@misc{LueckmannHoebelRoicketal., author = {Lueckmann, Sara Lena and Hoebel, Jens and Roick, Julia and Markert, Jenny and Spallek, Jacob and Knesebeck, Olaf von dem and Richter, Matthias}, title = {Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review}, series = {International journal for equity in health}, volume = {20}, journal = {International journal for equity in health}, issn = {1475-9276}, doi = {10.1186/s12939-020-01375-1}, pages = {19}, abstract = {Background Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries. Methods We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria. Results Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES. Conclusion This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare.}, language = {en} } @misc{SchillingSpallekMauletal., author = {Schilling, Laura and Spallek, Jacob and Maul, Holger and Schneider, Sven}, title = {Study on E-Cigarettes and Pregnancy (STEP) - Results of a Mixed Methods Study on Risk Perceptionof E-Cigarette Use During Pregnancy}, series = {Geburtshilfe und Frauenheilkunde}, volume = {81}, journal = {Geburtshilfe und Frauenheilkunde}, number = {02}, issn = {0016‑5751}, doi = {10.1055/a-1308-2376}, pages = {214 -- 223}, abstract = {Introduction E-cigarette use during pregnancy is a risk factor for maternal and fetal health. Early studies on animals showed that in utero exposure to e-cigarettes can have negative health outcomes for the fetus. There has been only limited research into the risk perceptions of e-cigarette use during pregnancy. This study was conducted to comprehensively characterize the constructs of risk perceptions with regard to e-cigarette use during pregnancy using an Integrated Health Belief Model (IHBM). Methods Our STudy on E-cigarettes and Pregnancy (STEP)used a mixed methods approach, with the study divided intoan initial qualitative part and a quantitative part. A netno-graphic approach was used for the first part, which consistedof the analysis of 1552 posts from 25 German-language on-line discussion threads on e-cigarette use during pregnancy. Using these qualitative results, a quantitative questionnaire was developed to explore risk perception constructs about e‑cigarette use during pregnancy. This questionnaire was subsequently administered to pregnant women (n = 575) in onehospital in Hamburg, Germany. Descriptive and bivariate analysis was used to examine differences in risk perception ac-cording to participantsʼ tobacco and e-cigarette user status before and during pregnancy. While the study design, methods and sample have been extensively described in our recently published study protocol in the January 2020 issue of Geburtshilfe und Frauenheilkunde, this paper is devoted to apresentation of the results of our mixed methods study. Results Themes related to perceived threats identified in the qualitative study part were nicotine-related health risks and po-tential health risks of additional ingredients. Perceived benefits were possibility and facilitation of smoking cessationand a pre-sumed potential to reduce harm. The subsequent quantitative part showed that nearly all participants (99.3\%) perceivede‑cigarettes which contained nicotine as constituting a threat to the health of the unborn child. The most commonly perceived barrier was health-related (96.6\%), while the most commonly perceived benefit was a reduction in the amount of tobacco cigarettes consumed (31.8\%). We found that partic-ularly perceived benefits varied depending on the partici-pantʼs tobacco and e-cigarette user status. Conclusion When considering future prevention strategies, the potential health risks and disputed effectiveness of e-cigarettes as a tool for smoking cessation need to be taken intoaccount and critically discussed.}, language = {en} } @misc{MianiBatramZantvoortWandschneideretal., author = {Miani, C{\´e}line and Batram-Zantvoort, Stephanie and Wandschneider, Lisa and Spallek, Jacob and Razum, Oliver}, title = {Potential of Standard Perinatal Data for Measuring Violation of Birth Integrity}, series = {Frontiers in global women's health}, journal = {Frontiers in global women's health}, number = {1}, issn = {2673-5059}, doi = {10.3389/fgwh.2020.581244}, pages = {8}, abstract = {Background: Measuring the phenomenon of violation of birth integrity (vBI) (e.g., obstetric violence) relies in part on the availability and content of maternity care providers' data. The population coverage and linkage possibilities that these data provide make for a yet untapped potential. Although vBI is a complex phenomenon best measured with dedicated instruments, we argue that maternity care providers' data could contribute to enhance our knowledge of the manifestations and frequency of vBI, and allow for analyses across different sub-groups of the population. Looking into the German standardized perinatal data, we investigate which variables are relevant to vBI-related research, and how complete their reporting is. Methods: First, we analyse state-of-the-art frameworks and recommendations, and, for each vBI-related domain, we search for and list corresponding variables in the perinatal data which could contribute to a better understanding of vBI issues. Second, we use an example and analyse the content of perinatal data obtained between 2013 and 2016 in the context of the BaBi birth cohort study set in Bielefeld, Germany. We use descriptive statistics to assess the completeness of the data. Results: The vBI-related variables can be classified in three main categories: discrimination based on specific patient socio-demographic attributes (e.g., height and weight to calculate BMI before pregnancy, foreign origin), indication for medical interventions (i.e., medicalization-related variables: indication for cesarean sections and induction), and supportive care, in particular the mobilization dimension (e.g., continuous fetal heartbeat monitoring). The data analyses included 876 births, of which 601 were vaginal birth. We found poor reporting on demographic variables in terms of completeness. Medicalization and mobilization variables are better documented, although limited in scope. Conclusions: Putting more emphasis on the completeness of standardized data could increase their potential for vBI-related research. Perinatal data alone are insufficient to assess vBI, but a broader, theory-informed discussion of indicators to be included in standardized datasets would contribute to capturing the different aspects of integrity violation in a more systematic way and expand the evidence-base on different types of vBI.}, language = {en} } @misc{OPUS4-16746, title = {Gesundheit von Schwangeren und S{\"a}uglingen mit Migrationshintergrund}, editor = {Razum, Oliver and Reeske, Anna and Spallek, Jacob}, edition = {1. Auflage}, publisher = {Peter Lang GmbH Internationaler Verlag der Wissenschaften}, address = {Frankfurt am Main}, isbn = {978-3-631-60575-2}, pages = {172}, abstract = {Schwangere und S{\"a}uglinge sind eine vulnerable Gruppe, besonders wenn sie einen Migrationshintergrund haben. Eine wirksame Versorgung dieser Zielgruppe ist unabdingbar, um nachhaltige gesundheitliche Sch{\"a}den bei Mutter und Kind zu vermeiden. Entlang der Zeitachse von der Konzeption bis zum ersten Geburtstag werden in diesem Band ausgew{\"a}hlte Aspekte der m{\"u}tterlichen und kindlichen Gesundheit bei Migranten dargestellt. Dabei stehen folgende Fragen im Vordergrund: Inwieweit bestehen gesundheitliche Unterschiede zwischen M{\"u}ttern und S{\"a}uglingen mit Migrationshintergrund und der Mehrheitsbev{\"o}lkerung Deutschlands ? Wie sind bestehende Unterschiede zu bewerten ? Welche Faktoren bedingen diese Unterschiede? Welche Maßnahmen sind Erfolg versprechend, um bestehende Ungleichheiten zu reduzieren und positive gesundheitliche Entwicklungen zu f{\"o}rdern?}, language = {de} } @incollection{RazumReeskeSpallek, author = {Razum, Oliver and Reeske, Anna and Spallek, Jacob}, title = {Schwangerschaft, Geburt und erstes Lebensjahr in der Migration: gesundheitliche Herausforderungen}, series = {Schwangerschaft, Geburt und fr{\"u}he Kindheit in der Migration}, booktitle = {Schwangerschaft, Geburt und fr{\"u}he Kindheit in der Migration}, editor = {David, Matthias and Borde, Theda}, publisher = {Mabuse-Verlag}, address = {Frankfurt am Main}, isbn = {979-3-940529-91-6}, pages = {57 -- 72}, abstract = {Dieser Artikel besch{\"a}ftigt sich mit den, durch mangelnde Akkulturation oder geringe Integration bedingte, Risikofaktoren f{\"u}r Gesundheitsprobleme w{\"a}hrend der Schwangerschaft, in der Perinatalzeit und im ersten Lebensjahr.}, language = {de} } @incollection{SpallekZeeb, author = {Spallek, Jacob and Zeeb, Hajo}, title = {Bedarf und Inanspruchnahme psychiatrischer Versorgung durch Menschen mit Migrationshintergrund in Deutschland}, series = {Handbuch transkulturelle Psychiatrie}, booktitle = {Handbuch transkulturelle Psychiatrie}, editor = {Hegemann, Thomas and Salman, Ramazan}, edition = {1. Auflage}, publisher = {Psychiatrie-Verlag}, address = {Bonn}, isbn = {978-3-88414-467-1}, pages = {58 -- 68}, abstract = {Obwohl die Migration ein offensichtlich psychisch stark belastender Vorgang ist, gibt es zu dem Bedarf und der Inanspruchnahme psychiatrischer Versorgung durch Menschen mit Migrationshintergrund in Deutschland wenig erforschtes Wissen. Dieser Artikel zeigt ein Modell auf, wie diese Belastung wirkt, wo Hindernisse und wo noch Bedarf in der Forschung f{\"u}r dieses Thema liegen.}, language = {de} } @book{Spallek, author = {Spallek, Jacob}, title = {Migrantengesundheit - Die Sicht der Life-Course-Epidemiologie am Beispiel von Krebs bei t{\"u}rkischen Zuwanderern}, edition = {1. Auflage}, publisher = {Beltz Juventa}, address = {Weinheim und Basel}, isbn = {978-3-7799-1983-4}, pages = {105}, abstract = {Die Gesundheit von Zuwanderern und von der nicht eingewanderten Bev{\"o}lkerung unterscheidet sich zum Teil erheblich. M{\"o}gliche Ursachen daf{\"u}r k{\"o}nnen w{\"a}hrend des ganzen Lebenslaufs der Zuwanderer aufgetreten sein. Dieses Buch besch{\"a}ftigt sich mit dieser Lebenslaufperspektive anhand der empirischen Ergebnisse von zwei epidemiologischen Untersuchungen zu Krebsrisiken von t{\"u}rkischen Zuwanderern in Deutschland.}, language = {de} } @misc{SpallekTempesRicksgersetal., author = {Spallek, Jacob and Tempes, Jana and Ricksgers, Hannah and Marquardt, Louisa and Pr{\"u}fer-Kr{\"a}mer, Luise and Kr{\"a}mer, Alexander}, title = {Gesundheitliche Situation und Versorgung unbegleiteter minderj{\"a}hriger Fl{\"u}chtlinge - eine N{\"a}herung anhand qualitativer und quantitativer Forschung in der Stadt Bielefeld}, series = {Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz}, volume = {59}, journal = {Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz}, number = {5}, issn = {1436-9990}, doi = {10.1007/s00103-016-2339-2}, pages = {636 -- 641}, abstract = {Unbegleitete minderj{\"a}hrige Fl{\"u}chtlinge (UMF) sind Kinder oder Jugendliche unter 18 Jahren, die sich ohne Begleitung eines f{\"u}r sie zust{\"a}ndigen Vormundes auf die Flucht begeben. Internationale Studien zeigen, dass minderj{\"a}hrige unbegleitete Fl{\"u}chtlinge eine besondere Risikogruppe darstellen. Empirische Ergebnisse {\"u}ber die gesundheitliche Situation von unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlingen in Deutschland in der aktuellen Situation sind kaum vorhanden. Ziel dieses Beitrags ist die Beschreibung der gesundheitlichen Situation und Versorgung von unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlingen in Bielefeld. Daf{\"u}r werden zwei qualitative und eine quantitative Studie aus Bielefeld genutzt. Die Ergebnisse zeigen, dass die gesundheitliche Versorgung von unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlingen Besonderheiten unterliegt und weisen vor allem auf zwei spezifische (medizinische) Bedarfe hin: die psychische/psychiatrische Versorgung und die Versorgung von Infektionskrankheiten. Weitere Herausforderungen in der gesundheitlichen Versorgung ergeben sich aus der spezifischen Situation der unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlinge und schließen die rechtlichen Rahmenbedingungen sowie sprachliche und kulturelle Kompetenzen auf Seiten der Versorger und auf Seiten der unbegleiteten minderj{\"a}hrigen Fl{\"u}chtlinge ein.}, language = {de} } @misc{SchillingSpallekMauletal., author = {Schilling, Laura and Spallek, Jacob and Maul, Holger and Tallarek, Marie and Schneider, Sven}, title = {Active and Passive Exposure to Tobacco and e-Cigarettes During Pregnancy}, series = {Maternal and Child Health Journal}, volume = {25}, journal = {Maternal and Child Health Journal}, number = {4}, issn = {1092-7875}, doi = {10.1007/s10995-020-03037-8}, pages = {656 -- 665}, abstract = {Objectives Active and passive exposure to tobacco cigarettes during pregnancy is associated with multiple negative health outcomes for the fetus. In addition, exposure to e-cigarettes has been progressively discussed as a new threat to fetal health. Until now, there has been a lack of studies examining active and passive exposure to tobacco and e-cigarettes among pregnant women. The objective of our current STudy on E-cigarettes and Pregnancy (STEP) was to advance and complement the current knowledge regarding active and passive exposure to tobacco and e-cigarettes before pregnancy and during early and late pregnancy. Methods One element of the STEP study was a quantitative cross-sectional design: A sample of 540 pregnant women recruited at an obstetrician clinic in Hamburg from April 2018 to January 2019 were surveyed once via a standardized questionnaire and provided complete information regarding their consumption of tobacco and e-cigarettes. We performed a descriptive analysis of tobacco and e-cigarette use before pregnancy and during early and late pregnancy, as well as bivariate analysis of these variables with sociodemographic determinants. Passive exposure was assessed by asking the participating pregnant women about the consumption of tobacco and e-cigarettes by their partners, in general, and in their homes. Results Before pregnancy, 20.0\% of the participants used tobacco cigarettes exclusively, 1.3\% used e-cigarettes exclusively, and 6.5\% were dual users. Educational level was significantly associated with tobacco cigarette use (p < 0.001) and dual use (p = 0.047) before pregnancy. During early (late) pregnancy, 8.7\% (2.8\%) used tobacco cigarettes and 0.4\% (0.0\%) used e-cigarettes exclusively. Twenty-point nine percent of women's partners consumed tobacco cigarettes exclusively, 2.7\% consumed e-cigarettes exclusively, and 2.7\% consumed both. A total of 8.5\% (16.7\%) of the partners who consumed tobacco cigarettes exclusively (e-cigarettes exclusively) did so in the women's homes. Conclusions for Practice Among pregnant women, the use of tobacco cigarettes remains prominent before and during pregnancy, while e-cigarette use predominately occurs before pregnancy. Our study shows that pregnant women are frequently exposed to their partners' tobacco and e-cigarette use within their homes. Strategies to reduce such exposure should be further intensified. Significance In the last decade, e-cigarettes have become popular, and e-cigarette use has been increasing, even among pregnant women. However, there is a lack of knowledge concerning the exposure to e-cigarettes before pregnancy and during early and late pregnancy, as well as studies comparing e-cigarettes and tobacco cigarettes. The current study found that active exposure to e-cigarettes before pregnancy is high, while exposure during pregnancy is marginal. In contrast, exposure to tobacco cigarettes before and in early pregnancy is high but decreases during late pregnancy. In addition, the results of our study show that pregnant women are passively exposed to tobacco and e-cigarettes at home. Pregnant women should be advised against exposing themselves, actively or passively, to tobacco and e-cigarette smoke.}, language = {en} } @misc{UlrichKohlerFachetal., author = {Ulrich, Hanna-Sophie and Kohler, Emma and Fach, Eva-Maria and Spallek, Jacob and Richter, Matthias and Mlinarić, Martin}, title = {Healthcare needs among unaccompanied minor refugees: a study protocol of a qualitative study explaining access and utilisation across place and gender}, series = {BMJ Open}, volume = {10}, journal = {BMJ Open}, number = {9}, issn = {2044-6055}, doi = {10.1136/bmjopen-2020-038882}, pages = {8}, abstract = {Introduction: Several studies have identified that unaccompanied minor refugees (UMRs) are allegedly 'vulnerable' and belong to a high-risk group in terms of psychological distress and post-traumatic stress disorder due to their preflight, periflight and postflight experiences. Psychosocial care (PSC) is of high importance for UMRs, but little is known about barriers to access and utilisation of PSC across place and gender. The aims of this gender-sensitive qualitative study will be to build on the existing body of literature and to provide qualitative evidence on the contexts and mechanisms of PSC for male and female UMRs in Germany by comparing two German regions. Methods and analysis: Following the study preparing realist review, a qualitative study will be undertaken in Berlin and Central German cities. Approximately 24 experts from the field of PSC and 12 lay UMRs will participate in face-to-face, semistructured interviews. Data will be transcribed and analysed based on the grounded theory research paradigm. Ethics and dissemination: Only participants who have been informed in both German and their native tongue and who have signed a declaration of consent will be included in the study. The study will comply rigorously with German data protection standards. Approval from the Ethical Review Committee at Martin Luther University Halle-Wittenberg, Germany has been obtained and granted. The results of the study will be presented at several conferences and will be published in high-quality, peer-reviewed international journals. The results will display a differentiated picture of the PSC of UMRs in Germany. Such knowledge is a precondition for a 'science of change' that translates explanations into practical recommendations on how to improve healthcare policies.}, language = {en} }