Subjektiv erlebte Barrieren von Personen mit Migrationshintergrund bei der Inanspruchnahme von Gesundheitsma?nahmen

Aim

Analysis of barriers regarding attendance at the health care system under consideration of cultural and migration-related factors.

Method

Cross-sectional survey with immigrants from Turkey (n?=?77), Spain (n?=?67), Italy (n?=?95) and German resettlers from the former Soviet Union (n?=?196), recruited on migration and addiction services of the German Caritasverband, the Arbeiterwohlfahrt and migrant organizations.

Results

Spanish and Italian immigrants mainly search for help within their families and social environment. Immigrants from the former Soviet Union use home remedies and experience more linguistic difficulties as barriers for the use of health services, just like Turkish immigrants. Turkish immigrants reported feeling misunderstood regarding their cultural peculiarities by the expert staff as another main barrier. Other major influencing factors were German language proficiency and the subjective wellbeing in Germany.

Conclusion

The consideration of cultural-related as well as linguistic factors in health care services is an essential contribution for improving health care of immigrants.     

Verständnis der bestehenden Ernährungsempfehlungen für Säuglinge bei Müttern deutscher und türkischer Herkunft

Background

The nutrition of children is also characterized by the cultural background. Till now, current recommendations do not consider this.

Methods

10 qualitative guideline-based interviews from German (n?=?5) and Turkish (n?=?5) mothers were conducted for this analysis, dealing with attitudes and behaviour towards nutrition and health of infants. The interviews were analysed by qualitative textual analysis.

Results

The implementation of existing recommendations (e.g. breastfeeding, complementary food) in everyday life did not work as desired by Turkish as well as German mothers. Therefore, mothers were in a state of inner conflict and stress situation. That was expressed in subjective justifications of behaviour. Further more, standard terms of infant nutrition were understood differently by German and Turkish mothers. Therefore, the findings suggest that German recommendations for infant nutrition are interpreted differently from Turkish mothers.

Conclusion

In advice, it can be useful to consult language or cultural mediator or choose simple words, so that language skill of parents doesn’t decide on the quality.     

Migrantinnen empowern!

Background

With regard to health promotion, certain immigrant groups are even today perceived as being “not readily accessible”, especially Turkish immigrant women. With its strategy of “enablement and empowerment”, the principle of empowerment is anchored in the Ottawa Charta for Health Promotion. But how can greater health literacy among immigrants be achieved?

Material and methods

Based on a literature search, potentials of improving health literature from migrants are presented.

Findings and conclusion

The health literacy model is a promising approach, and a literature analysis shows that the health literacy of ethnic minorities can be improved through the implementation of a comprehensive concept that takes a culturally sensitive long-term view and is realized at culturally appropriate locations. The use of mediators also appears to improve critical discussions on health issues. In order to enable Turkish immigrant women in Germany to achieve greater equality of opportunity with regard to health, more appropriate offers should be established.     

Schlaganfallprävention: Identifizierung von Präventionspotenzialen durch Bevölkerungssurveys

Background

Community knowledge of stroke risk factors and prevention in Germany is poor. Therefore, the municipal Health Conference of Düsseldorf city, capital of North Rhine-Westphalia, the Public Health authority commissioned the Institute of Public Health NRW (lögd) to carry out a telephone survey. The aim was to assess community knowledge of stroke risk factors and self-reported prevalence of established risk factors.

Methods

The study population was defined as comprising all residents in the city of Düsseldorf of at least 18 years of age (approx. 485,000 people). The sample of 1,318 persons was drawn randomly and the telephone survey was carried out by the CATI Laboratory (Computer Assisted Telephone Interviews) at the Institute of Public Health (lögd, Bielefeld) between 12 October and 17 November 2004. At the same time, the SUZ GmbH (Sozialwissenschaftliches Umfragezentrum) carried out the identical survey in the Turkish language with citizens of Turkish descent (n=310).

Results

The majority of respondents named smoking as a risk factor [46.2%, German sample (GS) 53.1%, Turkish sample (TS) 16.5%], while hypertension was mentioned by 33.9% of participants (GS 37.8%, TS 17.3%). Only one-third of the Turkish respondents could name at least one risk factor, as compared to about 82% of the German participants. Overweight (47.9%) and smoking (31.4%) were the most frequently reported risk factors concerning respondents. The main target groups for stroke prevention are men, “underclass”/lower socio-economic status, elderly people (>65 years) and immigrants of Turkish descent.

Conclusion

The present study demonstrates the need for stroke prevention and information aimed at specific target groups. Since 2003, the regional network “Healthy Lower Rhine” carries out broad prevention campaigns and the city of Düsseldorf, capital of NRW, established a Stroke Information Bureau for community health education. Local surveys play a central part in health planning and prevention on a municipal level.     

„Subjektiver sozialer Status“

Background

Social status is just about always assessed by ‘objective’ measures such as educational level, income or occupational status. In recent years, some studies have also included the assessment of ‘subjective social status’ (SSS). This new variable could be important for health promotion and prevention. In Germany, though, this discussion has hardly been recognized yet.

Methods

Based on different databases, we conducted a systematic review of empirical studies which include an assessment of SSS. As far as we know, a similar review has not been published in German yet. We looked for associations with morbidity, mortality and health risks such as smoking or obesity. We finish with recommendations for further research and practice.

Results

We were able to find 53 empirical studies. Most of them are from the USA; no study has been published from Germany, Austria or Switzerland. Most studies (46 of 53) were published in the last 5 years, clearly indicating that this discussion is still rather new. ‘Subjective social status’ is mostly assessed by the MacArthur Scale, i.e. a ladder where the respondents can mark their position between ‘low’ (low social status) and ‘high’ (high social status). The results of the studies often show increased health risks for people with low SSS, even if ‘objective’ measures such as educational level or income are controlled for statistically.

Conclusion

“Subjective social status” should also be included in German studies, in addition to ‘objective’ measures such as educational level or income. If people are to be reached in programmes for health promotion or prevention, it is important to know what social position they believe they have; and this subjective perception does not just depend on ‘objective’ measures such as educational level or income. We would recommend that ‘subjective social status’ be assessed with a German version of the MacArthur Scale. The picture of a ladder is apparently able to capture the meaning of ‘social status’ very well and it is very easy to understand.     

Individual- and area-level effects on mortality risk in Germany,both East and West,among male Germans aged 65+

Objectives

This study investigates whether mortality inequalities based on individual- and area-level deprivation exist at older ages in Germany, and whether there are differences between eastern and western Germany.

Methods

Data on population and death counts according to the individual-level socioeconomic status of male German pensioners aged 65+ years in Germany in 2002–2004 were obtained from the German Federal Pension Fund. Area-level characteristics for the 439 German districts were incorporated. Multilevel Poisson models were fitted.

Results

Individual-level socioeconomic mortality inequalities exist among elderly men in Germany. After controlling for differential population composition in the districts, we found that district-level factors contribute to the explanation of mortality inequalities in (western) Germany. The analysis further indicated that mortality and mortality inequalities tend to be higher in more economically deprived districts, and that minor mortality differences attributable to regional conditions exist in eastern Germany.

Conclusions

The results showed that regional conditions have moderate effects on health inequalities at older ages in (western) Germany, when the differential population composition in the districts is controlled for.     

The influence of insurance status on waiting times in German acute care hospitals: an empirical analysis of new data

Background

There is an ongoing debate in Germany about the assumption that patients with private health insurance (PHI) benefit from better access to medical care, including shorter waiting times (Lüngen et al. 2008), compared to patients with statutory health insurance (SHI).

Problem

Existing analyses of the determinants for waiting times in Germany are a) based on patient self-reports and b) do not cover the inpatient sector. This paper aims to fill both gaps by (i) generating new primary data and (ii) analyzing waiting times in German hospitals.

Methods

We requested individual appointments from 485 hospitals within an experimental study design, allowing us to analyze the impact of PHI versus SHI on waiting times (Asplin et al. 2005).

Results

In German acute care hospitals patients with PHI have significantly shorter waiting times than patients with SHI.

Conclusion

Discrimination in waiting times by insurance status does occur in the German acute hospital sector. Since there is very little transparency in treatment quality in Germany, we do not know whether discrimination in waiting times leads to discrimination in the quality of treatment. This is an important issue for future research.     

Herausforderungen der HIV-Pr?vention f��r Migranten

Background

Approximately 30% of new HIV infections in Germany occur among immigrants. HIV prevention thus needs to be better tailored to immigrant communities.

Methods

A survey of the 118 members of the national association of AIDS service organizations (Deutsche AIDS-Hilfe e.V.) was conducted to assess their experiences in providing HIV prevention services to immigrants. The survey is part of a participatory research project (PaKoMi). The analysis focuses on the challenges described by the AIDS service organization (ASO).

Results

A total of 90 ASO participated in the survey (return rate 76%). The great majority (89%) provide HIV prevention services to immigrants. More than half (53%) state a need for further action to improve prevention services to immigrants in their locality. Only a small minority (10%) are satisfied with the level of communal cooperation among local actors on this issue. Major challenges in providing HIV prevention services to immigrants include: intercultural challenges in dealing with cultural differences and taboos, lack of resources, limited access of ASOs to immigrant communities, language barriers, stigmatization processes, and practical and conceptual challenges resulting from the complex needs and multilayered problems of those immigrant groups who are most at risk for HIV/AIDS.

Conclusions

To better manage the challenges described by the ASOs, the participation of immigrant communities in HIV prevention and the cooperation of health and social service providers with community-based immigrant organizations should be improved. Given the social structural factors and legal issues which contribute to the specific vulnerability and increased HIV risks of immigrants, the concept of ??structural prevention?? seems appropriate which conceptualizes HIV prevention as health promotion in the broader social context.     

Estimating the contribution of mortality selection to the East–West German mortality convergence

Background

Before German reunification, old-age mortality was considerably higher in East Germany than West Germany but converged quickly afterward. Previous studies attributed this rapid catch-up to improved living conditions. We add to this discussion by quantifying for the first time the impact of mortality selection.

Methods

We use a gamma-Gompertz mortality model to estimate the contribution of selection to the East–West German mortality convergence before and after reunification.

Results

We find that, compared to the West, frailer East Germans died earlier due to deteriorating mortality conditions leading to converging mortality rates for women and men already over age 70 before 1990. After 1990, the selection of frailer individuals played only a minor role in closing the East–west German mortality gap. However, our study suggests that, after reunification, old-age mortality improved quickly because the more robust population in the East benefitted greatly from ameliorating external factors such as health care and better living standards.

Conclusion

Our results from a natural experiment show that selection of frail individuals plays an important role in population-level mortality dynamics. In the case of the German reunification, East German old-age mortality already converged before 1990 because of stronger selection pressure.

     

Response in individuals with and without foreign background and application to the National Cohort in Germany: which factors have an effect?

Objectives

Response rates in epidemiologic studies vary widely. This study examines response rates of potential study participants according to foreign versus German background and investigates effects of recruitment strategies.

Methods

Response rates and characteristics of recruitment procedures from feasibility studies for a large cohort study conducted in 2011 were analyzed.

Results

Among 1,235 participants the proportion of recruited individuals with a foreign background was 17.3 % (95 % confidence interval 15.3–19.5 %), significantly lower than in the sampling frame (23.1 %). The difference between observed and expected proportion was high among individuals with Turkish background and smaller among ethnic Germans from the Former Soviet Union and other foreign background groups. Common recruitment strategies to increase the response had positive effects in all groups. For the planned recruitment strategy in the forthcoming German National Cohort, we estimate an overall response of approximately 50 %.

Conclusions

Individuals with Turkish background may need particular efforts to be adequately represented in a population-based cohort in Germany. Other foreign background groups are relatively well represented using standard procedures. An adequate response can be obtained under carefully planned recruitment strategies.     

Förderung kognitiv-stimulierender Freizeitaktivitäten bei türkischen Migranten

Background

The prevalence of dementia in our society is rising as a result of demographic change. This also holds true for migrants living in Germany. The goal of this pilot study was to evaluate whether older Turkish migrants would benefit from a group intervention program designed to prevent cognitive decline by promoting cognitively stimulating leisure activities (AKTIVA-program).

Method

The study enrolled 15 participants (13 women, 60.2 years?±?5.4) and has a pre-post-follow-up-design.

Results

Amongst other encouraging findings, the impact of the training on Turkish migrants was significantly positive in terms of cognitive functioning (F_MMST?=?3.93*, F_ADAS-Kog?=?4.49*, F_{TMT A}?=?4.94*). However, the results differ from the intervention effects shown in a sample of elderly people of German origin.

Conclusion

The application of the AKTIVA intervention program also works for Turkish migrants. However, the special needs of this population group need to be taken into account.     

Factors associated with subjective quality of life in Korean patients with depressive disorders: the CRESCEND study

Purpose

A number of studies suggest that depression is associated with the significant disability and the poorer subjective quality of life (QOL). We aimed to assess subjective QOL in Korean patients with depression and explore the factors (sociodemographic characteristics and clinical features) associated with subjective QOL.

Methods

We obtained the data from 808 depressive patients who entered the Clinical Research Center for Depression (CRESCEND) study and evaluated the relationship between subjective QOL and personal sociodemographics, and various clinical features, including depressive severity, and subjective QOL. We assessed subjective QOL using the 26-item abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) instrument.

Results

Decrements in patients?? physical health, psychological health, social relationships, and environment domains of subjective QOL were all strongly associated with the greater depressive symptom severity. After controlling for age and depressive symptom severity, the lower subjective QOL was independently related to being divorced or separated, the less monthly household income, and having no religious practices.

Conclusion

Our results suggest the importance of sociodemographic characteristics in addition to symptoms for the understanding of subjective QOL in depressed patients. The prospective studies to compare the different treatments?? effects on various subjective QOL domains are needed.     

Das Spannungsfeld von Gesundheitszielen im F?deralismus in Deutschland

Background

In the past 20 years, health targets have been systematically decided first within the federal government and then at the state level. The process of setting health targets in Germany is characterized by a wide variety of topics, stakeholders, strategies, financing and implementation as well as associated evaluation.

Purpose

Presentation of the health targets in Germany at the federal and state levels. Overview of the state health targets according to topic, number, funding body and legal status. Classification of health targets within the health policy discussion in relation to health promotion and disease prevention in Germany.

Results

To date seven health targets have been published at the federal level. At the level of the 16 states, 28 topic areas were identified as state health targets or priority action areas and the most frequent topics were cancer, health of older people and health of children and adolescents.

Conclusions

The central guidelines of the seven federal health targets should lead to a reinforced coordination among the 16 federal states, despite their independent nature of governance. A stronger federal municipalization of the health target process should be pursued. Spending by the statutory health insurance funds, pursuant to the German Social Security Act V §?20 paragraphs 1 and 2, should be better integrated into the healthcare target process.     

Körperliche Leistungsfähigkeit und Gesundheit bei älteren Arbeitnehmern

Introduction

German executives are becoming increasingly aware of the growing significance of employee health for the future viability of their companies. For the practical implementation of health promotion in a business setting, it is imperative to identify the central determinants of health, so that targeted measures can be initiated.

Method

In the present article, results from a cross-sectional study in a German company are presented (n?=?160; mean?=?55.1 years; SD?=?3.61 years). The aim of the study was to empirically analyze whether physical fitness has a stronger association with subjective health and state of physical ailments than the determinants physical activity, BMI and smoker/non-smoker status. In order to address these questions, we calculated hierarchical regressions.

Results

The results show that fitness is the strongest determinant of subjective health perception with a Beta weight of 0.447 (T?=?5.502; p?<?0.001). The evaluation of the associational factors of the state of physical ailments also showed that the state of fitness is a highly significant predictor of physical ailments (β?=???0.498; T?=???5.838; p?<?0.001).

Conclusions

In the light of this, health promotion measures focusing on physical activity and particularly the physical fitness should be given a larger role in occupational practice.     

Prävention chronischer Herz-Kreislauf-Krankheiten

Background

For some years now, the German government has been discussing the introduction of a prevention bill (“Präventionsgesetz”) in order to structurally and financially strengthen the preventive efforts that have been outlined by many public health experts for decades. The main aim of this venture is to make the German health system and even physicians more responsive to the needs of socially disadvantaged citizens, less vulnerable to economic constraints and generally more efficient in the long term. Such a bill touches core interests of many actors in various social, political, medical and economic sectors and so far it has proved impossible to reach a compromise acceptable to all interest groups involved.

Aim

The difficulties surrounding this contentious bill arguably have roots in the structures and concepts of the German health system, which this paper sets out to analyse in a historical comparison of the health systems in West Germany, East Germany and the UK. Emphasis is put on the prevention of cardiovascular disease because according to the WHO it represents the ‘number one cause of death’ on a global and on the national level.

Result

The historical analysis shows that political action is needed: prevention should be understood in broad terms, focus on the reduction of social inequality and be grounded in law.     

Potenziale pflegerischer Berufe in Prävention und Gesundheitsförderung

Background

The nursing profession hardly appears in current discussions and developments in prevention and health promotion in Germany. The reasons are manifold. Nursing in Germany is not prepared to tackle the developments in health politics and the health care system in order to fulfil the tasks and duties in prevention and health promotion. Concepts and theoretical basics as well as systematic knowledge are missing regarding which areas in Germany nurses are able to participate in an effective and beneficial way in prevention and health promotion.

Material and methods

Based on a systematic national and international literature search, potentials and preventive tasks of nurses in different health care systems are presented.

Findings and conclusion

The findings show that nurses in different countries are firmly anchored in health care systems. They are an integrated part of preventive programs. The integration of nursing professions in prevention and health promotion in the selected countries goes far beyond the German level.     

Potenzielle Bildungsaufsteiger leben ges��nder

Background

Social disparities in adolescents?? health risk behaviour point to insufficiently utilised potential of disease prevention and health promotion. The influence of parental education, own educational status and intergenerational educational mobility on various health risk behaviours is being analysed.

Material and methods

The data were derived from a subsample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (age=14 to 17 years, n=3737). Sex-specific prevalences and binary logistic regressions for smoking, body mass index, physical inactivity, heavy use of electronic media, regular alcohol intake and daily consumption of fresh fruits and vegetables have been calculated.

Results

Independent from the educational status of their parents, boys and girls attending upper secondary schools (??Gymnasium??) tend to adopt less negative health behaviours than their peers attending other types of schools. Statistically significant differences are detected for four out of six health risk behaviours in boys and five out of six health risk behaviours in girls. Parental education is independently associated with four out of six health risk behaviours only in girls.

Conclusion

Besides adolescents with a stable high educational status, potentially upwardly mobile boys and girls tend to have a healthier lifestyle than stable low and potentially downwardly mobile adolescents. From a public health point of view the findings underline the demand for investments in education and equal opportunities within the educational system.     

Programme und Projekte zum Abbau sozial bedingter Ungleichheit von Gesundheitschancen in Deutschland und Europa

Background

Health inequalities have been documented for all European countries. Also in Germany there is a clear association of social status and health, and there are many activities to tackle disparities in health status.

Aim

This contribution documents some existing strategies on the national level and focuses on two large-scale projects which are being coordinated by the German Federal Centre for Health Education (BZgA): the national cooperation project Gesundheitsförderung bei sozial Benachteiligten (health promotion in the socially disadvantaged) and the European project “Closing the Gap: Strategies for Action to Tackle Health Inequalities in Europe”. Both projects aim at identifying effective strategies to reduce inequalities in health, at exchanging expertise within the peer group of health professionals and at developing good practice.

Conclusion

Networking activities on the national and international level contribute to exchanging ideas, projects and even overarching strategies. This exchange helps to promote the field of ‘tackling health inequalities’.     

Die Gesundheit von Studierenden im Bologna-Prozess

Background

In comparison with different countries, there is a sporadic database in Germany which reflects the health status of students. According to this, the needs of the target group have to be mapped and conclusions for health promotion in the university setting have to be drawn.

Aims

Initially, the health-related behavior and the health status of the students of the Coburg University of Applied Sciences were evaluated. Based on these results, specific measures that can be integrated into the daily routine of the university are recommended. These procedures can be transferred to comparable universities.

Results

About 85% of the students describe their health as important. Female students tend to evaluate their health higher. Less than 50% of the respondents declare their well-being as??good?? or??very good.?? More than 90% of the students express aims concerning their personal health behavior. Almost one in two students describe an above average stress dimension as well as feelings of strain, which are mainly caused by the consequences of organizing their studies. Studying is partly accompanied by a higher consumption of legal drugs. Only 5% of the students use relaxation techniques for decreasing stress regularly. However, one in four students show an interest in methods aimed at relaxation. Half of the students participate in endurance sports.

Conclusion

The majority of the respondents describe an interest in a whole food diet, although awareness of healthy eating is missing. The results show a lack of efficient stress management. Structured and sustainable integrated health promotion initiatives within the university environment are strongly recommended.     

Different components of nutritional status in older inpatients with cognitive impairment

Objectives

To evaluate different components of nutritional status in older patients with cognitive deficit, particularly in those with mild cognitive impairment (MCI).

Design

Cross-sectional study.

Setting and participants

560 elderly subjects aged ?? 65 years consecutively admitted to an acute Geriatric Unit of Apulia region of southern Italy.

Measurements

A standardized comprehensive geriatric assessment was used to evaluate medical, cognitive, affective and social aspects. Nutritional status was assessed using the mini nutritional assessment (MNA). The cognitive function was categorized into three levels ?? MCI, dementia or normal cognition (NoCI) ?? according to the neuropsychological test score.

Results

Subjects with cognitive decline had significantly lower frequency of well-nourished (MCI=10%, dementia=8%, NoCI=22%, p<0.05) and higher frequency of malnourished (MCI=47%, dementia=62%, NoCI=19%, p<0.001) than patients with normal cognition. Similarly, MNA total score, MNA-3 and MNA-4 subscores were significantly lower in patients with MCI and dementia than patients with normal cognition (p<0.001).

Conclusions

These results suggest that cognitive decline may be associated with malnutrition in this sample of hospitalized older patients. Dietary habits (MNA-3) and subjective assessment of self-perceived quality of health and nutrition (MNA-4) are particularly poor also in patients with MCI and could be. very important variables to be considered in the multidimensional evaluation of subjects with cognitive impairment.