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Trauth J, Kantelhardt V, Usenko B, Knipper M, Kuhns M, Friesen I, Herold S. Bedaquiline, pretomanid and linezolid in multidrug-resistant and pre-extensively drug-resistant tuberculosis in refugees from Ukraine and Somalia in Germany. Eur Respir J 2024; 63:2400303. [PMID: 38636988 DOI: 10.1183/13993003.00303-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Janina Trauth
- Department of Medicine V - Infectious Diseases, Justus-Liebig-University Giessen, member of the German Lung Center (DZL) and the German Center for Infectious Diseases Research (DZIF), Giessen, Germany
| | - Vera Kantelhardt
- Department of Medicine V - Infectious Diseases, Justus-Liebig-University Giessen, member of the German Lung Center (DZL) and the German Center for Infectious Diseases Research (DZIF), Giessen, Germany
| | - Bohdan Usenko
- Department of Medicine V - Infectious Diseases, Justus-Liebig-University Giessen, member of the German Lung Center (DZL) and the German Center for Infectious Diseases Research (DZIF), Giessen, Germany
| | - Michael Knipper
- Global Health, Migration and Medical Humanities, University of Giessen, Giessen, Germany
| | - Martin Kuhns
- National and WHO Supranational Reference Laboratory for Tuberculosis, Research Center Borstel, Borstel, Germany
| | - Inna Friesen
- National and WHO Supranational Reference Laboratory for Tuberculosis, Research Center Borstel, Borstel, Germany
| | - Susanne Herold
- Department of Medicine V - Infectious Diseases, Justus-Liebig-University Giessen, member of the German Lung Center (DZL) and the German Center for Infectious Diseases Research (DZIF), Giessen, Germany
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Jaramillo Contreras AC, Cabieses B, Knipper M, Rocha-Jiménez T. Borders and liminality in the right to health of migrants in transit: The case of Colchane in Chile and Necoclí in Colombia. J Migr Health 2024; 9:100230. [PMID: 38707968 PMCID: PMC11067324 DOI: 10.1016/j.jmh.2024.100230] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024] Open
Abstract
The absence of the right to health of migrants in transit has evolved into a significant global health concern, particularly in the border regions thus, this study aims to improve knowledge in this area by exploring the effects of the spatio-temporal liminal characteristics at borders in the achievement of the right to health of migrants in transit moving across two of the most transited and dangerous borders in Latin America: Colchane (Chile-Bolivia) and the Darién Gap (Colombia-Panamá). Through a qualitative descriptive multi-case study, we implemented 50 semi-structured interviews (n = 30 in Chile and n = 20 in the Darién/Necoclí) involving national, regional, and local stakeholders. The findings highlight that the fulfilment of the right to health of migrants in transit is hindered by liminal dynamics at the borders. These dynamics include closure of borders, (in)securities, uncertainty and waiting, lack of economic resources, lack of protection to all, liminal politics, and humanitarian interventions. These findings surface how the borders' liminality exacerbates the segregation of migrants in transit by placing them in a temporospatial limbo that undermines their right to health. Our study concludes that not just the politics but also the everyday practices, relationships and social infrastructure at borders impedes the enjoyment of the right to health of distressed migrants in transit. The short-term humanitarian response; illicit dynamics at borders; migratory regulations; and border and cross-border political structures are some of the most significant determinants of health at these borderlands.
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Affiliation(s)
| | - Báltica Cabieses
- Director of the research Centre of Global Intercultural Health at ICIM Universidad del Desarrollo, Chile, Avenida Plaza 680 Edificio O, ICIM UDD, Las Condes, Santiago Chile
- Senior visiting scholar, Department of Health Sciences, University of York, England. Seebohm Rowntree Building University of York, Heslington, York, YO10 5DD, UK
| | - Michael Knipper
- Institute of History, Theory, Ethics of Medicine at Justus-Liebig University of Giessen, Leihgesterner Weg 52, 35392 Giessen, Germany
| | - Teresita Rocha-Jiménez
- Society and Health Research Centre, Faculty of Social Sciences and Arts, Universidad Mayor, José Toribio Medina 29, Santiago Centro, Santiago, Chile
- Principal Investigator, Millennium Nucleus on Sociomedicine, José Toribio Medina 29, Santiago Centro, Santiago, Chile
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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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Rocha-Jimenez T, Olivari C, Martínez A, Knipper M, Cabieses B. "Border closure only increased precariousness": a qualitative analysis of the effects of restrictive measures during the COVID-19 pandemic on Venezuelan's health and human rights in South America. BMC Public Health 2023; 23:1846. [PMID: 37735379 PMCID: PMC10515012 DOI: 10.1186/s12889-023-16726-0] [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: 05/02/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND In 2010, a political and social crisis pushed thousands of Venezuelans out of their country; today, seven million Venezuelans live abroad. In addition, during the COVID-19 pandemic, border closure increased and affected specific vulnerable migration flows, such as Venezuelans trying to migrate to Chile through the Northern borders. In this context, there is little evidence of migrants' health status and needs, their access to health services, and other basic needs (e.g., housing) from a human rights perspective. Therefore, we qualitatively explored the effects of border closure due to the COVID-19 pandemic on Venezuelan migrants' health and human rights, focusing on access to healthcare in the Northern Chilean border that adjoins Peru and Bolivia. METHODS Following a case-study qualitative design, we conducted an ethnography that included participatory observation of relevant sites (e.g., hospitals, main squares, migrant shelters) in Antofagasta, Iquique, and Arica and 30 in-depth interviews with actors in the health sector (n = 7), experts from the non-governmental sector (n = 16), and governmental actors (n = 7) in three large cities close to the Northern border. RESULTS We found four main dimensions: (i) border and migration processes, (ii) specific groups and intersectionality, (iii) barriers to healthcare services, and (iv) regional and local responses to the crisis during the COVID-19 pandemic. Programs characterized by the presence of healthcare providers in the field were essential to attend to migrants' health needs at borders. CONCLUSIONS Coordination between actors is crucial to implement regional protocols that respond to current migration phenomena and migrants' health needs. Health policies using a human rights approach are urgently required to respond to migrants' healthcare needs at borders in South America.
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Affiliation(s)
- Teresita Rocha-Jimenez
- Society and Health Research Center, School of Psychology, Faculty of Social Sciences and Arts, Universidad Mayor, Santiago, Chile
- Millennium Nucleus On Sociomedicine, Santiago, Chile
| | - Carla Olivari
- Society and Health Research Center, School of Psychology, Faculty of Social Sciences and Arts, Universidad Mayor, Santiago, Chile
| | - Alejandra Martínez
- Center for Technology and Behavioral Health, Dartmouth College, Hanover, New Heaven, USA
| | - Michael Knipper
- Global Health, Migration and Medical Humanities, University of Giessen, Giessen, Germany
- Board of Lancet Migration Latin America, Lima, Peru
| | - Báltica Cabieses
- Board of Lancet Migration Latin America, Lima, Peru.
- Centre for Global Intercultural Health (CeSGI), Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
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Fülbert H, Schäfer LN, Gerspacher LM, Bösner S, Schut C, Krolewski R, Knipper M. Elective course "Climate-sensitive health counselling" - prevention as an opportunity for people and planet? An interactive, student-led project focusing on prevention and agency in physician's climate communication. GMS J Med Educ 2023; 40:Doc34. [PMID: 37377566 PMCID: PMC10291343 DOI: 10.3205/zma001616] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 12/15/2022] [Accepted: 02/06/2023] [Indexed: 06/29/2023]
Abstract
Objective According to the WHO, anthropogenic climate change poses the greatest threat to human health in the 21st century. However, the link between climate change and human health is not an integral part of medical education in Germany. Within a student-led project, an elective clinical course was designed and successfully implemented, which has been made accessible to undergraduate medical students at the Universities of Giessen and Marburg. The implementation and didactic concept are explained in this article. Methodology In a participatory format, knowledge is imparted using an action-based, transformative approach. Topics discussed are, amongst others, interactions of climate change and health, transformative action, and health behavior, as well as "green hospital" and the simulation of a "climate-sensitive health counselling". Lecturers from different disciplines within and beyond medicine are invited as speakers. Results Overall, the elective was evaluated positively by the participants. The fact that there is a high demand among students for participation in the elective, as well as for the transfer of concepts underlines the need for including this topic into medical education. The implementation and further development of the concept at two universities with different study regulations demonstrates its adaptability. Conclusion Medical education can raise awareness of the multiple health consequences of the climate crisis, can have a sensitizing and transformative effect on various levels, and can promote climate-sensitive action ability in patient care. In the long term, however, these positive consequences can only be guaranteed by including mandatory education on climate change and health in medical curricula.
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Affiliation(s)
- Hannah Fülbert
- Justus Liebig University Giessen, Medical Faculty, Giessen, Germany
- Health for Future Giessen, Giessen, Germany
| | - Louis N. Schäfer
- Philipps University Marburg, Medical Faculty, Marburg, Germany
- Health for Future Marburg, Marburg, Germany
| | - Laura M. Gerspacher
- Justus Liebig University Giessen, Medical Faculty, Giessen, Germany
- Health for Future Giessen, Giessen, Germany
| | - Stefan Bösner
- Philipps University Marburg, Department of General Practice/Family Medicine, Marburg, Germany
| | - Christina Schut
- Justus Liebig University Giessen, Institute of Medical Psychology, Giessen, Germany
| | - Ralph Krolewski
- Academic teaching practice of the University of Cologne, Gummersbach, Germany
| | - Michael Knipper
- Justus Liebig University Giessen, Institute for History of Medicine, Giessen, Germany
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Hanewald B, Knipper M, Daub J, Ebert S, Bogdanski C, Hinder L, Hall M, Berthold D, Stingl M. Addressing the Mental Health Challenges of Refugees-A Regional Network-Based Approach in Middle Hesse Germany. Int J Environ Res Public Health 2022; 19:13436. [PMID: 36294018 PMCID: PMC9602567 DOI: 10.3390/ijerph192013436] [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] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Refugees constitute a vulnerable group with an increased risk of developing trauma-related disorders. From a clinician's integrative perspective, navigating the detrimental impact of the social, economic, structural, and political factors on the mental health of refugees is a daily experience. Therefore, a collective effort must be made to reduce health inequities. The authors developed a treatment concept which provides broader care structures within a scientific practitioner's approach. The resulting "Trauma Network" addresses the structural challenges for refugees in Middle Hesse. Accompanying research provided a sound basis for further discussions with policy-makers to improve the situation for refugees in the short- and long-term.
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Affiliation(s)
- Bernd Hanewald
- Center for Psychiatry and Psychotherapy, University of Giessen, 35392 Giessen, Germany
| | - Michael Knipper
- Institute for the History of Medicine, University of Giessen, 35392 Giessen, Germany
| | - Janneke Daub
- Refugee Law Clinic Giessen, Public and European Law at the University of Giessen Law School, 35394 Giessen, Germany
| | - Saskia Ebert
- Refugee Law Clinic Giessen, Public and European Law at the University of Giessen Law School, 35394 Giessen, Germany
| | | | - Laura Hinder
- Research Network on Migration and Human Rights, Public and European Law at the University of Giessen Law School, 35394 Giessen, Germany
| | - Mila Hall
- Center for Psychiatry and Psychotherapy, University of Giessen, 35392 Giessen, Germany
| | - Daniel Berthold
- Department for Medical Oncology and Palliative Care, University of Giessen, 35392 Giessen, Germany
| | - Markus Stingl
- Center for Psychiatry and Psychotherapy, University of Giessen, 35392 Giessen, Germany
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Bojorquez I, Cabieses B, Arósquipa C, Arroyo J, Novella AC, Knipper M, Orcutt M, Sedas AC, Rojas K. Migration and health in Latin America during the COVID-19 pandemic and beyond. Lancet 2021; 397:1243-1245. [PMID: 33812478 PMCID: PMC9753767 DOI: 10.1016/s0140-6736(21)00629-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/05/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Ietza Bojorquez
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, CP 22560, Mexico.
| | - Báltica Cabieses
- Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo, Las Condes, Santiago, Chile
| | | | - Juan Arroyo
- Pontificia Universidad Católica del Perú, Lima, Perú
| | | | - Michael Knipper
- Institute for the History of Medicine, University Justus Liebig Giessen, Giessen, Germany
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | - Ana Cristina Sedas
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Karol Rojas
- Universidad de Costa Rica, San José, Mercedes, Costa Rica
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Knipper M, Sedas AC, Keshavjee S, Abbara A, Almhawish N, Alashawi H, Lecca L, Wilson M, Zumla A, Abubakar I, Orcutt M. The need for protecting and enhancing TB health policies and services for forcibly displaced and migrant populations during the ongoing COVID-19 pandemic. Int J Infect Dis 2021; 113 Suppl 1:S22-S27. [PMID: 33775886 PMCID: PMC8752449 DOI: 10.1016/j.ijid.2021.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
Disruption of health services due to the COVID-19 pandemic threatens to derail progress being made in tuberculosis control efforts. Forcibly displaced people and migrant populations face particular vulnerabilities as a result of the COVID-19 pandemic, which leaves them at further risk of developing TB. They inhabit environments where measures such as “physical distancing” are impossible to realize and where facilities like camps and informal temporary settlements can easily become sites of rapid disease transmission. In this viewpoint we utilize three case studies—from Peru, South Africa, and Syria—to illustrate the lived experience of forced migration and mobile populations, and the impact of COVID-19 on TB among these populations. We discuss the dual pandemics of TB and COVID-19 in the context of migration through a syndemic lens, to systematically address the upstream social, economic, structural and political factors that - in often deleterious dynamics - foster increased vulnerabilities and risk. Addressing TB, COVID-19 and migration from a syndemic perspective, not only draws systematic attention to comorbidity and the relevance of social and structural context, but also helps to find solutions: the true reality of syndemic interactions can only be fully understood by considering a particular population and bio- social context, and ensuring that they receive the comprehensive care that they need. It also provides avenues for strengthening and expanding the existing infrastructure for TB care to tackle both COVID-19 and TB in migrants and refugees in an integrated and synergistic manner.
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Affiliation(s)
- Michael Knipper
- Institute for the History of Medicine, University Justus Liebig Giessen, 35392 Giessen, Germany.
| | - Ana Cristina Sedas
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Aula Abbara
- Imperial College London, Department of Infectious Disease, St Mary's Hospital, London, UK; Syria Public Health Network, Syria.
| | - Naser Almhawish
- Assistance Coordination Unit (ACU), Early Warning Alert and Response Network (EWARN), Gaziantep, Turkey.
| | | | - Leonid Lecca
- Partners in Health, Lima, Peru, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Almuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Miriam Orcutt
- Institute for Global Health, University College London, London WC1N 1EH, UK.
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Zumla A, Chakaya J, Khan M, Fatima R, Wejse C, Al-Abri S, Fox GJ, Nachega J, Kapata N, Knipper M, Orcutt M, Goscé L, Abubakar I, Nagu TJ, Mugusi F, Gordon AK, Shanmugam S, Bachmann NL, Lam C, Sintchenko V, Rudolf F, Amanullah F, Kock R, Haider N, Lipman M, King M, Maeurer M, Goletti D, Petrone L, Yaqoob A, Tiberi S, Ditiu L, Sahu S, Marais B, Issayeva AM, Petersen E. World Tuberculosis Day 2021 Theme - 'The Clock is Ticking' - and the world is running out of time to deliver the United Nations General Assembly commitments to End TB due to the COVID-19 pandemic. Int J Infect Dis 2021; 113 Suppl 1:S1-S6. [PMID: 33746094 DOI: 10.1016/j.ijid.2021.03.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Jeremiah Chakaya
- Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - Mishal Khan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Razia Fatima
- National TB Control Program, Islamabad, Common Unit (HIV, TB, Malaria), Chak Shahzad, Islamabad, Pakistan.
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark.
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Oman.
| | - Greg J Fox
- WHO Collaborating Centre for Tuberculosis, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.
| | - Jean Nachega
- Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa; University of Pittsburgh, Pittsburgh, PA, USA; University of Stellenbosch, South Africa.
| | - Nathan Kapata
- Ministry of Health, Zambia National Public Health Institute, Lusaka, Zambia.
| | - Michael Knipper
- Institute for the History of Medicine, University Justus Liebig Giessen, Germany.
| | - Miriam Orcutt
- Institute for Global Health, University College London, United Kingdom.
| | - Lara Goscé
- University College London, United Kingdom.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, United Kingdom.
| | - Tumaini Joseph Nagu
- Muhimbili University of Health and Allied Sciences Dar es Salaam, Dar es Salaam, Tanzania.
| | - Ferdinand Mugusi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Alice Kizny Gordon
- Centre for Infectious Diseases and Microbiology (CIDM), Institute of Clinical Pathology and Medical Research (ICPMR), The University of Sydney, New South Wales, Australia.
| | - Sivakumar Shanmugam
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India.
| | - Nathan Lloyd Bachmann
- Centre for Infectious Diseases and Microbiology (CIDM), University of Sydney, New South Wales, Australia.
| | - Connie Lam
- Institute of Clinical Pathology and Medical Research (ICPMR), Westmead, New South Wales, Australia.
| | - Vitali Sintchenko
- WHO Collaborating Centre for Tuberculosis, Marie Bashir Institute for Infectious Diseases and Biosecurity and Centre for Infectious Diseases and Microbiology (CIDM), University of Sydney, New South Wales, Australia.
| | - Frauke Rudolf
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark; Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau.
| | | | - Richard Kock
- Royal Veterinary College, Hatfield, United Kingdom.
| | - Najmul Haider
- Pathobiology and Population Sciences, The Royal Veterinary College, Hawkshead Campus, Hatfield, United Kingdom.
| | - Marc Lipman
- Respiratory Medicine, Royal Free London NHS Foundation Trust, UCL Respiratory Medicine, University College London, London, United Kingdom.
| | - Michael King
- NTM Patient Care UK, The Grove Centre London, United Kingdom.
| | - Markus Maeurer
- Champalimaud Centre for the Unknown, Lisbon, Portugal; University of Mainz, Mainz, Germany.
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani"- IRCCS, Rome, Italy.
| | - Linda Petrone
- Translational Research Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani"- IRCCS, Rome, Italy.
| | - Aashifa Yaqoob
- Common Management Unit (TB, HIV & Malaria), Islamabad, Pakistan.
| | - Simon Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
| | | | | | - Ben Marais
- WHO Collaborating Centre for Tuberculosis and the Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, New South Wales, Australia.
| | | | - Eskild Petersen
- Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark; European Society for Clinical Microbiology and Infectious Diseases, ESCMID, Basel, Switzerland; International Society for Infectious Diseases, ISID, Boston, USA.
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Affiliation(s)
- Michael Knipper
- Institute for the History of Medicine, University Justus Liebig Giessen, 35392 Giessen, Germany.
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
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Orcutt M, Mussa R, Hiam L, Veizis A, McCann S, Papadimitriou E, Ponthieu A, Knipper M. EU migration policies drive health crisis on Greek islands. Lancet 2020; 395:668-670. [PMID: 31948786 DOI: 10.1016/s0140-6736(19)33175-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Miriam Orcutt
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Reem Mussa
- MSF Operational Centre Brussels, Brussels, Belgium
| | - Lucinda Hiam
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | | | | | | | | | - Michael Knipper
- Justus Liebig University Giessen, Erwin Stein Building, Giessen, Germany
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Hanewald B, Knipper M, Fleck W, Pons-Kühnemann J, Hahn E, Ta TMT, Brosig B, Gallhofer B, Mulert C, Stingl M. Different Patterns of Mental Health Problems in Unaccompanied Refugee Minors (URM): A Sequential Mixed Method Study. Front Psychiatry 2020; 11:324. [PMID: 32411027 PMCID: PMC7198874 DOI: 10.3389/fpsyt.2020.00324] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/31/2020] [Indexed: 11/18/2022] Open
Abstract
Unaccompanied refugee minors (URM) represent one of the most vulnerable refugee groups due to their young age, developmental status, and insufficient coping strategies. Clinical observations indicate that the frequency of mental health problems varies between different URM subgroups. In the present research project, clinical interviews as a source of qualitative data were combined with quantitative psychometric information in a mixed-method approach in order to study the patterns of mental health problems in 561 URM from four different language groups (Arabic, Farsi, Somali, and Tigrinya) immediately after arrival in the host country (Germany). Qualitative analysis obtained as differentiating categories "language, countries of origin, age, and gender"; quantitatively, the Refugee Health Screener (RHS-15) was applied. According to the positive screening results, the highest number of mental complaints was returned by children and adolescents speaking Farsi (65.9%) and Somali (65.8%). They were followed by URM speaking Arabic (49.4%) and Tigrinya (43.3%). The results were influenced not only by origin, but also by age (with higher burden among older Farsi-speaking URM) and gender (with higher burden among male URM). Although the prevalences in URM subgroups differ, the observed high rates of positive screening results in our sample of URM from Germany substantiate the need for early detection of mental complaints and appropriate mental health care for at least every second URM.
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Affiliation(s)
- Bernd Hanewald
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Michael Knipper
- Institute of History of Medicine, Culture, Migration & Global Health, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Jörn Pons-Kühnemann
- Institute of Medical Informatics, Justus-Liebig-University Giessen, Giessen, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Burkhard Brosig
- Department of Family Psychosomatics, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernd Gallhofer
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Christoph Mulert
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Markus Stingl
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
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13
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Stingl M, Knipper M, Hetzger B, Richards J, Yazgan B, Gallhofer B, Hanewald B. Assessing the special need for protection of vulnerable refugees: testing the applicability of a screening method (RHS-15) to detect traumatic disorders in a refugee sample in Germany. Ethn Health 2019; 24:897-908. [PMID: 29081242 DOI: 10.1080/13557858.2017.1379598] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Although EU member states are obligated to take special account of the situation of particularly vulnerable refugees, appropriate and specific measures to detect affected asylum seekers are not yet available. This study tries to pave the way for the implementation of an adequate instrument which at the same time assesses these needs of suffering people whilst responding to the need for mental health assessments specifically designed for refugees. This was done by testing the implementation of a screening method (Refugee Health Screener RHS-15) for trauma related mental health problems in refugees. Design: Two refugee samples in Germany (differing in arrival time: 126 applicants for asylum residing in the initial reception center and 116 living in long term communal accommodations) were assessed with the culturally sensitive Refugee Health Screener (RHS-15) to detect the incidence of mental health problems amongst them. Test fairness, reasonableness, susceptibility, transparency, acceptance, external design, utility and economy of the instrument were examined to check the applicability of the RHS-15 standardization test. Results: The RHS-15 indicates a good practical feasibility as the examination of the focused psychometric characteristics suggests. It became apparent, that implementing a screening procedure depends on political, legal and medical context factors that need to be considered. 2/3 of the participants had a positive screening result, which needs further diagnostic clarification in a second step. Conclusion: The RHS-15 seems to be practicable, economical, and rapidly deployable for the widespread detection of traumatic disorders in refugees living in Europe. The tool proved useful to aid diagnostic assessments and provide treatment to individuals in need, however the time of examination (resp. the duration of staying in the target land) influences the results.
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Affiliation(s)
- Markus Stingl
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Michael Knipper
- Institute for the History of Medicine, Justus-Liebig-University , Giessen , Germany
| | - Björge Hetzger
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Jessica Richards
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Bülent Yazgan
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Bernd Gallhofer
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
| | - Bernd Hanewald
- Centre for Psychiatry and Psychotherapy, Justus-Liebig-University , Giessen , Germany
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14
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Abstract
Due to demographic change and altered recreational behavior, a rapid increase in hearing deficits is expected in the next 20-30 years. Consequently, the risk of age-related loss of speech discrimination, tinnitus, hyperacusis, or-as recently shown-dementia, will also increase. There are increasing indications that the loss of specific hearing fibers in humans and animals is involved in various hearing disorders. This fiber loss can be caused by cochlear synaptopathy or deafferentation and does not necessarily lead to clinically measurable threshold changes. Animal experiments have shown that reduced auditory nerve activity due to acoustic trauma or aging can be centrally compensated by disproportionately elevated and faster auditory brainstem responses (ABR). The analysis of the suprathreshold amplitudes of auditory evoked brain stem potentials and their latency in combination with non-invasive imaging techniques such as magnetic resonance imaging can help to identify the central compensatory ability of subjects and to assign defined hearing deficits.
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Affiliation(s)
- M Knipper
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Plastische Operationen, Sektion Molekulare Hörphysiologie, Hörforschungszentrum Tübingen (THRC), Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Deutschland.
| | - B Hofmeier
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Plastische Operationen, Sektion Molekulare Hörphysiologie, Hörforschungszentrum Tübingen (THRC), Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Deutschland
| | - W Singer
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Plastische Operationen, Sektion Molekulare Hörphysiologie, Hörforschungszentrum Tübingen (THRC), Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Deutschland
| | - S Wolpert
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Plastische Operationen, Sektion Molekulare Hörphysiologie, Hörforschungszentrum Tübingen (THRC), Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Deutschland
| | - U Klose
- MR-Forschung, Abteilung für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - L Rüttiger
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Plastische Operationen, Sektion Molekulare Hörphysiologie, Hörforschungszentrum Tübingen (THRC), Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Deutschland
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15
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Mazurek B, Knipper M, Biesinger E, Schulze H. Special issues for the 55th Inner Ear Biology Workshop 06.-08.09.2018 in Berlin : Basic research and clinical aspects-translational aspects of hearing research. HNO 2019; 67:43-45. [PMID: 31197410 DOI: 10.1007/s00106-019-0624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- B Mazurek
- Tinnitus Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - M Knipper
- Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | | | - H Schulze
- Experimental Otolaryngology, Department of Otorhinolaryngology - Head and Neck Surgery, University of Erlangen, Erlangen, Germany
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16
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Abubakar I, Aldridge RW, Devakumar D, Orcutt M, Burns R, Barreto ML, Dhavan P, Fouad FM, Groce N, Guo Y, Hargreaves S, Knipper M, Miranda JJ, Madise N, Kumar B, Mosca D, McGovern T, Rubenstein L, Sammonds P, Sawyer SM, Sheikh K, Tollman S, Spiegel P, Zimmerman C. The UCL-Lancet Commission on Migration and Health: the health of a world on the move. Lancet 2018; 392:2606-2654. [PMID: 30528486 PMCID: PMC7612863 DOI: 10.1016/s0140-6736(18)32114-7] [Citation(s) in RCA: 369] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/22/2022]
Abstract
With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency. In response to these issues, the UCL-Lancet Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report. First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move. Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses. Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants. Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required. Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.
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Affiliation(s)
- Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK.
| | - Robert W Aldridge
- Institute for Health Informatics, University College London, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | - Rachel Burns
- Institute for Global Health, University College London, London, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health, Fundação Oswaldo Cruz, Salvador-Bahia, Brazil
| | - Poonam Dhavan
- International Organization for Migration, Geneva, Switzerland
| | - Fouad M Fouad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nora Groce
- Leonard Cheshire Centre, Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Yan Guo
- School of Public Health, Peking University, Beijing, China
| | - Sally Hargreaves
- Institute of Infection and Immunity, St George's, University of London, London, UK; International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Michael Knipper
- Institute for the History of Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nyovani Madise
- African Institute for Development Policy, Lilongwe, Malawi; Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
| | - Bernadette Kumar
- Norwegian Centre for Minority Health Research, Oslo, Norway; Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Davide Mosca
- International Organization for Migration, Geneva, Switzerland
| | - Terry McGovern
- Program on Global Health Justice and Governance, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Leonard Rubenstein
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, and Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Sammonds
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Kabir Sheikh
- Public Health Foundation of India, Institutional Area Gurgaon, India; Nossal Institute of Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Spiegel
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cathy Zimmerman
- Gender, Violence and Health Centre, London School of Hygiene and Tropical Medicine, London, UK
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17
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Wickramage K, Vearey J, Zwi AB, Robinson C, Knipper M. Migration and health: a global public health research priority. BMC Public Health 2018; 18:987. [PMID: 30089475 PMCID: PMC6083569 DOI: 10.1186/s12889-018-5932-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [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: 03/14/2018] [Accepted: 08/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background With 244 million international migrants, and significantly more people moving within their country of birth, there is an urgent need to engage with migration at all levels in order to support progress towards global health and development targets. In response to this, the 2nd Global Consultation on Migration and Health– held in Colombo, Sri Lanka in February 2017 – facilitated discussions concerning the role of research in supporting evidence-informed health responses that engage with migration. Conclusions Drawing on discussions with policy makers, research scholars, civil society, and United Nations agencies held in Colombo, we emphasize the urgent need for quality research on international and domestic (in-country) migration and health to support efforts to achieve the Sustainable Development Goals (SDGs). The SDGs aim to ‘leave no-one behind’ irrespective of their legal status. An ethically sound human rights approach to research that involves engagement across multiple disciplines is required. Researchers need to be sensitive when designing and disseminating research findings as data on migration and health may be misused, both at an individual and population level. We emphasize the importance of creating an ‘enabling environment’ for migration and health research at national, regional and global levels, and call for the development of meaningful linkages – such as through research reference groups – to support evidence-informed inter-sectoral policy and priority setting processes.
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Affiliation(s)
- Kolitha Wickramage
- Migration Health Division, International Organization for Migration, United Nations Migration Agency, Geneva, Switzerland.
| | - Jo Vearey
- African Centre for Migration & Society, University of the Witwatersrand and Centre of African Studies, University of Edinburgh, PO Box 76, Wits, 2050, South Africa
| | - Anthony B Zwi
- Health, Rights and Development (HEARD@UNSW), School of Social Science, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Courtland Robinson
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Knipper
- Institute of the History of Medicine, University Justus Liebig Giessen, Iheringstr. 6, 35392, Giessen, Germany
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18
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Mews C, Schuster S, Vajda C, Lindtner-Rudolph H, Schmidt LE, Bösner S, Güzelsoy L, Kressing F, Hallal H, Peters T, Gestmann M, Hempel L, Grützmann T, Sievers E, Knipper M. Cultural Competence and Global Health: Perspectives for Medical Education - Position paper of the GMA Committee on Cultural Competence and Global Health. GMS J Med Educ 2018; 35:Doc28. [PMID: 30186938 PMCID: PMC6120152 DOI: 10.3205/zma001174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 05/11/2023]
Abstract
Introduction: Routine medical care in Germany, Austria and Switzerland is being increasingly impacted by the cultural and linguistic diversity of an ever more complex world. Both at home and as part of international student exchanges, medical students are confronted with different ways of thinking and acting in relation to health and disease. Despite an increasing number of courses on cultural competence and global health at German-speaking medical schools, systematic approaches are lacking on how to integrate this topic into medical curricula. Methodological approach: This paper is based on a structured consensus-building process by a multidisciplinary committee composed of faculty and students. In a first step, a qualitative online survey was carried out in order to establish an inventory of definitions and concepts. After the second step, in which a literature search was conducted and definitions of global health and transcultural and intercultural competence were clarified, recommendations were formulated regarding content, teaching and institutional infrastructure. Based on small-group work and large-group discussions, different perspectives and critical issues were compiled using multiple feedback loops that served to ensure quality. Results: An inventory on the national and international level showed that great heterogeneity exists in regard to definitions, teaching strategies, teaching formats and faculty qualification. Definitions and central aspects considered essential to medical education were thus established for the use of the terms "cultural competence" and "global health". Recommendations are given for implementation, ranging from practical realization to qualification of teaching staff and education research. Outlook: High-quality healthcare as a goal calls for the systematic internationalization of undergraduate medical education. In addition to offering specific courses on cultural competence and global health, synergies would be created through the integration of cultural competence and global health content into the curricula of already existing subject areas. The NKLM (the national competence-based catalogue of learning objectives for undergraduate medical education) would serve as a basis for this.
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Affiliation(s)
- Claudia Mews
- University Medical Center Hamburg-Eppendor,f Department of General Practice/Primary Care , Hamburg, Germany
- *To whom correspondence should be addressed: Claudia Mews, University Medical Center Hamburg-Eppendor,f Department of General Practice/Primary Care , Martinistr. 52, D-20246 Hamburg, Germany, Phone: +49 (0)40/7410-56854, Fax: +49 (0)40/7410-53681, E-mail:
| | - Sylvie Schuster
- University Hospital Basel, Head of Program on Diversity Management, Basel, Switzerland
| | - Christian Vajda
- Medical University of Graz, Department of Medical Psychology and Psychotherapy, Graz, Austria
| | - Heide Lindtner-Rudolph
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Institute and Outpatients Clinic Medical Psychology, Research Group on Migration and Psychosocial Health (MiPH), Hamburg, Germany
| | - Luise E. Schmidt
- University of Greifswald, Department of Psychiatry and Psychotherapy, Greifswald, Germany
- Helios Hanseklinikum Stralsund, Department of Psychiatry and Psychotherapy, Stralsund, Germany
| | - Stefan Bösner
- University of Marburg, Department of General Practice/Family Medicine, Marburg, Germany
| | - Leyla Güzelsoy
- Paracelsus Medical Private University, Nuremberg Hospital, Department of Psychosomatic Medicine and Psychotherapy, Psychosomatic Consultation and Liaison Service, Nuremberg, Germany
| | - Frank Kressing
- Ulm University, Institute of the History, Philosophy and Ethics of Medicine, Ulm, Germany
| | - Houda Hallal
- University of Cologne, Faculty of Medicine, Cologne, Germany
| | - Tim Peters
- Ruhr-University Bochum, Medical Faculty, Center for Medical Education, Bochum, Germany
| | - Margarita Gestmann
- University of Duisburg-Essen, Medical Faculty, Dean's office for student affairs, Essen, Germany
| | - Linn Hempel
- University of Dusseldorf, Medical Faculty, Psychosomatic and Psychotherapy, Dusseldorf, Germany
| | - Tatjana Grützmann
- RWTH Aachen University, Dean's office for student affairs, Aachen, Germany
| | - Erika Sievers
- Academy of Public Health Services, Düsseldorf, Germany
| | - Michael Knipper
- Justus Liebig University Giessen, Institute for the History of Medicine, Giessen, Germany
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Abstract
Investigators working both in syndemics, a field of applied health research with roots in medical anthropology, and in the field of health and human rights recognise that upstream social, political, and structural determinants contribute more to health inequities than do biological factors or personal choices. Syndemics investigates synergistic, often deleterious interactions among comorbid health conditions, especially under circumstances of structural and political adversity. Health and human rights research draws on international law to argue that all people deserve access not only to health care, but also to the underlying determinants of good health. Taking the urgent matter of migrant health as an empirical focus, we juxtapose the fields of syndemics and health and human rights, identify their complementarities, and advocate for a combined approach. By melding insights from these fields, the combined syndemics/health and human rights approach advanced here can provide clinicians and other key stakeholders with concrete insights, tools, and strategies to tackle the health inequities that affect migrants and other vulnerable groups by: (1) mapping the effect of social, political, and structural determinants on health; (2) identifying opportunities for upstream intervention; and (3) working collaboratively to tackle the structures, institutions, and processes that cause and exacerbate health inequities. Undergirding this approach is an egalitarian interpretation of the right to health that differs from narrow legalistic and individual interpretations by insisting that all people are equal in worth and, as a result, equally deserving of protection from syndemic vulnerability.
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Affiliation(s)
- Sarah S Willen
- Department of Anthropology, University of Connecticut, Storrs, CT, USA.
| | - Michael Knipper
- Institute for the History of Medicine, Justus Liebig University Giessen, Giessen, Germany
| | | | - Nadav Davidovitch
- Department of Health Systems Management, Ben Gurion University of the Negev, Beersheva, Israel
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20
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Gutsche C, Knipper M, Plaggenborg T, Parisi J, Kolny-Olesiak J. Synthesis of facetted Pt nanoparticles on SnO 2 as an oxygen reduction catalyst. CrystEngComm 2017. [DOI: 10.1039/c7ce00365j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Neuhaus C, Lang-Roth R, Zimmermann U, Heller R, Eisenberger T, Weikert M, Markus S, Knipper M, Bolz H. Extension of the clinical and molecular phenotype of DIAPH1
-associated autosomal dominant hearing loss (DFNA1
). Clin Genet 2016; 91:892-901. [DOI: 10.1111/cge.12915] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/27/2016] [Indexed: 12/11/2022]
Affiliation(s)
- C. Neuhaus
- Bioscientia Center for Human Genetics; Ingelheim Germany
| | - R. Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Cologne; Cologne Germany
| | - U. Zimmermann
- Molecular Physiology of Hearing, Hearing Research Centre Tübingen (THRC), Department of Otolaryngology; University of Tübingen; Tübingen Germany
| | - R. Heller
- Institute of Human Genetics; University Hospital of Cologne; Cologne Germany
| | - T. Eisenberger
- Bioscientia Center for Human Genetics; Ingelheim Germany
| | - M. Weikert
- Gemeinschaftspraxis für Phoniatrie; Pädaudiologie und Hals-Nasen-Ohrenheilkunde; Regensburg Germany
| | - S. Markus
- Kompetenzzentrum für Humangenetik; Gynäkologie und Laboratoriumsmedizin; Regensburg Germany
| | - M. Knipper
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Cologne; Cologne Germany
| | - H.J. Bolz
- Bioscientia Center for Human Genetics; Ingelheim Germany
- Institute of Human Genetics; University Hospital of Cologne; Cologne Germany
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Knipper M, Baumann A, Hofstetter C, Korte R, Krawinkel M. Internationalizing Medical Education: The Special Track Curriculum 'Global Health' at Justus Liebig University Giessen. GMS Z Med Ausbild 2015; 32:Doc52. [PMID: 26604994 PMCID: PMC4647159 DOI: 10.3205/zma000994] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/29/2015] [Accepted: 07/15/2015] [Indexed: 11/30/2022]
Abstract
Internationalizing higher education is considered to be a major goal for universities in Germany and many medical students aspire to include international experiences into their academic training. However, the exact meaning of “internationalizing” medical education is still poorly defined, just as is the possible pedagogic impact and effects. Against this background, this article presents the special track curriculum on global health (in German: Schwerpunktcurriculum Global Health, short: SPC) at Justus Liebig University Giessen, which was established in 2011 as a comprehensive teaching program to integrate international perspectives and activities systematically into the clinical years of the medical curriculum. The report of the structure, content, didactic principles and participants’ evaluations of the SPC is embedded into a larger discussion of the pedagogic value of a broad and interdisciplinary perspective on “global health” in medical education, that explicitly includes attention for health inequities, social determinants of health and the cultural dimensions of medicine and health abroad and “at home” (e.g. in relation to migration). We conclude that if properly defined, the emerging field of “global health” represents a didactically meaningful approach for adding value to medical education through internationalizing the curriculum, especially in regard to themes that despite of their uncontested value are often rather weak within medical education. The concrete curricular structures, however, have always to be developed locally. The “SPC” at Giessen University Medical School is only one possible way of addressing these globally relevant issues in one particular local academic setting.
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Affiliation(s)
- Michael Knipper
- Justus Liebig University Giessen, Institute for History of Medicine, Giessen, Germany
| | - Adrian Baumann
- Justus Liebig University Giessen, Medical Students, Giessen, Germany
| | | | - Rolf Korte
- Justus Liebig University Giessen, Institute of Hygiene and Environmental Medicine, Giessen, Germany
| | - Michael Krawinkel
- Justus Liebig University Giessen, Institute of Nutritional Science, Giessen, Germany
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Hanewald B, Gieseking J, Vogelbusch O, Markus I, Gallhofer B, Knipper M. Asylrecht und psychische Gesundheit: Eine interdisziplinäre Analyse des Zusammenwirkens medizinischer und juristischer Aspekte. Psychiat Prax 2015; 43:165-71. [DOI: 10.1055/s-0035-1552730] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Bernd Hanewald
- Zentrum für Psychiatrie, Justus-Liebig-Universität Gießen
| | - Janina Gieseking
- Professur für Öffentliches Recht, Prof. Dr. Jürgen Bast, Refugee Law Clinic, Justus-Liebig-Universität Gießen
| | | | - Inessa Markus
- Institut für Geschichte der Medizin, AG Kultur, Migration & Global Health, Justus-Liebig-Universität Gießen
| | | | - Michael Knipper
- Institut für Geschichte der Medizin, AG Kultur, Migration & Global Health, Justus-Liebig-Universität Gießen
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Gutsche C, Moeller CJ, Knipper M, Borchert H, Parisi J, Plaggenborg T. Influence of Vanadium Ions on the Degradation Behavior of Platinum Catalysts for Oxygen Reduction Reaction. Electrocatalysis (N Y) 2015. [DOI: 10.1007/s12678-015-0264-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Raynaud C, Ricard S, Knipper M. New developments in renal physiopathology acquired using a quantitative renal functional test: the 197Hg uptake test. Contrib Nephrol 2015; 11:80-8. [PMID: 699599 DOI: 10.1159/000401781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The renal function of 331 obstructive uropathies, of which 112 were unilateral, were studied using the radioactive Hg renal uptake technique. The results obtained lead to the following observations: (1) Kidneys silent because of a chronic pelviureteric obstruction maintain a minimum function representing approximately one quarter of the normal value, which does not seem to be improved following the removal of the obstruction. (2) Operative relief of obstruction in unilateral obstructive uropathy, except for cases of silent kidneys, is followed by a significative improvement in the function of the kidney on the operated side in more than a third of the cases studied. (3) In 43% of obstructive uropathies considered as unilateral, the functional value of the two kidneys is decreased.
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Oehl N, Hardenberg L, Knipper M, Kolny-Olesiak J, Parisi J, Plaggenborg T. Critical size for the β- to α-transformation in tin nanoparticles after lithium insertion and extraction. CrystEngComm 2015. [DOI: 10.1039/c5ce00148j] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The formation of the α-Sn phase in Sn/SnOx core/shell nanoparticles after lithium insertion and extraction was investigated for the first time and a critical size for the transformation was determined.
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Affiliation(s)
- N. Oehl
- Energy and Semiconductor Research Laboratory
- Institute of Physics
- Carl-von-Ossietzky Universität
- 26129 Oldenburg, Germany
| | - L. Hardenberg
- Energy and Semiconductor Research Laboratory
- Institute of Physics
- Carl-von-Ossietzky Universität
- 26129 Oldenburg, Germany
| | - M. Knipper
- Energy and Semiconductor Research Laboratory
- Institute of Physics
- Carl-von-Ossietzky Universität
- 26129 Oldenburg, Germany
| | - J. Kolny-Olesiak
- Energy and Semiconductor Research Laboratory
- Institute of Physics
- Carl-von-Ossietzky Universität
- 26129 Oldenburg, Germany
| | - J. Parisi
- Energy and Semiconductor Research Laboratory
- Institute of Physics
- Carl-von-Ossietzky Universität
- 26129 Oldenburg, Germany
| | - T. Plaggenborg
- Energy and Semiconductor Research Laboratory
- Institute of Physics
- Carl-von-Ossietzky Universität
- 26129 Oldenburg, Germany
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Affiliation(s)
- M Knipper
- Molecular Physiology of Hearing, Hearing Research Centre Tübingen, THRC Elfriede Aulhornstr. 5, 72076 Tübingen, Germany. http://thrc.hno.medizin.uni-tuebingen.de
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Bozorgmehr K, Bruchhausen W, Hein W, Knipper M, Korte R, Razum O, Tinnemann P. The global health concept of the German government: strengths, weaknesses, and opportunities. Glob Health Action 2014; 7:23445. [PMID: 24560258 PMCID: PMC3925816 DOI: 10.3402/gha.v7.23445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 12/04/2022] Open
Abstract
Recognising global health as a rapidly emerging policy field, the German federal government recently released a national concept note for global health politics (July 10, 2013). As the German government could have a significant impact on health globally by making a coherent, evidence-informed, and long-term commitment in this field, we offer an initial appraisal of the strengths, weaknesses, and opportunities for development recognised in this document. We conclude that the national concept is an important first step towards the implementation of a coherent global health policy. However, important gaps were identified in the areas of intellectual property rights and access to medicines. In addition, global health determinants such as trade, economic crises, and liberalisation as well as European Union issues such as the health of migrants, refugees, and asylum seekers are not adequately addressed. Furthermore, little information is provided about the establishment of instruments to ensure an effective inter-ministerial cooperation. Finally, because implementation aspects for the national concept are critical for the success of this initiative, we call upon the newly elected 2013 German government to formulate a global health strategy, which includes a concrete plan of action, a time scale, and measurable goals.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of General Practice & Health Services Research, University of Heidelberg, Heidelberg, Germany;
| | - Walter Bruchhausen
- Institute of History, Theory and Ethics in Medicine, Aachen University, Aachen, Germany
| | - Wolfgang Hein
- Institute of Latin American Studies, German Institute of Global and Area Studies (GIGA), Hamburg, Germany
| | - Michael Knipper
- Faculty of Medicine, Institute of the History of Medicine, University Giessen, Giessen, Germany
| | - Rolf Korte
- Faculty of Medicine, Institute of Hygiene and Environmental Health, University Giessen, Giessen, Germany
| | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Peter Tinnemann
- Department of International Health Sciences, Institute for Social Medicine, Epidemiology and Health Economics, Charité-University Medical Centre Berlin, Berlin, Germany
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg 69115, Germany.
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Bozorgmehr K, Gabrysch S, Müller O, Neuhann F, Jordan I, Knipper M, Razum O. Relationship between financial speculation and food prices or price volatility: applying the principles of evidence-based medicine to current debates in Germany. Global Health 2013; 9:44. [PMID: 24131565 PMCID: PMC3819662 DOI: 10.1186/1744-8603-9-44] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/02/2013] [Indexed: 11/10/2022] Open
Abstract
There is an unresolved debate about the potential effects of financial speculation on food prices and price volatility. Germany’s largest financial institution and leading global investment bank recently decided to continue investing in agricultural commodities, stating that there is little empirical evidence to support the notion that the growth of agricultural-based financial products has caused price increases or volatility. The statement is supported by a recently published literature review, which concludes that financial speculation does not have an adverse effect on the functioning of the agricultural commodities market. As public health professionals concerned with global food insecurity, we have appraised the methodological quality of the review using a validated and reliable appraisal tool. The appraisal revealed major shortcomings in the methodological quality of the review. These were particularly related to intransparencies in the search strategy and in the selection/presentation of studies and findings; the neglect of the possibility of publication bias; a lack of objective or rigorous criteria for assessing the scientific quality of included studies and for the formulation of conclusions. Based on the results of our appraisal, we conclude that it is not justified to reject the hypothesis that financial speculation might have adverse effects on food prices/price volatility. We hope to initiate reflections about scientific standards beyond the boundaries of disciplines and call for high quality, rigorous systematic reviews on the effects of financial speculation on food prices or price volatility.
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Affiliation(s)
| | | | | | | | | | | | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, D-33501 Bielefeld, Germany.
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Affiliation(s)
- Michael Knipper
- Institute of the History of Medicine, Justus Liebig University, Giessen, Germany.
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Knipper M. “Nuevas tareas médicas en la nueva Rusia” (1924) * : La visión de ‘patología étnica’ y medicina científica de Max Kuczynski en los años anteriores a su emigración al Perú. An Fac med 2013. [DOI: 10.15381/anales.v66i3.1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Basado en un artículo publicado originalmente en 1924, se ofrece un acercamiento a los trabajos y pensamientos científicos de Maxime Kuczynski-Godard en los años anteriores de 1933 y su emigración forzosa de Alemania al Perú. El artículo se titula “Nuevas tareas médicas en la nueva Rusia”, y recoge las experiencias de Kuczynski durante de su primera estadía en Rusia como profesor invitado en el Instituto Médico de Omsk (Siberia) y de la siguiente expedición médico-geográfica a la estepa kirguiz entre 1923 y 1924. Al ejemplo de la situación en la Rusia de la época postrevolucionaria, el entonces profesor de patología de la Universidad de Berlín describe aquí su visión de lo que podría ser la medicina científica del futuro. Como concepto clave, introduce la noción de la ‘patología cultural’ o ‘étnica’, entendida como ciencia médica integral que combina planteamientos y métodos tanto de las ciencias naturales como sociales y culturales. La traducción del artículo original está enmarcada por informaciones adicionales acerca del contexto biográfico, científico e histórico en general.
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Knipper M, Strotmann J, Mädler U, Kahle C, Breer H. Monoclonal antibodies against the high affinity choline transport system. Neurochem Int 2012; 14:217-22. [PMID: 20504421 DOI: 10.1016/0197-0186(89)90125-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/1988] [Accepted: 11/07/1988] [Indexed: 10/27/2022]
Abstract
Monoclonal antibodies have been isolated that specifically block the high affinity, Na(+)-dependent transport of choline in insect synaptosomes and synaptosomal ghosts. Antibodies were derived after immunization of mice with synaptosomal membranes from locust. Antibody VIB6F5, an IgG isotype, significantly inhibited the high affinity translocation of choline, the effect exhibited saturation at increased antibody concentrations. Antibodies recognized a 80 kDa antigen identified by Western blot analysis of synaptosomal membranes. In immunocytochemical approaches VIB6F5 specifically stained distinct areas in the neuropil of head and thoracic ganglia.
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Affiliation(s)
- M Knipper
- University Hohenheim, Institute of Zoophysiology, 7000 Stuttgart 70 F.R.G
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35
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Knipper M, Seeleman IC, Essink M. How should ethnic diversity be represented in medical curricula? A plea for systematic training in cultural competence. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s12507-010-0010-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Lubka-Pathak M, Shah AA, Gallozzi M, Müller M, Zimmermann U, Löwenheim H, Pfister M, Knipper M, Blin N, Schimmang T. Altered expression of securin (Pttg1) and serpina3n in the auditory system of hearing-impaired Tff3-deficient mice. Cell Mol Life Sci 2010; 68:2739-49. [PMID: 21076990 DOI: 10.1007/s00018-010-0586-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 10/22/2010] [Accepted: 10/26/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Tff3 peptide exerts important functions in cytoprotection and restitution of the gastrointestinal (GI) tract epithelia. Moreover, its presence in the rodent inner ear and involvement in the hearing process was demonstrated recently. However, its role in the auditory system still remains elusive. Our previous results showed a deterioration of hearing with age in Tff3-deficient animals. RESULTS Present detailed analysis of auditory brain stem response (ABR) measurements and immunohistochemical study of selected functional proteins indicated a normal function and phenotype of the cochlea in Tff3 mutants. However, a microarray-based screening of tissue derived from the auditory central nervous system revealed an alteration of securin (Pttg1) and serpina3n expression between wild-type and Tff3 knock-out animals. This was confirmed by qRT-PCR, immunostaining and western blots. CONCLUSIONS We found highly down-regulated Pttg1 and up-regulated serpina3n expression as a consequence of genetically deleting Tff3 in mice, indicating a potential role of these factors during the development of presbyacusis.
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Affiliation(s)
- M Lubka-Pathak
- Division of Molecular Genetics, Institute of Human Genetics, University of Tübingen, Wilhelmstraße, Germany
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Knipper M, Salaverry O. [M. Kuczynski-Godard (1890-1967): medical-anthropological pictures of the Peruvian Amazon and the Andes, 1938-1948]. Rev Peru Med Exp Salud Publica 2010; 27:146-50. [PMID: 21072461 DOI: 10.1590/s1726-46342010000100020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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38
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Topp K, Borchert H, Johnen F, Tunc AV, Knipper M, von Hauff E, Parisi J, Al-Shamery K. Impact of the incorporation of Au nanoparticles into polymer/fullerene solar cells. J Phys Chem A 2010; 114:3981-9. [PMID: 20030383 DOI: 10.1021/jp910227x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The addition of small amounts of dodecylamine-capped Au nanoparticles into the active layer of organic bulk heterojunction solar cells consisting of poly(3-octylthiophene) (P3OT) and C(60) was recently suggested to have a positive impact on device performance due to improved electron transport. This issue was systematically further investigated in the present work. Different strategies to incorporate colloidally prepared Au nanoparticles with a narrow size distribution into organic solar cells with the more common donor/acceptor system consisting of poly(3-hexylthiophene) (P3HT) and [6,6]-phenyl C(61)-butyric acid methyl ester (PCBM) were pursued. Au nanoparticles were prepared with either P3HT or dodecylamine as ligands. Additionally, efforts were undertaken to incorporate nearly ligand-free Au nanoparticles into the system. Therefore, a procedure was successfully developed to remove the dodecylamine ligand shell by a postpreparative ligand exchange with pyridine, a much smaller molecule that can later partly be removed from solid films by annealing. However, for all types of nanoparticles studied here, the performance of the P3HT/PCBM solar cells was found to decrease with the Au particles as an additive to the active layer, meaning that adding Au nanoparticles is not a suitable strategy in the case of the P3HT/PCBM system. Possible reasons are discussed on the basis of detailed investigations of the structure, photophysics and charge transport in the system.
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Affiliation(s)
- K Topp
- Institute of Pure and Applied Chemistry, University of Oldenburg, Carl-von-Ossietzky-Strasse 9-11, 26129 Oldenburg, Germany
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Knipper M, Akinci S, Soydan N. Culture and healthcare in medical education: migrants' health and beyond. GMS Z Med Ausbild 2010; 27:Doc41. [PMID: 21818207 PMCID: PMC3140342 DOI: 10.3205/zma000678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 01/25/2010] [Accepted: 03/25/2010] [Indexed: 11/30/2022]
Abstract
One of the main challenges for teaching programs on immigration, ethnic diversity and health is to transform the commonplace notion of "culture" into a helpful tool for medical training and practice. This paper presents the teaching approach of an interdisciplinary course on "migrants' health" established at the University of Giessen since 2004, which has recently been complemented by a thematically related collaboration with two universities in Latin America (Ecuador, Peru). The overall goal is to translate the abstract philosophy of "think global and teach local" into medical practice, and to provide students with the insights, attitudes and skills needed for a fruitful use of concepts like "culture", "ethnicity" and "migration background". A key feature of the course is the strong commitment to ethnography as an important means for looking under the surface of superficial attributions to culture, and for grasping the interplay of medicine and health with cultural, social, religious, economic and legal aspects in its particular local and/or individual shape. Three elements of the course are presented to illustrate this approach: First, a unit on Islam and Medicine, as important parts of the local immigrant community are Muslims. The second one deals with psychosomatic aspects, because in case of immigrants, complex symptoms and disease representations like somatisation are easily misinterpreted as "cultural". The third element consists of a unit with specialized social workers form outside the university, who provide direct insights into the living conditions and health problems of local immigrant communities.
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Affiliation(s)
- Michael Knipper
- Justus-Liebig-University Giessen, Institut für Geschichte der Medizin, Giessen, Deutschland
| | - Secil Akinci
- Pfitzer GmbH & Co.KG, Klinik am Südpark, Fachabteilung Psychosomatik, Bad Nauheim, Deutschland
| | - Nedim Soydan
- Universitätsklinikum Giessen und Marburg GmbH, Medizinische Klinik und Poliklinik 3, Gießen, Deutschland
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Knipper M, Seeleman C, Essink-Bot ML. How should ethnic diversity be represented in medical curricula? A plea for systematic training in cultural competence. GMS Z Med Ausbild 2010; 27:Doc26. [PMID: 21818195 PMCID: PMC3140353 DOI: 10.3205/zma000663] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/14/2009] [Accepted: 01/21/2010] [Indexed: 11/30/2022]
Abstract
Ethnic diversity has become a common reality in European societies, including those of Germany and the Netherlands. Given that ethnic minority groups and immigrants are known to be especially vulnerable to inequalities in health, access to services and quality of care, the need for cultural competency training in medical education is widely acknowledged. This paper presents four key issues in providing medical students and physicians with the knowledge, attitudes and skills to adapt medical care to ethnically diverse populations. It then describes two educational programmes delivered by the University of Amsterdam (UvA Academic Medical Centre, the Netherlands) and Giessen University Medical School (Germany), respectively, to illustrate that translating theoretical educational objectives into educational practice can lead to different teaching programmes depending on specific local conditions. In the conclusions, emphasis is placed on the need for systematic approaches that do not limit their focus to patients and groups of specific ethnic or migration backgrounds. Issues of culture, communication and research in relation to ethnically diverse populations are magnifications of general problems in medicine and healthcare. Explicit attention to ethnic diversity thus offers a view through a 'magnifying glass' of subjects of much broader importance and can be a means for improving health care in general.
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Affiliation(s)
- Michael Knipper
- Justus-Liebig-University Giessen, Institute of the History of Medicine, Giessen, Germany
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Knipper M, Salaverry O. M. Kuczynski-Godard (1890-1967): fotografías médico-antropológicas de la Amazonía y de los Andes peruanos 1938-1948. Rev Peru Med Exp Salud Publica 2010. [DOI: 10.17843/rpmesp.2010.271.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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42
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Knipper M. Más allá de lo indígena: salud e interculturalidad a nivel global. Rev Peru Med Exp Salud Publica 2010. [DOI: 10.17843/rpmesp.2010.271.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Knipper M. [Anthropology and "crisis in medicine": The pathologist M. Kuczynski-Godard (1890-1967) and the indigenous peoples of Central Asia and Peru]. Dynamis 2009; 29:97-9. [PMID: 19852393 DOI: 10.4321/s0211-95362009000100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article examines the work of the German-Peruvian physician Max Kuczynski/Máxime Kuczynski-Godard (Berlin 1890-Lima 1967) in rural areas of Central Asia (1924-26) and Peru (1938-48). The main focus of the text is on the scientific approach behind the specific interest of this pathologist in disease and health issues among native populations. Kuczynski's theoretical considerations are analyzed in the context of the wide controversies within the German medical community around a "crisis in medicine" when he was professor at Berlin University during the interwar years. Accordingly, his determination to leave the laboratory and to shift research and healthcare practice closer to rural populations proves to be the expression of profound epistemological and ethical considerations.
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Affiliation(s)
- Michael Knipper
- Instituto de Historia de la Medicina de la Universidad de Giessen, Alemania.
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Heidrych P, Zimmermann U, Bress A, Pusch CM, Ruth P, Pfister M, Knipper M, Blin N. Rab8b GTPase, a protein transport regulator, is an interacting partner of otoferlin, defective in a human autosomal recessive deafness form. Hum Mol Genet 2008; 17:3814-21. [DOI: 10.1093/hmg/ddn279] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- M Knipper
- Molekulare Neurobiologie, Hörforschungszentrum Tübingen, Universitäts-Hals-Nasen-Ohren-Klinik, 72076, Tübingen.
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Tan J, Rüttiger L, Panford-Walsh R, Singer W, Schulze H, Kilian SB, Hadjab S, Zimmermann U, Köpschall I, Rohbock K, Knipper M. Tinnitus behavior and hearing function correlate with the reciprocal expression patterns of BDNF and Arg3.1/arc in auditory neurons following acoustic trauma. Neuroscience 2007; 145:715-26. [PMID: 17275194 DOI: 10.1016/j.neuroscience.2006.11.067] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 11/28/2006] [Accepted: 11/30/2006] [Indexed: 12/24/2022]
Abstract
The molecular changes following sensory trauma and the subsequent response of the CNS are poorly understood. We focused on finding a molecular tool for monitoring the features of excitability which occur following acoustic trauma to the auditory system. Of particular interest are genes that alter their expression pattern during activity-induced changes in synaptic efficacy and plasticity. The expression of brain-derived neurotrophic factor (BDNF), the activity-dependent cytoskeletal protein (Arg3.1/arc), and the immediate early gene c-Fos were monitored in the peripheral and central auditory system hours and days following a traumatic acoustic stimulus that induced not only hearing loss but also phantom auditory perception (tinnitus), as shown in rodent animal behavior models. A reciprocal responsiveness of activity-dependent genes became evident between the periphery and the primary auditory cortex (AI): as c-Fos and BDNF exon IV expression was increased in spiral ganglion neurons, Arg3.1/arc and (later on) BDNF exon IV expression was reduced in AI. In line with studies indicating increased spontaneous spike activity at the level of the inferior colliculus (IC), an increase in BDNF and GABA-positive neurons was seen in the IC. The data clearly indicate the usefulness of Arg3.1/arc and BDNF for monitoring trauma-induced activity changes and the associated putative plasticity responses in the auditory system.
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Affiliation(s)
- J Tan
- University of Tübingen, Department of Otorhinolaryngology, Hearing Research Center Tübingen, Molecular Neurobiology, Elfriede-Aulhorn-Strasse 5, 72076 Tübingen, Germany
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Engel J, Braig C, Rüttiger L, Kuhn S, Zimmermann U, Blin N, Sausbier M, Kalbacher H, Münkner S, Rohbock K, Ruth P, Winter H, Knipper M. Two classes of outer hair cells along the tonotopic axis of the cochlea. Neuroscience 2006; 143:837-49. [PMID: 17074442 DOI: 10.1016/j.neuroscience.2006.08.060] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 08/11/2006] [Accepted: 08/15/2006] [Indexed: 11/28/2022]
Abstract
The molecular basis of high versus low frequency hearing loss and the differences in the sensitivity of outer hair cells depending on their cochlear localization are currently not understood. Here we demonstrate the existence of two different outer hair cell phenotypes along the cochlear axis. Outer hair cells in low frequency regions exhibit early sensitivity for loss of Ca(v)1.3 (alpha1 subunit 1.3 forming the class D L-type voltage-gated Ca(2+) channel), while high frequency regions display a progressive susceptibility for loss of the Ca(2+)-activated large conductance K(+) (BK) channel. Despite deafness, young Ca(v)1.3-deficient mice displayed distortion-product otoacoustic emissions (DPOAEs), indicating functional outer hair cells in the higher frequency range of the cochlea. Considering that DPOAEs are also found in the human deafness syndrome DFNB9 caused by mutations in the synaptic vesicle protein otoferlin, we tested the expression of otoferlin in outer hair cells. Surprisingly, otoferlin showed a distinct tonotopic expression pattern at both the mRNA and protein level. Otoferlin-expressing, Ca(v)1.3 deletion-sensitive outer hair cells in the low frequency range could be clearly separated from otoferlin-negative, BK deletion-sensitive outer hair cells in the high frequency range. In addition, BK deletion led to a higher noise vulnerability in low frequency regions, which are normally unaffected by the BK deletion alone, suggesting that BK currents are involved in survival mechanisms of outer hair cells under noise conditions. Our findings propose new mechanisms and candidate genes for explaining high and low frequency hearing loss.
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MESH Headings
- Acoustic Stimulation/methods
- Alcohol Oxidoreductases
- Animals
- Animals, Newborn
- Auditory Threshold/physiology
- Calcium Channels, L-Type/deficiency
- Co-Repressor Proteins
- Cochlea/cytology
- Cochlea/growth & development
- DNA-Binding Proteins/metabolism
- Evoked Potentials, Auditory, Brain Stem/genetics
- Gene Expression Regulation/genetics
- Hair Cells, Auditory, Outer/cytology
- Hair Cells, Auditory, Outer/physiology
- Hearing Loss, Sensorineural/metabolism
- Hearing Loss, Sensorineural/pathology
- Hearing Loss, Sensorineural/physiopathology
- Immunohistochemistry/methods
- In Situ Hybridization/methods
- Large-Conductance Calcium-Activated Potassium Channel alpha Subunits/deficiency
- Large-Conductance Calcium-Activated Potassium Channel alpha Subunits/physiology
- Membrane Proteins/metabolism
- Mice
- Mice, Knockout
- Otoacoustic Emissions, Spontaneous/genetics
- Phosphoproteins/metabolism
- RNA, Messenger
- Rats
- Rats, Wistar
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Time Factors
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Affiliation(s)
- J Engel
- University of Tübingen, Institute of Physiology II and Department of Otolaryngology, THRC, Gmelinstrasse 5, 72076 Tübingen, Germany
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Tropitzsch A, Gültig K, Knipper M, Löwenheim H. Caspase abhängige Regulationsmechanismen des apoptotischen Zelltods im Corti’schen Organ. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Waka N, Knipper M, Engel J. Localization of the calcium channel subunits Cav1.2 (alpha1C) and Cav2.3 (alpha1E) in the mouse organ of Corti. Histol Histopathol 2003; 18:1115-23. [PMID: 12973680 DOI: 10.14670/hh-18.1115] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Voltage-activated Ca2+ channels play an important role in synaptic transmission, signal processing and development. The immunohistochemical localization of Cav1.2 (alpha1C) and Cav2.3 (alpha1E) Ca2+ channels was studied in the developing and adult mouse organ of Corti using subunit-specific antibodies and fluorescent secondary antibodies with cochlear cryosections. Cav1.2 immunoreactivity has been detected from postnatal day 14 (P14) onwards at the synapses between cholinergic medial efferents and outer hair cells as revealed by co-staining with anti-synaptophysin and anti-choline acetyltransferase. Most likely the Cav1.2 immunoreactivity was located presynaptically at the site of contact of the efferent bouton with the outer hair cell which suggests a role for class C L-type Ca2+ channels in synaptic transmission of the medial efferent system. The localization of the second Ca2+ channel tested, Cav2.3, showed a pronounced change during cochlear development. From P2 until P10, Cav2.3 immunoreactivity was found in the outer spiral bundle followed by the inner spiral bundle, efferent endings and by medial efferent fibers. Around P14, Cav2.3 immunoreactivity disappeared from these structures and from P19 onwards it was observed in the basal poles of the outer hair cell membranes.
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MESH Headings
- Animals
- Calcium Channels/genetics
- Calcium Channels/metabolism
- Calcium Channels/ultrastructure
- Calcium Channels, L-Type/metabolism
- Calcium Channels, R-Type
- Cation Transport Proteins/genetics
- Cation Transport Proteins/metabolism
- Cation Transport Proteins/ultrastructure
- Cerebellum/metabolism
- Cerebellum/ultrastructure
- Choline O-Acetyltransferase/metabolism
- Electrophysiology
- Fluorescent Antibody Technique
- Hair Cells, Auditory, Inner/metabolism
- Hair Cells, Auditory, Inner/ultrastructure
- Hair Cells, Auditory, Outer/metabolism
- Hair Cells, Auditory, Outer/ultrastructure
- Immunohistochemistry
- Mice
- Neurofilament Proteins/metabolism
- Organ of Corti/growth & development
- Organ of Corti/metabolism
- Organ of Corti/ultrastructure
- Presynaptic Terminals/metabolism
- Presynaptic Terminals/ultrastructure
- Synaptophysin/metabolism
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Affiliation(s)
- N Waka
- Institute of Physiology II and Department of Otolaryngology, Tuebingen Hearing Research Centre (THRC), University of Tuebingen, Tuebingen, Germany
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