Diversity markers such as sex, migration background and socioeconomic status are associated with different needs and expectations in health care. In rehabilitation these needs and expectations are ...often not adequately accounted for. This may affect health care outcomes. In order to improve rehabilitative care, it is not sufficient to only focus on selected diversity criteria such as migration background. This has two reasons: First, health care users are defined by a wide range of different diversity markers; second, diversity markers are closely interrelated. Diversity management allows to address the population as a whole by establishing conditions in health care institutions which permit to cater for the diversity of all health care users, thereby allowing to provide a more patient-oriented health care.
Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. ...Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other.
In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section.
Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups.
Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.
Health and access to health care are considered a human right. "Regular" immigrants such as work migrants in Germany have the same entitlement to health care coverage through the statutory health ...insurance as the majority population. This, however, is not the case for refugees and asylum seekers. According to paragraphs 4 and 6 of the Asylum Seekers' Benefit Act, their entitlement is restricted to care for acute pain, pregnancy and childbirth, as well as immunizations in the first 15 months. Additional care can be financed on a case-by-case basis. Care provision is regulated in different ways by the communities; it is further complicated by different regulations at the federal state levels and by differences in knowledge of the physicians on how entitlement restrictions can be circumvented on a case-by-case basis. Thus, entitlement and access to care of asylum seekers and refugees is driven by chance in 3 respects: when they are assigned to a federal state, when they are assigned to a community, and when they are treated by a doctor with more or less knowledge of the legal regulations. Restrictions on entitlement to health care are associated with higher health care expenditure. They may also lead to delayed treatment of life-threatening conditions. Furthermore, they may negatively affect social integration of asylum seekers. Therefore, the restrictions of entitlement in paragraphs 4 and 6 of the Asylum Seekers' Benefit Act need to be lifted immediately. Asylum seekers should be granted the same entitlements to health care as the majority population in the whole of Germany.
All asylum seekers in Germany undergo upon-entry screening for tuberculosis TB, but comprehensive evidence on the yield is lacking. We compared the national estimates with the international ...literature in a systematic review and meta-analysis of studies reporting the yield of TB, defined as the fraction of active TB cases detected among asylum seekers screened in Germany upon entry. We searched 11 national and international databases for empirical studies and the internet for grey literature published in English or German without restrictions on publication time. Among 1,253 screened articles, we identified six articles reporting the yield of active TB based on German data, ranging from 0.72 (95% confidence interval (CI): 0.45-1.10) to 6.41 (95% CI: 4.19-9.37) per 1,000 asylum seekers. The pooled estimate across all studies was 3.47 (95% CI: 1.78-5.73; I
= 94.9%; p < 0.0001) per 1,000 asylum seekers. This estimate was in line with international evidence (I
= 0%; p for heterogeneity 0.55). The meta-analysis of available international estimates resulted in a pooled yield of 3.04 (95% CI: 2.24-3.96) per 1,000. This study provides an estimate across several German federal states for the yield of TB screening in asylum seekers. Further research is needed to develop more targeted screening programmes.
Foodborne disease outbreaks (FBDOs) occur frequently in Europe. Employing analytical epidemiological study designs increases the likelihood of identifying the suspected vehicle(s), but these studies ...are rarely applied in FBDO investigations. We used multivariable binary logistic regression analysis to identify characteristics of investigated FBDOs reported to the European Food Safety Authority (2007–2011) that were associated with analytical epidemiological evidence (compared to evidence from microbiological investigations/descriptive epidemiology only). The analysis was restricted to FBDO investigations, where the evidence for the suspected vehicle was considered ‘strong’, i.e. convincing. The presence of analytical epidemiological evidence was reported in 2012 (50%) of these 4038 outbreaks. In multivariable analysis, increasing outbreak size, number of hospitalizations, causative (i.e. aetiological) agent (whether identified and, if so, which one), and the setting in which these outbreaks occurred (e.g. geographically dispersed outbreaks) were independently associated with presence of analytical evidence. The number of investigations with reported analytical epidemiological evidence was unexpectedly high, likely indicating the need for quality assurance within the European Union foodborne outbreak reporting system, and warranting cautious interpretation of our findings. This first analysis of evidence implicating a food vehicle in FBDOs may help to inform public health authorities on when to use analytical epidemiological study designs.
In many European countries, foreign nationals experience, on average, less favorable treatment outcomes in rehabilitative care than the respective majority population. In Germany, this for example is ...reflected in a lower occupational performance and a higher risk of disability retirement after rehabilitation as analyses of routine data show. However, little is known about the perspective of health care users. The aim of the present study was to compare self-rated treatment outcomes between German and non-German nationals undergoing in-patient medical rehabilitation in Germany.
We analyzed data from a cross-sectional representative rehabilitation patient survey of 239,811 patients from 642 clinics in Germany who completed about 3 weeks of in-patient rehabilitative treatment. The self-rating of the treatment outcome was based on a dichotomized Likert scale consisting of three items. A multilevel logistic regression analysis adjusted for various demographic, socio-economic, health and other covariates was conducted to examine differences in the self-rated treatment outcome between German and non-German nationals.
Of the 239,811 respondents 0.9% were nationals from Turkey, 0.8% had a nationality from a former Yugoslavian country, 0.9% held a nationality from the South European countries Portugal, Spain, Italy or Greece and 1.9% were nationals from other countries. Non-German nationals reported a less favorable self-rated outcome than Germans. Adjusted odds ratios OR for reporting a less favorable treatment outcome were 1.24 (95%-confidence interval 95%-CI: 1.12-1.37) for nationals from the South European countries Portugal/Spain/Italy/Greece, 1.62 (95%-CI: 1.45-1.80) for Turkish nationals and 1.68 (95%-CI: 1.52-1.85) for nationals from Former Yugoslavia.
Knowledge on health outcomes from the patients' point of view is important for the provision of patient-centered health care. Our study showed that non-German nationals report less favorable outcomes of rehabilitative care than Germans. This may be due to cultural and religious needs not sufficiently addressed by health care providers. In order to improve rehabilitative care for non-German nationals, rehabilitative services must become sensitive to the needs of this population group. Diversity management can contribute to this process.
People with migration background (PMB) make up a huge section of the population with specific health chances and risks. There are only limited data available on the health situation of PMB, since ...inclusion of PMB in surveys is hindered, e.g. due to language barriers. The present study has examined to what extent the population-based health surveys of the Robert Koch Institute have managed to include a representative extent of PMB, with the aim of deriving recommendations for analysis options and future recruitment strategies. The 2009 microcensus (MC) of the Federal Statistical Office was used as the basis to check whether the sample of KiGGS Wave 1 (2009-2012) and DEGS 1 (2008-2011) are representative regarding socio-demographic and migrant-specific characteristics. 1107 PMB participated in DEGS 1. In comparison to the MC, particular sub-groups are underrepresented in the sample: people who immigrated themselves (first-generation migrants), people with a low education and Turkish citizens. On the other hand, some age groups are overrepresented. In KiGGS Wave 1, 2021 children and adolescents with a migration background participated. Response was lower if parents had a low education. In total, the participation of children and adolescents with a migration background was lower in comparison to the KiGGS baseline survey. The data on PMB in DEGS 1 and KiGGS Wave 1 are appropriate for health analyses of this population group. However, analyses should be stratified according to characteristics like migrant generation, age or education level, or these characteristics should be adjusted for in statistical models. In order to achieve a representative inclusion of people with a migration background, in future surveys sub-group-specific activities to increase participation of PMB are recommended.
Interdisciplinarity is not only a constitutive element of public health; it also contributes significantly to the solution of complex public health problems. Only through the cooperation of different ...disciplines and professions can the diverse social and methodological-technical challenges of developing, implementing and evaluating health-related interventions be solved. In this context, public health in Germany is facing challenges in its further development, two of which we discuss here. Firstly, there is a gap between aspiration and reality of interdisciplinary research and teaching of public health. Secondly, related to that, there is an increasingly difficult balance between professional breadth and specialisation in the university education of future public health experts.
The June 2015 political statement of the National Academy of Sciences Leopoldina on Public Health in Germany emphasizes the need to strengthen Public Health and Public Health research in Germany. The ...Leopoldina authors' discernable desire to take into consideration the largest possible number of aspects and disciplines related to Public Health, however, leads to an accumulation of concepts with little or no content or even contradictive statements. Besides highly welcome explanation, for instance on the relevance of social determinants, the policy statement one-sidedly argues in favour of promoting genomics and other "omics" technologies. Indeed, the Leopoldina paper overrates the relevance of this and other technological approaches within Public Health and focuses too much on biomedical solutions. The potential of such technologies in the context of the health-in-all-policies approach which Leopoldina asks for is rather limited, however, when it comes to creating healthy living conditions. Genetic and other innovative technologies of medical research are hardly able to improve these conditions; they can merely contribute to enhancing the resilience of human beings in view of the increasingly uncontrollable environmental conditions - rather than changing these conditions.
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