to human trafficking. Thus, comprehensive and coordinated efforts involving government agencies, communities, and other stakeholders are needed to help curb human trafficking and its consequences.

A Cross-Sectional Community Readiness Assessment for Implementing School-Based Comprehensive Sexuality Education in Islamabad, Pakistan

Evidence indicates that school-based sexuality education empowers children and adolescents with the skills, values, and attitudes that will enable them to appreciate their health and well-being, nourish respectful social and sexual relationships, understand their rights, and to make informed choices. Owing to organized community resistance and prevalent misconceptions, promoting sexual and reproductive health has been challenging, especially in conservative settings like Pakistan. This study aimed at systematically exploring communities' perceptions regarding implementing school-based comprehensive sexuality education by conducting a cross-sectional community readiness assessment in Islamabad, Pakistan. A total of 35 semi-structured interviews were conducted with community key informants. Following the guidelines of the community readiness handbook, the interviews were transcribed and scored by two independent raters. The results indicate that, overall, the Islamabad community is at stage two of community readiness, the denial/resistance stage. Individual dimension scores indicate that knowledge of efforts, resources for efforts, knowledge about the issue, and leadership dimensions are at the denial/resistance stage. Only community climate was rated at stage three of community readiness, the vague awareness stage. This indicates that, for promoting sexuality education in the Pakistani context, it is essential to tackle resistance by sensitizing the community and the stakeholders through awareness campaigns.

"It's the First Barrier" - Lack of Common Language a Major Obstacle When Accessing/Providing Healthcare Services Across Europe

International migration is shaping and changing urban areas as well as impacting on healthcare access and provision in Europe. To investigate how residents of superdiverse neighborhoods put together their healthcare, we conducted qualitative interviews with 76 healthcare providers and 160 residents in four European cities - Bremen, Germany; Birmingham, UK; Lisbon, Portugal and Uppsala, Sweden, between September 2015 and April 2017. A common theme arising from the data was language and communication obstacles, with both healthcare providers and users experiencing language difficulties, despite all four countries having interpretation policies or guidelines to address language barriers in healthcare. Official interpreter services were seen to be unreliable and sometimes of poor quality, leading to a reliance on informal interpretation. Some coping strategies used by both service providers and users led to successful communication despite the lack of a common language. Where communication failed, this led to feelings of dissatisfaction and frustration among both users and providers. Language difficulties came up across all participating countries even though this was not prompted by interview questions, which highlights the widespread nature of language barriers and communication barriers and the need to address them in order to promote equal accessibility to good quality healthcare.

Superdiversity, migration and use of internet-based health information - results of a cross-sectional survey conducted in 4 European countries

BACKGROUND

Studies of factors associated with the use of Internet-based health information generally focus on general, rather than migrant populations. This study looked into the reasons why Internet-based health information is used and the effects of migration-related factors, other socio-demographic characteristics and health-related factors on the tendency to consult the Internet.

METHODS

In a cross-sectional survey conducted in eight superdiverse neighbourhoods - two each in Birmingham, United Kingdom; Bremen, Germany; Lisbon, Portugal and Uppsala, Sweden - participants were presented with six scenarios and asked to indicate the resources they most relied on when addressing a health concern from a given list. The scenarios included establishing the underlying causes of a health concern and seeking information about prescription drugs, treatments and services available as part of the public healthcare system. The list of resources included the public healthcare system, alternative medicine, family and friends, and the Internet. Frequencies for which the Internet was consulted for each different scenario were calculated and compared across the participating cities. The association between consulting Internet-based health information and migration-related factors, and further socio-demographic characteristics as well as health-related factors such as self-reported health and health literacy was assessed using multivariable logistic regressions.

RESULTS

Of the 2570 participants from all four cities who were included in the analyses, 47% had a migrant background and 35% originated from non-EU countries. About a third reported relying on Internet-based health information for at least one of the given scenarios. The two most frequently chosen scenarios were to find out about other possible treatments and prescription drugs. Generally, using Internet-based health information was negatively associated with being a first generation migrant (OR 0.65; 95% CI 0.46-0.93), having poor local language competency (OR 0.25; 95% CI 0.14-0.45), older age (≥60 years, OR 0.21; 95% CI 0.15-0.31), low education (OR 0.35; 95% CI 0.24-0.50) and positively associated with low trust in physicians (OR 2.13; 95% CI 1.47-3.10).

CONCLUSION

Our findings indicate the need to consider migration background and language competency when promoting the provision of healthcare services via the Internet so that information and services are widely accessible.

Determinants and impact of role-related time use allocation on self-reported health among married men and women: a cross-national comparative study

Background

Research on the effects of marriage on health maintains that there is a gender-specific gradient, with men deriving far greater benefits than women. One reason provided for this difference is the disproportionate amount of time spent by women on housework and childcare. However, this hypothesis has yet to be explicitly tested for these role-related time use activities. This study provides empirical evidence on the association between role-related time use activities (i.e. housework, childcare and paid work) and self-reported health among married men and women.

Methods

Data from the Multinational Time Use Study (MTUS) on 32,881 men and 26,915 women from Germany, Italy, Spain, the UK and the US were analyzed. Seemingly unrelated regression (SUR) models and multivariable logistic regression were used to estimate the association between role-related time use activities and self-reported health among married men and women.

Results

The findings showed that education, occupation and number of children under 18 years old in the household were the most consistent predictors of time allocation among married men and women. Significant gender differences were also found in time allocation, with women sacrificing paid working time or reducing time devoted to housework for childcare. Men, in contrast, were less likely to reduce paid working hours to increase time spent on childcare, but instead reduced time allocation to housework. Allocating more time to paid work and childcare was associated with good health, whereas time spent on housework was associated with poor health, especially among women.

Conclusions

Time allocation to role-related activities have differential associations on health, and the effects vary by gender and across countries. To reduce the gender health gap among married men and women, public policies need to take social and gender roles into account.

Community Intervention Self-Efficacy Scale for Parent Leaders (CONNECTED): Parents' Empowerment to Prevent Adolescent Alcohol Use

Empowering parents by actively engaging them in environmental prevention strategies is a promising approach that only a few programs use. Evidence suggests that when families and the wider community are engaged, alcohol prevention is more efficient. However, due to the novelty of this approach, no specific assessment tools for measuring this type of engagement are available. The objective of this study is to design a parental empowerment measurement tool to evaluate parents’ self-efficacy when engaging in environmental and community actions and to analyze its psychometric properties. A total of 132 parents active in in-school parent associations from Spain (n = 77; 58.4%) and Portugal (n = 55; 41.7%) completed a pencil and paper battery of four questionnaires, including the developed scale COmmuNity iNtervention SElf-Efficacy SCale for ParenT LEaDers (CONNECTED). The scale showed a good reliability and good test-retest stability in a three-month period. The convergent validity with other well-established instruments that assess similar constructs was significant. A preliminary confirmatory factor analysis (CFA) showed an acceptable fit. Environmental prevention supported by families is a promising preventive strategy because the participation and involvement of families is an effective way to address some risks in adolescence; however, new assessment tools are needed in this field. The developed scale could be a first step to identify the areas of need in a community and to monitor the progress and evaluate the outcomes of the preventive interventions implemented.

Racial/ethnic differences in the prevalence and incidence of metabolic syndrome in high-income countries: a protocol for a systematic review

BACKGROUND

Metabolic syndrome is a constellation of various cardiovascular and type 2 diabetes risk factors, such as abdominal obesity, atherogenic dyslipidemia, high blood pressure, and high blood glucose, but its prevalence varies widely by geographical region, sex, and race/ethnicity. The objective of this study is to examine the prevalence and incidence of metabolic syndrome among adults of different racial/ethnic origins in high-income countries.

METHODS

We designed and registered a study protocol for a systematic review of descriptive epidemiological data. Observational studies (e.g., cross sectional and cohort studies) reporting morbidity data of metabolic syndrome and conducted in a wide range of adult people (e.g., different racial/ethnic origins, including migrants) will be included. The primary outcome will be the prevalence and incidence of metabolic syndrome. Secondary outcomes will be the prevalence and incidence of individual components of metabolic syndrome (e.g., abdominal obesity, dyslipidemia, high blood pressure, and high blood glucose). Literature searches will be conducted in several electronic databases (from inception onwards), including MEDLINE, Web of Science Core Collection (Science Citation Index and Social Science Citation Index), CINAHL, and Cochrane Library. Two investigators will independently screen all reference titles, abstracts, and full-text articles. The methodological quality (or potential bias) of selected studies will be appraised using an appropriate tool. Our results will be described narratively. Random-effects meta-analysis will be conducted, if feasible and appropriate. Additional analyses will be conducted to explore the potential sources of heterogeneity.

CONCLUSION

This systematic review will identify, evaluate, and integrate prevalence and incidence data of metabolic syndrome, with focus on racial/ethnic differences in high-income countries. We anticipate our findings may guide policy formulation and identify knowledge gaps in the literature that future research should address.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42020157189.

[Socio-Culturally Sensitive Disease Prevention and Health Promotion: Development of a Theoretical Framework and Results of a Survey of Physical Activity Promotion Projects.]

OBJECTIVE

To develop a framework for socio-culturally sensitive disease prevention and health promotion and to assess which components of socio-cultural appropriateness are used in physical activity projects targeting migrants.

METHODS

Based on 9 expert interviews and a rapid review in PubMed and PsycInfo, we identified domains and strategies of socio-cultural sensitivity for disease prevention and health promotion. The domains were used as a basis for a survey of physical activity projects targeting migrants as listed in a national project data base ("Gesundheitliche Chancengleichheit").

RESULTS

We identified 5 domains for socio-cultural adaptation of prevention programs (peripheral, evidential, linguistic, constituent-involving and socio-cultural strategies). Using multiple strategies seems to increase the efficacy of the interventions. Of the 48 contacted projects, 29 participated in the survey. Almost all projects used strategies from 4 of the 5 domains. Evidential strategies were used to a lesser extent.

CONCLUSIONS

The developed framework can be used for both, planning and evaluating prevention programs targeting migrants. The project survey shows how socio-cultural appropriateness can be improved through a variety of strategies.

Feasibility of using respondent-driven sampling to recruit participants in superdiverse neighbourhoods for a general health survey

OBJECTIVES

Respondent-driven sampling (RDS), a modified chain-referral system, has been proposed as a strategy for reaching 'hidden' populations. We applied RDS to assess its feasibility to recruit 'hard-to-reach' populations such as migrants and the unemployed in a general health survey and compared it to register-based sampling (RBS).

METHODS

RDS was applied parallel to standard population RBS in two superdiverse neighbourhoods in Bremen, Germany. Prevalences of sample characteristics of interest were estimated in RDS Analyst using the successive sampling estimator. These were then compared between the samples.

RESULTS

Only 115 persons were recruited via RDS compared to 779 via RBS. The prevalence of (1) migrant background, (2) unemployment and (3) poverty risk was significantly higher in the RDS than in the RBS sample. The respective estimates were (1) 51.6 versus 32.5% (95% CI_RDS 40.4-62.7), (2) 18.1 versus 7.5% (95% CI_RDS 8.4-27.9) and (3) 55.0 versus 30.4% (95% CI_RDS 41.3-68.7).

CONCLUSIONS

Although recruitment was difficult and the number of participants was small, RDS proved to be a feasible method for reaching migrants and other disadvantaged persons in our study.

Exploring ethnic differences in understanding of self-rated health among persons of Turkish, Bosnian and German origin

OBJECTIVE

Self-rated health (SRH) is a widely used indictor of the subjective health status in population-based studies. However, differences in the reporting style across ethnic groups may limit the predictive ability of SRH for objective health outcomes. As part of the preparation phase of the UPWEB (understanding the practice and developing the concept of welfare bricolage) project, this study explored ethnic differences in the understanding of self-rated health among persons of Turkish, Bosnian and German origin, living in two northern Germany cities, Bremen and Hamburg.

RESULTS

Thirty persons, 10 per ethnic group, aged 32-82 years, took part in the assessment based on cognitive interviewing. All three ethnic groups defined SRH as the absence or presence of visible or non-visible disturbances and/or deviations from the norm, the ability or limited ability to act as well as the result of specific behaviours. However, only participants from the two migrant groups referred to community cohesion and religious or traditional beliefs as aspects of their SRH, indicating a systematic difference in the understanding of this question.

Smokeless tobacco and oral potentially malignant disorders in South Asia: a protocol for a systematic review

INTRODUCTION

Oral potentially malignant disorders (OPMDs) are chronic lesions or conditions characterized by a potential for malignant transformation. Apart from being possible pre-cursors to oral cancer, OPMDs themselves are usually painful and debilitating conditions having an influence on the quality of life, both in terms of pain and social disability. Smokeless tobacco (SLT) use is considered a major risk factor for OPMDs. SLT use is a culturally and socially acceptable habit in South Asia. According to a recent report, 90 % of the SLT burden of the whole world lies in the South Asian countries of Pakistan, India, Sri Lanka, Bangladesh, Bhutan, Nepal, Afghanistan, and Maldives. This review aims to assess the association between the use of various SLT products in South Asia and risk of OPMDs.

METHODS

This review will focus on epidemiological studies on the use of SLT and risk modification for OPMDs, which have been carried out in the human population of South Asian countries. Articles reporting estimates of relative risk, e.g., odds ratio (OR) or relative risk (RR) with their 95 % confidence intervals (CI) for SLT users versus non-users. Articles reporting data from which these effect estimates can be computed will be included in the review. We will search MEDLINE, the Science Citation Index (SCI), Scopus, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for relevant literature using a combination of keywords and MeSH terms, where applicable. Appropriate sources of gray literature will also be included in the search. The electronic searches will be supplemented by a hand search of the bibliographies of the included articles. The included studies will be assessed for their quality using an established quality assessment tool. All relevant data from the included articles will be recorded in an MS Excel spread sheet and then transferred to Rev Man 5.3 to carry out a meta-analysis. Heterogeneity among the estimates will be assessed through the I (2) statistic. Sensitivity and subgroup analysis will be carried out to see the effects of individual or group of studies on the pooled effect estimate. Results of the review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DISCUSSION

This review may have a potential limitation with regard to the designs of the studies included as we expect that most of the included studies will be of the observational types. We will however try to address this issue by conducting sensitivity and subgroup analysis of similar quality studies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015029705 .

Assessing the Acceptability and Usability of an Internet-Based Intelligent Health Assistant Developed for Use among Turkish Migrants: Results of a Study Conducted in Bremen, Germany

The Internet offers a new chance for health professionals to reach population groups not usually reached through traditional information channels, for example, migrants. Criticism has, however, been raised that most health information on the Internet is not easy to read and lacks cultural sensitivity. We developed an Internet-based bilingual health assistant especially for Turkish migrants in Germany, tested its acceptance, and evaluated its usability in a participatory research design with families with and without Turkish migrant background. The interactive health assistant covered the following: nutrition, physical activity, overweight, diabetes, as well as pregnancy and pregnancy support. The idea of an Internet-based health assistant was generally accepted by all participants of the evaluation study, as long as it would be incorporated in existing appliances, such as smartphones. The bilingual nature of the assistant was welcomed especially by first generation migrants, but migrant participants also indicated that not all health information needed to be made available in a culture-specific way. The participants were least satisfied with the nutrition component, which they felt should include recipes and ingredients from the culture of origin, as well as specific aspects of food preparation.

Retrospective assessment of self-reported exposure to medical ionizing radiation: results of a feasibility study conducted in Germany

Background

Exposure to medical ionizing radiation has been increasing over the past decades and constitutes the largest contributor to overall radiation exposure in the general population. While occupational exposures are generally monitored by national radiation protection agencies, individual data on medical radiation exposure for the general public are not regularly collected. The aim of this study was to determine the feasibility of assessing lifetime medical ionizing radiation exposure from diagnostic and therapeutic procedures retrospectively and prospectively within the framework of the German National Cohort study.

Methods

Retrospective assessment of individual medical radiation exposure was done using an interviewer-based questionnaire among 199 participants (87 men and 112 women) aged 20–69 randomly drawn from the general population at two recruitment locations in Germany. X-ray cards were distributed to 97 participants at one recruitment center to prospectively collect medical radiation exposure over a 6-month period. The Wilcoxon–Mann–Whitney test was used to test differences in self-reported median examination frequencies for the variables age, sex, and recruitment center. To evaluate the self-reported information on radiological procedures, agreement was assessed using health insurance data as gold standard for the time period 2005 to 2010 from 8 participants.

Results

Participants reported a median of 7 lifetime X-ray examinations (interquartile range 4–13), and 42% (n = 83) reported having had a CT scan (2, IQR = 1–3). Women reported statistically significant more X-ray examinations than men. Individual frequencies above the 75th percentile (≥15 X-ray examinations) were predominantly observed among women and in individuals >50 years of age. The prospective exposure assessment yielded a 60% return-rate of X-ray cards (n = 58). 16 (28%) of the returned cards reported radiological examinations conducted during the 6-month period but generally lacked more detailed exposure information. X-ray examinations reported for the period for which health insurance data were available provided a moderately valid measure of individual medical radiation exposure.

Conclusions

The assessment of more recent medical examinations seems in the German National Cohort study feasible, whereas lifetime medical radiation exposure appears difficult to assess via self-reports. Health insurance data may be a potentially useful tool for the assessment of individual data on medical radiation exposure both retrospectively and prospectively.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-015-1268-8) contains supplementary material, which is available to authorized users.

[Effectiveness of School-based Interventions to Prevent and/or Reduce Substance Use among Primary and Secondary School Pupils: A Review of Reviews]

OBJECTIVE

The aim of this study is to provide a current overview of the effectiveness of school-based interventions on prevention and/or reduction of substance use among children and adolescents aged 5-19 years.

METHODS

A systematic literature search was conducted in PubMed, Cochrane Library, Campbell Collaboration, NICE and ERIC. Systematic reviews and meta-analyses published between 2007 and 2013 were included in the analysis. 2 reviewers assessed the quality of the identified review articles and extracted the data.

RESULTS

14 review articles of moderate to good quality fulfilled the a-priori defined inclusion criteria. Capacity-promoting interventions, e. g., those focusing on strengthening self-confidence and peer resistance, show promising evidence of effectiveness. Multi-component and multi-level interventions are more suitable for the prevention of alcohol and cannabis consumption. Findings on the prevention of tobacco consumption are inconsistent. The effectiveness of knowledge-based interventions is limited. The long-term effectiveness of smoke-free competitions cannot be conclusively evaluated as the findings are discrepant.

CONCLUSIONS

School-based interventions should include capacity-promoting components and should address further levels beyond the individual, for example, organisational changes of the school setting. Further research is needed, in particular on the effectiveness of multi-component and multi-level interventions for the prevention of tobacco consumption.

Occupational exposure to low doses of ionizing radiation and cataract development: a systematic literature review and perspectives on future studies

Ionizing radiation is a well-known but little understood risk factor for lens opacities. Until recently, cataract development was considered to be a deterministic effect occurring at lens doses exceeding a threshold of 5-8 Gy. Substantial uncertainty about the level and the existence of a threshold subsists. The International Commission on Radiation Protection recently revised it to 0.5 Gy. Based on a systematic literature review of epidemiological studies on exposure to low levels of ionizing radiation and the occurrence of lens opacities, a list of criteria for new epidemiological studies was compiled, and a list of potential study populations was reviewed. Among 24 publications finally identified, six report analyses of acute exposures in atomic bomb survivors and Chernobyl liquidators, and the others report analyses of protracted exposures in occupationally, medically or accidentally exposed populations. Three studies investigated a dose threshold: in atomic bomb survivors, the best estimates were 1 Sv (95 % CI <0-0.8 Sv) regarding lensectomies; in survivors exposed as children, 0.6 Sv (90 % CI <0.0-1.2 Sv) for cortical cataract prevalence and 0.7 Sv (90 % CI 0.0-2.8 Sv) for posterior subcapsular cataract; and in Chernobyl liquidators, 0.34 Sv (95 % CI 0.19-0.68 Sv) for stage 1 cataract. Current studies are heterogeneous and inconclusive regarding the dose-response relationship. Protracted exposures and high lens doses occur in several occupational groups, for instance, in physicians performing fluoroscopy-guided interventional procedures, and in accidentally exposed populations. New studies with a good retrospective exposure assessment are feasible and should be initiated.

Higher risk perception of HIV than of chlamydia and HPV among secondary school students in two German cities

Background

Chlamydia and genital human papillomavirus (HPV) are the two most common sexually transmitted infections (STIs) among teens and young adults in industrialised countries. The majority of adolescents, however, have limited or no knowledge of these infections. Within the context of a cross-sectional survey on awareness and knowledge of sexually transmitted infections, secondary school students attending the 8th grade and above in Bremen and Bremerhaven, two cities in northern Germany, were asked to rate the risk of peers to get infected with HIV, HPV or chlamydia.

Methods

Between October and December 2011, students aged 12–20 years completed an anonymous, self-administered questionnaire at their school. In addition to answering questions on awareness and knowledge of sexually transmitted infections, all students were also asked to rate the risk of peers to get infected with HIV, HPV or chlamydia. Furthermore, those reporting ever having sexual intercourse were asked to rate their own risk of getting infected with each of the three infections.

Results

1,148 students, 55% female, completed the questionnaire. 27% of the students reported having had sexual intercourse. 68% of all students rated the risk of same-aged students to get infected with HIV/AIDS as high/medium. The corresponding proportions for HPV and chlamydia were 19 and 25% respectively. Those reporting ever having sexual intercourse generally perceived their own risk of getting infected with HIV, chlamydia or HPV as lower than that of their peers.

Conclusion

Generally, the risk of getting infected with HIV was perceived as being higher than that of getting infected with HPV or chlamydia, most likely due to the fact that the students were more aware of HIV than of the other two infections. Efforts should be made to improve awareness and knowledge of HPV and chlamydia among school going adolescents, and to make them realize that these are common infections that are preventable.

HPV infection awareness and self-reported HPV vaccination coverage in female adolescent students in two German cities

Low levels of human papillomavirus (HPV) awareness and knowledge have been observed in the few studies conducted among school-going adolescents. Such data are lacking in Germany. To assess awareness of HPV and of vaccination status among girls attending grades 8-13 in Bremen and Bremerhaven, two German cities. Participants completed a questionnaire in school including questions on demographic characteristics, about HPV awareness and on vaccination status. We analysed the relationship between awareness of HPV, of vaccination status and vaccine uptake and several variables including age and migrant background using univariate and multivariate logistic regression. Six hundred and thirty-two girls aged 12-20 years completed the questionnaire. 50 % had no awareness of HPV, 12 % reported being vaccinated against HPV and 57 % did not know whether or not they were vaccinated against HPV. In multivariate analyses, ever had sex was associated with awareness of HPV, and ever been to a gynaecologist with awareness of vaccination status. Our results may be an indication that female adolescents in Germany are not adequately informed and counselled about HPV and associated issues.

Occupation and risk of glioma, meningioma and acoustic neuroma: results from a German case-control study (interphone study group, Germany)

BACKGROUND

Several epidemiological studies have investigated the association between occupation and brain tumour risk, but results have been inconclusive. We investigated the association between six occupational categories defined a priori: chemical, metal, agricultural, construction, electrical/electronic and transport, and the risk of glioma, meningioma and acoustic neuroma.

METHODS

In a population-based case-control study involving a total of 844 cases and 1688 controls conducted from 2000 to 2003, detailed information on life-long job histories was collected during personal interviews and used to create job calendars for each participant. Job title, job activity, job number, and the starting and ending dates of the activity were recorded for all activities with duration of at least 1 year. Reported occupational activities were coded according to the International Standard Classification of Occupations 1988 (ISCO 88). For the analyses we focused on six a priori defined occupational sectors, namely chemical, metal, agricultural, construction, electrical/electronic and transport. Multiple conditional logistic regression analysis was used to estimate odds ratios and their 95% confidence intervals.

RESULTS

Most of the observed odds ratios were close to 1.0 for ever having worked in the six occupational sectors and risk of glioma, meningioma and acoustic neuroma. Sub-group analyses according to duration of employment resulted in two elevated odds ratios with confidence intervals excluding unity.

CONCLUSIONS

We did not observe an increased risk of glioma or meningioma for occupations in the agricultural, construction, transport, chemical, electrical/electronic and metal sectors. The number of 'significant' odds ratios is consistent with an overall 'null-effect'.

Emerging aspects of mobile phone use

The mobile phone is a modern-day invention, which has managed to reach many parts of the world enabling telecommunications across areas where it was not possible before. Although these devices have proved to be life saving in certain circumstances (e.g., after accidents) and helped improve the quality of life in some sectors, concerns continue to be raised about potential adverse health impacts associated with their use. These range from cancer and cognitive deficiencies to subjective effects, such as a feeling of warmth around the ear used, headache and fatigue. We provide an overview of the concerns raised and summarise what is known about them. We conducted a literature search in Pubmed/Medline to identify published papers on health effects of mobile phones, and an intensive search on the Internet to collect data on the global use of mobile phones. In the year 2000, there were an estimated 500 million mobile phone users worldwide. Today, there are about 3.3 billion users. The use of mobile phones among young children and adolescents is also increasing. Health-risk research has mainly focused on adults and on a single outcome, brain tumours. No significant relationship has been established between mobile phone use and the incidence or growth of brain tumours. Other research indicates emerging concerns, including hearing problems and self-reported health symptoms, such as tiredness, stress, headache, anxiety, concentration difficulties and sleep disturbances, but results remain inconclusive. Currently, there is little epidemiological evidence indicating that the use of mobile phones causes adverse health effects.

Medical exposure to ionising radiation and the risk of brain tumours: Interphone study group, Germany

BACKGROUND

The role of exposure to low doses of ionising radiation in the aetiology of brain tumours has yet to be clarified. The objective of this study was to investigate the association between medically or occupationally related exposure to ionising radiation and brain tumours.

METHODS

We used self-reported medical and occupational data collected during the German part of a multinational case-control study on mobile phone use and the risk of brain tumours (Interphone study) for the analyses.

RESULTS

For any exposure to medical ionising radiation we found odds ratios (ORs) of 0.63 (95% confidence interval (CI)=0.48-0.83), 1.08 (95% CI=0.80-1.45) and 0.97 (95% CI=0.54-1.75) for glioma, meningioma and acoustic neuroma, respectively. Elevated ORs were found for meningioma (OR 2.32, 95% CI: 0.90-5.96) and acoustic neuroma (OR 6.45, 95% CI: 0.62-67.16) for radiotherapy to the head and neck regions.

CONCLUSION

We did not find any significant increased risk of brain tumours for exposure to medical ionising radiation.

Predicting non-return to work in patients attending cardiac rehabilitation

Return to work (RTW) is the primary goal in the rehabilitation of patients suffering from coronary heart diseases. However, in spite of expensive rehabilitative efforts, many patients do not resume work following cardiac rehabilitation. To increase cost-effectiveness, predictive tests for non-RTW are needed to identify patients who are at risk of applying for early retirement, for reasons other than medical ones, at the beginning of the rehabilitation process, so that the necessary intervention is incorporated into the rehabilitation programme. As part of a study aiming at developing an advisory programme which can be integrated into existing rehabilitation programmes, we developed a screening instrument for the identification of persons at risk of not returning to work at the onset of the rehabilitation process. More than 65% of the participants who had not returned to work 6 and 12 months following rehabilitation had been correctly identified as risk patients at the beginning of the rehabilitation process. Seventy-five percent had been correctly identified as not being at risk. Multiple regression analysis results showed that increased age, profession, positive expectations concerning RTW and level of depression were significant predictors of RTW. Gender and anxiety were not significant predictors.

Assessment of radiofrequency exposure from cellular telephone daily use in an epidemiological study: German Validation study of the international case-control study of cancers of the brain--INTERPHONE-Study

OBJECTIVE

The objective of the study is to validate self-reported cellular phone use information by comparing it with the cumulative emitted power and duration of calls measured by software-modified cellular phones (SMP). The information was obtained using a questionnaire developed for the international case-control study on the risk of the use of mobile phones in tumours of the brain or salivary gland (INTERPHONE-study).

METHOD

The study was conducted in Bielefeld, Germany. Volunteers were asked to use SMPs instead of their own cellular phones for a period of 1 month. The SMP recorded the power emitted by the mobile phone handset during each base station contact. Information on cellular phone use for the same time period from traffic records of the network providers and from face-to-face interviews with the participants 3 months after the SMP use was assessed. Pearson's correlation coefficients and linear regression models were used to analyse the association between information from the interview and from the SMP.

RESULTS

In total, 1757 personal mobile phone calls were recorded for 45 persons by SMP and traffic records. The correlation between the self-reported information about the number and the duration of calls with the cumulative power of calls was 0.50 (P<0.01) and 0.48 (P<0.01), respectively. Almost 23% of the variance of the cumulative power was explained by either the number or the cumulative duration of calls. After inclusion of possible confounding factors in the regression model, the variance increased to 26%. Minor confounding factors were "network provider", "contract form", and "cellular phone model".

DISCUSSION

The number of calls alone is a sufficient parameter to estimate the cumulative power emitted by the handset of a cellular telephone. The cumulative power emitted by these phones is only associated with number of calls but not with possible confounding factors. Using the mobile phone while driving, mainly in cities, or mainly in rural areas is not associated with the recorded cumulative power in the SMP.

Validation of self-reported cellular phone use

BACKGROUND

In recent years, concern has been raised over possible adverse health effects of cellular telephone use. In epidemiological studies of cancer risk associated with the use of cellular telephones, the validity of self-reported cellular phone use has been problematic. Up to now there is very little information published on this subject.

METHODS

We conducted a study to validate the questionnaire used in an ongoing international case-control study on cellular phone use, the "Interphone study". Self-reported cellular phone use from 68 of 104 participants who took part in our study was compared with information derived from the network providers over a period of 3 months (taken as the gold standard).

RESULTS

Using Spearman's rank correlation, the correlation between self-reported phone use and information from the network providers for cellular phone use in terms of the number of calls per day was good (r=0.62, 95% CI: 0.45-0.75), while that of the average duration of each call was rather moderate (r=0.34, 95% CI: 0.11-0.54). Similar results were found when Kappa coefficients were estimated. A value of r=0.56 (Spearman's correlation, CI: 0.38-0.70) was found for cumulative cellular phone use.

CONCLUSION

Our study suggests that cellular phone use is easier to recall in terms of number of calls made than in terms of cumulative phone use and should thus be used as the basis for the dose-response analysis.