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Einleitung
Die gesundheitliche Entwicklung von Kindern wird neben der sozioökonomischen Position (SEP) der Familie auch von Merkmalen der Lebensumgebung geprägt. Ruralität oder regionale sozioökonomische Deprivation werden als mögliche unabhängige Einflussgrößen postuliert, ohne dass bisher ausreichende empirische Ergebnisse vorliegen. In dieser Studie wurde untersucht, ob regionale sozioökonomische Deprivation und Ruralität unabhängig von familiärer SEP mit der Entwicklung von Kindern assoziiert sind.
Methoden
Daten des Sozialpädiatrischen Entwicklungsscreenings im Rahmen der Einschulungsuntersuchungen aus dem Jahr 2018/2019 in Brandenburg (n=22.801 Kinder) wurden verknüpft mit Daten zur regionalen Bevölkerungsdichte (Ruralität) sowie mit dem German Index of Socioeconomic Deprivation (regionale Deprivation). Mittels gemischter Modelle wurde der Zusammenhang einer Allgemeinen Entwicklungsverzögerung (AEV) mit Ruralität und mit regionaler Deprivation analysiert (OR=Odds Ratio (95% Konfidenzintervall)), wobei für familiäre SEP (hoch, mittel, niedrig) adjustiert und nach Geschlecht (M=Mädchen, J=Jungen) stratifiziert wurde.
Ergebnisse
Kinder mit hoher familiärer SEP zeigten geringere Chancen einer AEV als Kinder mit mittlerer familiärer SEP (ORM=4,26(3,14-5,79); ORJ=3,46(2,83-4,22)) und niedriger familiärer SEP (ORM=16,58(11,90-23,09); ORJ=12,79(10,13-16,16)). Größere regionale Deprivation war unabhängig von familiärer SEP und Ruralität mit AEV assoziiert (ORM=1,35(1,13-1,62); ORJ=1,20(1,05-1,39)). Neben familiärer SEP und regionaler Deprivation zeigte Ruralität keine Assoziation mit AEV.
Schlussfolgerung
Neben der familiären SEP wirkt sich die regionale sozioökonomische Deprivation auf Entwicklungsverzögerungen von Kindern aus. Sozialepidemiologie und Public Health sollten daher neben den individuellen sozioökonomischen Voraussetzungen auch die regionalen sozioökonomischen Bedingungen als Determinante der gesundheitlichen Entwicklung über den Lebenslauf berücksichtigen.
Elevated stress during pregnancy in women of Turkish origin: Results from a prospective cohort study
(2022)
Background
Ethnic health disparities exist in the context of pregnancy and childbirth, suggesting that women of Turkish origin (i.e., they or their parents born in Turkey) in Germany have higher risks for some adverse maternal health and child developmental outcomes. Stress is believed to be a relevant pathway by which migration may be associated with these risks. In this study, we tested associations of Turkish origin with stress biology and psychological stress experiences during pregnancy.
Methods
140 pregnant women (33 of Turkish/26 of other origin) participated in a prospective cohort study that was carried out in Bielefeld and Berlin (Spallek et al., 2020). Inflammatory markers CRP and IL-6 from venous blood samples and diurnal cortisol profiles from salivary cortisol samples were derived and participants completed the Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CESD) at two study visits during pregnancy (T1: 20-25 weeks of gestation, T2: 30-35 weeks of gestation). Multilevel models were conducted to account for the nested data structure due to repeated measurements.
Results
Compared to non-migrant women, women of Turkish origin had significantly higher inflammatory levels (b = 0.28, SE = 0.14, p=.052) (Spallek et al., 2021), a blunted cortisol awakening response (b=-0.21, CI=-0.38–0.03, p<.05), a flatter diurnal cortisol slope (b = 0.02, CI = 0.00-0.04, p<.05), and higher PSS (b = 0.46, SE = 0.13, p< .001) and CESD scores (b = 0.29, SE = 0.08, p<.001) during pregnancy after adjusting for socioeconomic factors.
Conclusions
The results of our study suggest higher stress at the biological and psychological level in pregnant women of Turkish origin. Stress is a risk factor for pregnancy complications and poor birth and child developmental outcomes. To reduce such unequally distributed risks, interventions for stress reduction are needed that are tailored to women of Turkish origin.
Background
Children's overweight is associated with many factors, including their living situation, in particular their family's socioeconomic position (SEP) and family characteristics. Research on the extent to which family characteristics account for a social gradient in overweight in early life is scarce. This study evaluated whether family characteristics explain SEP differences in the risk of overweight in early childhood.
Methods
The study used baseline data of 3-6 year-old children (n = 1,116) from the intervention ‘Ene mene fit’ conducted at kindergartens in Baden-Württemberg, Germany. Data included overweight (body mass index > 90 percentile) and parents’ reports on their education and family characteristics associated with overweight (child consumes: sweets in front of TV, soft drinks; family joined time: outdoor, breakfast, sports; cooking; child sets table; role model). Model-based single mediation analyses decomposed the total effect of highest parental education on overweight into direct (unmediated) and indirect (mediated) effects (OR, 95% CI).
Results
Girls and boys with low parental education had higher odds for overweight than children with high/medium education. Among boys, low education influenced the risk of overweight via indirect effects of i. ‘sweets consumption in front of TV’ (OR = 1.31, 1.05-1.59) and ii. ‘no joined sports’ (OR = 1.14, 1.00-1.44). The direct effect of low education only remained significant when ‘no joined sports’ was considered (OR = 2.19, 1.11-5.19). Among girls, family characteristics measured here did not explain SEP differences in overweight.
Conclusions
The family characteristics ‘sweets consumption in front of TV’ and ‘no joined sports’ contribute to inequalities in overweight among boys, but not among girls. Therefore, more gender-sensitive research is needed to identify family risk and protective characteristics that explain health inequalities among both boys and girls.
Socioeconomic position and self-rated health among adolescents: the mediating role of the family
(2022)
Background
Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining adolescents’ health inequalities. The study aimed to explore whether the association between socioeconomic position and self-rated health (SRH) was mediated by familial determinants.
Methods
Using data from wave 2 of the KiGGS study (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of parents’ education, occupation, income, socioeconomic position index, and adolescents’ subjective social status on SRH into direct effects and indirect effects through familial determinants (family cohesion, parenting styles, parental well-being, stress, obesity, smoking and sporting activity).
Results
A significant total effect of all socioeconomic position indicators on SRH was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations of parental education, the socioeconomic position index and subjective social status with SRH were also mediated by familial determinants (family cohesion, parental smoking and obesity). However, a significant direct effect of subjective social status remained.
Conclusions
The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions, community-based strategies, as well as programs to improve parenting and family functioning.
Background
Claims for self-determined childbirth (SDC) have gained increasing scientific, political and societal attention. However, research on SDC is limited. This study analyzes and compares midwives’ experiences and perspectives on factors that promote or limit SDC in hospitals, birthing centers and during home births in Germany. We argue that these insights are essential in order to foster self-determination and to avoid its violation.
Methods
A qualitative case study was conducted based on semi-structured face-to-face interviews with midwives working in hospitals, birthing centers, and offering home births in Germany. In total, nine interviews were conducted in 2021 and have been audiotaped, transcribed, anonymized and analyzed by use of Thematic Analysis.
Results
The results indicate eight inter-related categories, each of which imply promoting and limiting factors: 1) Structural/ legal conditions; 2) Perception of birth (e. g. as natural or medical process; required competence and control); 3) Trust and atmosphere; 4) Getting acquainted/relationship building; 5) Birthing person’s socioeconomic position; 6) Birthing person’s preparation/ education; 7) Birthing person’s capability of decision making and expression; and 8) Behavior of accompanying persons. Moreover, we identified midwives’ strategies to extend possibilities of choice. Several factors clearly differ depending on the birth setting.
Conclusions
The opportunities for SDC seem to differ according to the setting (e.g. institutional routines), inter-personal relations (e.g. getting acquainted, trust), and individual factors (e.g. socioeconomic position, capabilities). Hence, political, institutional and individual strategies may support SDC in consideration of the above factors. Measures may, among others, include the improvement of information processes, the reduction of economic barriers, relationship building before and during birth as well as respective structural adjustments.
The role of regional health policy for socioeconomic inequality in health services utilization
(2022)
Background
“J1” is a preventative routine examination in Germany recommended for adolescents at the age of 12-14 years. In contrast to the well-established U1-U9 examinations for younger children, with participation rates above 90%, the attendance of the J1 examination is approximately only 40%. The most frequent reason for not attending J1 is the unawareness of this examination. “Ticket to J1” is an intervention including an information leaflet introduced in Bavaria in 2017 to inform adolescents about J1. The aims of the present analysis are to investigate (1) if the regional policy was effective in increasing the attendance in J1, (2) if the effects vary by family socioeconomic status (SES), and (3) which meso-level characteristics of the healthcare system correlate with attendance rates in J1.
Methods
We used anonymised data of a large statutory health insurance in Germany for the timeframe of 2016-2018. To investigate the effect of the policy, a difference-in-differences design at the individual level was used. Assuming a parallel trend at the level of federal states, the likelihood of attendance in J1 of 13- and 14-year-olds was compared between Bavaria and other federal German states before and after policy introduction. All analyses were additionally stratified by SES.
Results
The introduction of “Ticket to J1” increased participation in J1 by 1% after controlling for all confounders. Furthermore, the effect was stronger for children from families with lower SES (an increase of 5%). Density of pediatricians was positively significantly correlated with participation in J1.
Discussion
Regional health policy intervention had a significant positive impact on attendance of J1 and appears to have the potential to reduce socioeconomic inequalities in healthcare utilization. Informing adolescents about J1 seems to increase the attendance, in particular for children from families with lower SES.
Do regional characteristics predict developmental delay? Analyses of German school entry examination
(2022)
Background
Children's health and development are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living region. However, research on the impact of the living region on children's development beyond family SEP is scarce. This study evaluated whether rurality and regional socioeconomic deprivation (DEP) are associated with children's development independently of family SEP.
Methods
The study used population-based data of 5-6.5 years old children (n = 22,801) from mandatory school entry examinations (SEE) in the German federal state of Brandenburg, which were examined in 2018/2019. The SEE data have been linked with data on i. rurality that was defined by an inverted population density and ii. regional DEP that were provided by the German Index of Socioeconomic Deprivation. By binary multilevel models, the predictive values of rurality and regional DEP for global developmental delay (GDD) were evaluated, while adjusting for family SEP.
Results
Children with high family SEP showed reduced odds for GDD compared to medium family SEP (female: OR = 4.26, CI95=3.14-5.79, male: OR = 3.46, CI95=2.83-4.22) and low family SEP (female: OR = 16.58, CI95=11.90-23.09, male: OR = 12.79, CI95=10.13-16.16). Regional DEP additionally predicted GDD, with higher odds for children from more deprived regions (female: OR = 1.35, CI95=1.13-1.62, male: OR = 1.20, CI95=1.05-1.39). Rurality did not predict GDD beyond family SEP and regional DEP.
Conclusions
In addition to family SEP, the regional DEP has an effect on children's developmental delay. Hence, Public Health should take into account regional socioeconomic conditions as determinant of health over the life course in addition to family SEP.
Angesichts der immer stärker werdenden Diskussion um die Bedeutung von Gesundheit für den schulischen und außerschulischen Bildungs- und Lernprozess und der Risiken wachsender gesundheitlicher Ungleichheit bei Kindern und Jugendlichen (Hurrelmann/Richter 2013, Lampert et al. 2019) ist die Etablierung eines Studienganges „Gesundheitspädagogik und Gesundheitsdidaktik“ längst überfällig und von besonderer Bedeutung für gesundheitliche Chancengleichheit (Goldfriedrich & Hurrelmann, 2021a; 2021b).
Dieses Konzeptpapier stellt einen Modellstudiengang vor, bei dem insbesondere die Vermittlungsebenen – also die gesundheitsdidaktischen Gegenstandsbereiche – im Vordergrund stehen. Die Ausarbeitungen des Entwurfs basieren auf der Grundlage politischer Bestrebungen, der bisherigen Forschung zur Gesundheitspädagogik und Gesundheitsdidaktik, den Erkenntnissen der Erziehungs- und Gesundheitswissenschaften sowie wissenschaftlichen und interprofessionellen Beiträgen des Netzwerks Gesundheitsdidaktik (bestehend aus 33 Expert*innen aus 24 Fachbereichen).
Background: Nurses’ work-related strain and psychological burden increased during the Covid-19 pandemic, resulting in high prevalences of mental health problems among nurses worldwide. Nurses in long-term care facilities seem to be particularly prone to overall heightened burden and poor mental health.
Research question: We investigated which work-related psychosocial burdens and potential positive aspects nurses working in nursing homes experience during the Covid-19 pandemic.
Method: We conducted a mixed-methods study. Eligible for participation were nurses and nursing assistants working in nursing homes within the state of Brandenburg, Germany. Between August and October 2020, we distributed an anonymous survey containing the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch’s t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses, drawn from the German COPSOQ databank and kindly shared by the Freiburg Research Centre for Occupational Science. In June 2021, we also conducted semi-structured interviews with geriatric nurses to reach a deeper understanding of their experiences on work-related changes and burdens during the first phases of the pandemic. Data were analysed using thematic coding (Braun and Clarke).
Results: Our survey sample (n=177) differed significantly from the reference group in 14 out of 31 COPSOQ scales. Amongst others, our sample scored significantly worse regarding the scales ‘support at work’, ‘recognition’, ‘quantitative demands’, ‘hiding emotions’, ‘role conflicts’, ‘intention to leave profession’, ‘burnout’ and ‘inability to relax’. The interviews (n=17) revealed five main themes related to nurses’ psychosocial stress: ‘overall working conditions under the hygiene measures’, ‘concern for isolated residents’, ‘management of relatives’, ‘inability to provide terminal care‘, ‘tensions between being infected and infecting others’ and ‘technicisation of care’. ‘Enhanced community cohesion’ and ‘meaning of work’ were identified as positive effects of the pandemic.
Discussion: Results indicate that nurses in nursing homes experience enhanced psychosocial and work-related strain. The comparisons with the pre-pandemic reference group suggest that the situation further aggravated during the pandemic. Nurses exhibited high psychosocial burden, e.g., due to strongly impeded possibilities to fulfill the emotional and social dimensions of care and the constant fear of infection or transmission. Deteriorated working conditions (e.g., higher workload through staff shortages and additional tasks) further exacerbated these burdens. Few positive aspects of the pandemic may be important sources of resilience.
Practical implications: The reduction of nurses’ strain through psychosocial support and the improvement of working conditions is crucial for the protection of nurses’ health.
Appeal for practice in one sentence: Political players as well as care facilities should take measures to improve nurses’ situation in order to maintain a healthy workforce and high-quality care.
Hintergrund und Stand (inter)nationaler Forschung: Die Forderung nach einer selbstbestimmten Geburt ist in Deutschland und weltweit in den fachlichen und öffentlichen Fokus gerückt. Allerdings liegen bisher wenige Forschungsergebnisse zur Selbstbestimmung Gebärender und ihrer förderlichen und begrenzenden Bedingungen vor. Diese Erkenntnisse sind jedoch essentiell, um Selbstbestimmung gezielt unterstützen und ihre Verletzung vermeiden zu können.
Fragestellung und Zielsetzung: Die Studie untersucht und vergleicht die Erfahrungen und Perspektiven von Hebammen in Bezug auf förderliche und begrenzende Faktoren einer selbstbestimmten Geburt in Krankenhäusern, Geburtshäusern und bei Hausgeburten in Deutschland.
Methode: Es wurde eine qualitative Fallstudie auf der Basis von zehn problemzentrierten Einzelinterviews mit Hebammen durchgeführt. Eingeschlossen wurden Hebammen mit laufender oder abgeschlossener Ausbildung, deren letzte begleitete Geburt nicht länger als sechs Monate zurücklag. Die Sampling-Strategie erlaubte die Berücksichtigung unterschiedlicher Geburtshilfe-Settings und Regionen in Deutschland. Alle Interviews wurden aufgezeichnet, transkribiert, anonymisiert und mittels der Thematischen Analyse ausgewertet. Ein positives Ethik-Votum liegt vor.
Ergebnisse: Die Ergebnisse legen acht zusammenhängende Kategorien nahe, die jeweils fördernde und begrenzende Faktoren implizieren:
1.
Strukturelle/rechtliche Bedingungen auf Meso-/Makroebene;
2.
Wahrnehmung von Geburt (z.B. als medizinischer/natürlicher Vorgang, notwendige Kompetenz und Kontrolle);
3.
Vertrauen/Atmosphäre;
4.
Kennenlernen/ Beziehungsaufbau mit Gebärenden;
5.
Sozioökonomische Position (SEP) der Gebärenden;
6.
Information der Gebärenden;
7.
Entscheidungs- und Artikulationsfähigkeit der Gebärenden und
8.
Verhalten der Begleitpersonen.
Zudem wurden Strategien der Hebammen zur Erweiterung des Handlungsspielraums identifiziert. Mehrere Faktoren unterscheiden sich abhängig vom Geburtssetting.
Diskussion: Die Möglichkeiten für eine selbstbestimmte Geburt können sich je nach Setting (z.B. institutionelle Routinen), zwischenmenschlichen Beziehungen (z.B. Vertrauen) und individuellen Faktoren (z.B. SEP) unterscheiden. Folglich können politische, institutionelle und individuelle Strategien eine selbstbestimmte Geburt – und damit eine personenzentrierte, situativ angemessene Versorgung – unter Berücksichtigung der oben genannten Faktoren unterstützen.
Praktische Implikationen: Die Ergebnisse liefern konkrete Anhaltspunkte für Maßnahmen zur Unterstützung einer selbstbestimmten Geburt in verschiedenen Geburtssettings. Empfohlen werden u. a. die Verbesserung von Informationsprozessen vor und während der Geburt, die Verbesserung des Zugangs zu Versorgungsangeboten, der Abbau finanzieller Hürden in der Inanspruchnahme, die Förderung von Beziehungsaufbau und eine Stärkung der hebammengeleiteten Geburt.
Appell für die Praxis (Wissenschaft und/oder Versorgung) in einem Satz: Akteur*innen und Entscheidungsträger*innen der Geburtshilfe können die Selbstbestimmung Gebärender durch gezielte individuelle, institutionelle und politische Maßnahmen fördern.
Background: At the end of secondary education, young people can either start vocational training, enter university, directly transition to employment or become unemployed. Research assumes that post-secondary pathways have immediate and/or long-term impacts on health and well-being, but empirical investigations on this are scarce and
restricted to few countries. Therefore, this study traced the development of health and well-being throughout the highly institutionalised school-to-work transition (STWT) in Germany.
Methods: We used longitudinal data of the National Educational Panel Study (NEPS), a representative sample of 11,098 school-leavers (50.5% girls) repeatedly interviewed between 2011 and 2020. We estimated the effect of post-secondary transitions on self-rated health and subjective well-being by applying fixed-effects (FE) regression, elimi-nating bias resulting from time-constant confounding and self-selection into different pathways. A multiple-sample strategy was used to account for the increasing diversity of STWTs patterns. Models were controlled for age, as well as household and residential changes to minimise temporal heterogeneity. Results: Findings indicate that leaving school was good for health and well-being. Compared with participants who did not find a training position after school, direct transitions to vocational training or university were linked to higher
absolute levels of health and well-being, but also to a lower relative decline over time. Furthermore, upward transi-tions (e.g. to programs leading to better education or from unemployment to employment) were associated with improvements in health and well-being, while downward transitions were followed by deteriorations. Conclusion: Findings suggest that school-leave is a sensitive period and that post-secondary pathways provide young people with different abilities to maintain health and well-being. Youth health interventions might benefit when setting a stronger focus on unsuccessful school-leavers.
Dieser Beitrag gibt einen Überblick über theoretische Konzepte sowie epidemiologisch-empirische Erkenntnisse zu Häufigkeit und Determinanten psychischer Erkrankungen bei zugewanderten Menschen sowie zur Inanspruchnahme und Versorgungspraxis. Auf der Basis dieser Erkenntnisse werden vielversprechende Ansätze der Versorgungspraxis sowie der weiteren Forschung vorgestellt.
Background
Immigrants from Turkey experience health disadvantages relative to non-immigrant populations in Germany that are manifest from the earliest stages of the lifespan onwards and are perpetuated across generations. Chronic stress and perturbations of stress-responsive physiological systems, including the hypothalamus-pituitary-adrenal (HPA)-axis, are believed to in part mediate this relationship. Cortisol plays an important role in the association between maternal stress during pregnancy and many pregnancy-, birth- and offspring-related outcomes. We therefore examined whether maternal migrant background is associated with diurnal cortisol variation during pregnancy.
Methods
109 pregnant women (incl. n = 32 Turkish origin women) that participated in a multi-site prospective cohort study in Germany collected saliva samples across the day on two consecutive days around 24 and 32 weeks gestation. Hierarchical linear models were applied to quantify associations between migrant background and diurnal cortisol variation across pregnancy.
Results
Women of Turkish origin exhibited a significantly lower cortisol awakening response (CAR) and a flatter diurnal cortisol slope (DCS) compared to non-migrant women after adjusting for household income. These relationships between migrant status and diurnal cortisol variation were mainly driven by 2nd generation migrants.
Discussion
A potential HPA axis dysregulation of Turkish-origin pregnant women may contribute to the intergenerational transmission of health disadvantages in this group.
Objectives:
Mothers of young children have been identified as a particularly vulnerable group during the COVID-19 pandemic. We aimed to explore how occupational, psychosocial and partnership-related factors were associated with their self-reported mental well-being during the first COVID-19 wave.
Methods:
Five hundred fifty participants of the BaBi cohort study (est. 2013, Bielefeld, North-Rhine Westphalia, Germany) were invited to complete an online survey and to take part in email interviews (April–May 2020). With survey data, we assessed self-reported mental well-being through validated instruments (eight-item Patient Health Questionnaire; short version of the Symptom Checklist) and ran linear regression models for occupational, psychosocial and partnership-related factors. We performed content analysis on the interviews’ data to further understand the determinants of the women’s mental well-being.
Results:
One hundred twenty-four women participated in the survey; of which 17 also participated in the interviews. A perceived lack of support in childcare was associated with higher levels of depressive symptoms, while having a higher internal locus of control was associated with lower levels. Psychological distress was higher in those reporting lack of emotional or childcare support. Interviews confirmed the interplay of potential stressors and highlighted the difficulties to reconcile different expectations of motherhood.
Discussion:
Occupational, psychosocial and partner-related factors can act (to varying degree) both as resources and stressors to the self-reported mental well-being of mothers of young children. These impacts took different forms and created opportunities or challenges, depending on specific life circumstances, such as work or family situations, relationships and own psychosocial resources. Although not representative, our study contributes to building the COVID-19 evidence base, delineating the mental health toll of the pandemic on mothers of young children and the factors that contribute to it.
Kernaussagen:
- Menschen mit Migrationshintergrund sind nicht per se kränker oder gesünder als die Bevölkerung ohne Migrationshintergrund. Expositionen vor, während und nach der Migration können aber unterschiedliche Gesundheitsressourcen und Krankheitsrisiken mit sich bringen.
- Über das Merkmal „Migrationshintergrund“ hinaus variiert eine Vielzahl an Krankheitsrisiken abhängig vom sozioökonomischen Status (SES), dem Alter, Geschlecht und der Aufenthaltsdauer im Zielland.
- Bei 11 bis 17-jährigen Kindern und Jugendlichen mit und ohne Migrationshintergrund bestehen kaum Unterschiede in der Selbsteinschätzung der körperlichen Gesundheit.
- Erwachsene mit Migrationshintergrund aus spezifischen Herkunftsländern weisen statistisch ein geringeres Risiko für bösartige Neubildungen wie Brust-, Haut- oder Lungenkrebs sowie für Herz-Kreislauf-Erkrankungen auf. Erhöhte Risiken bestehen für Arbeitsunfälle, psychsiche Erkrankungen sowie in einzelnen Sub-Gruppen für Infektionskrankheiten wie Tuberkulose, Hepatitis und HIV.
- Ausländische Säuglinge, Kinder und Jugendliche in Deutschland weisen eine höhere Mortalitätsrate auf als deutsche Gleichaltrige. Zugewanderte Menschen im Alter von 20 bis 60 Jahren haben eine geringere, im Alter von 65 bis 69 Jahren eine höhere Mortalitätsrate als die nicht-migrierte Bevölkerung.
- Die Sterblichkeit ausländischer Personen gleicht sich mit zunehmender Aufenthaltsdauer in Deutschland an das Mortalitätsmuster der einheimischen Bevölkerung an.
Background
Evaluation of the current physical therapy practice for German stroke rehabilitation with respect to the ‘Rehabilitation of Mobility after Stroke (ReMoS)’ guideline recommendations and the associated implementation factors.
Methods
A descriptive cross-sectional study employing an online survey was performed among German physical therapists in 2019. The survey consisted of three sections with open and closed questions: 1) self-reported use of ReMoS recommendations, 2) barriers of guideline use and 3) socio-demographic characteristics. The benchmark level for guideline adherent physical therapy was set at > 80%.
Results
Data from 170 questionnaires were eligible for analysis. Participants’ mean age was 41.6 years, 69.4% were female, while 60.1% had no academic degree. The ReMoS guideline was unknown to 52.9% of the responders. Out of all the 46 ReMoS guideline recommendations, only ‘intensive walking training without a treadmill’ was reported to be performed in a guideline adherent manner. Respondents usually denied any personal limitations, such as limited knowledge, or that the ReMoS guideline did not fit their routine practice.
Conclusions
Among German physical therapists, the ReMoS guideline is not well-known and many interventions are not performed as recommended, illustrating the discrepancies between the ReMoS guideline recommendations and current physical therapy practice. Interventions aimed at overcoming this gap should consider both knowledge of existing barriers and facilitators of guideline usage.
Objective: Evidence-based guidelines are important for informing clinical decision-making and improving patient outcomes. There is inconsistent usage of guidelines among physical therapists involved in stroke rehabilitation, suggesting the existence of a gap between theory and practice. Addressing the German guideline “evidence-based rehabilitation of mobility after stroke (ReMoS),” the aims of this project are (1) to describe the current physical therapy practice within the context of stroke rehabilitation in Germany, (2) to evaluate barriers and facilitators of guideline usage, (3) to develop, and (4) to pilot test a theory-based, tailored implementation intervention for the benefit of guideline recommendations.
Materials and Methods: This study uses a stepwise mixed methods approach for implementing a local guideline. A self-reported online questionnaire will be used to survey the current physical therapy practice in stroke rehabilitation. The same survey and systematic-mixed methods review will be used to evaluate the barriers and facilitators of guideline usage quantitatively. Semi-structured interviews will add a qualitative perspective on factors that influence ReMoS guideline implementation. The Behavior Change Wheel and Theoretical Domains Framework will be used to support the development of a tailored implementation intervention which will be pilot tested in a controlled study. Patient and physical therapy-related outcomes, as well as the appropriateness, such as acceptance and feasibility of the tailored implementation intervention, will be analyzed.
Conclusion: This will be the first endeavor to implement a guideline in German stroke rehabilitation with a focus on changing care provider behavior based on the knowledge of current practice and determining factors using a tailored and theory-based intervention.
Background: The Covid-19 pandemic led to increased work-related strain and psychosocial burden in nurses worldwide, resulting in high prevalences of mental health problems. Nurses in long-term care facilities seem to be especially affected by the pandemic. Nevertheless, there are few findings indicating possible positive changes for health care workers. Therefore, we investigated which psychosocial burdens and potential positive aspects nurses working in long-term care facilities experience during the Covid-19 pandemic.
Methods: We conducted a mixed-methods study among nurses and nursing assistants working in nursing homes in Germany. The survey contained the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch's t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses from Germany. Additionally, we conducted semi-structured interviews with geriatric nurses with a special focus on psychosocial stress, to reach a deeper understanding of their experiences on work-related changes and burdens during the pandemic. Data were analysed using thematic coding (Braun and Clarke).
Results: Our survey sample (n = 177) differed significantly from the pre-pandemic reference group in 14 out of 31 COPSOQ scales. Almost all of these differences indicated negative changes. Our sample scored significantly worse regarding the scales 'quantitative demands', 'hiding emotions', 'work-privacy conflicts', 'role conflicts', 'quality of leadership', 'support at work', 'recognition', 'physical demands', 'intention to leave profession', 'burnout', 'presenteeism' and 'inability to relax'. The interviews (n = 15) revealed six main themes related to nurses' psychosocial stress: 'overall working conditions', 'concern for residents', 'management of relatives', 'inability to provide terminal care', 'tensions between being infected and infecting others' and 'technicisation of care'. 'Enhanced community cohesion' (interviews), 'meaning of work' and 'quantity of social relations' (COPSOQ III) were identified as positive effects of the pandemic.
Conclusions: Results clearly illustrate an aggravation of geriatric nurses' situation and psychosocial burden and only few positive changes due to the Covid-19 pandemic. Pre-existing hardships seem to have further deteriorated and new stressors added to nurses' strain. The perceived erosion of care, due to an overemphasis of the technical in relation to the social and emotional dimensions of care, seems to be especially burdensome to geriatric nurses.
Background
The number of obese children is rising worldwide. Many studies have investigated single determinants of children’s body mass index (BMI), yet studies measuring determinants at different potential levels of influence are sparse. The aim of this study is to investigate the independent role of parental socioeconomic position (SEP), additional family factors at the micro level, as well as early childhood education and care (ECEC) centre characteristics at the meso level regarding BMI.
Methods
Analyses used the baseline data of the PReschool INtervention Study (PRINS) including up to 1,151 children from 53 ECEC centres. Multi-level models first estimated the associations of parental SEP indicators (parental school education, vocational training, and household income) with the children’s standard deviation scores for BMI (SDS BMI, standardised for age and gender). Second, structural (number of siblings), psychosocial (strained family relationships), and nutrition behavioural (soft-drink consumption, frequency of fast-food restaurant visits) family factors at the micro level were included. Third, characteristics of the ECEC centre at the meso level in terms of average group size, the ratio of overweight children in the group, ECEC centre type (all-day care), and the location of the ECEC centre (rural vs urban) were included. All analyses were stratified by gender and adjusted for age, migration background, and parental employment status.
Results
Estimates for boys and girls appeared to differ. In the full model, for boys the parental SEP indicators were not related to SDS BMI. Factors related to SDS BMI in boys were: two or more siblings; B = -.55; p = 0.045 [ref.: no sibling]), the characteristics of the ECEC centre in terms of average group size (20 – 25 children; B = -.54; p = 0.022 [ref.: < 20 children]), and the ratio of overweight children (more overweight children B = -1.39; p < 0.001 [ref.: few overweight children]). For girls the number of siblings (two and more siblings; B = .67; p = 0.027 [ref.: no sibling]) and average group size (> 25 children; B = -.52; p = 0.037 [ref.: < 20 children]) were related to SDS BMI.
Conclusions
The BMI of preschool children appears to be associated with determinants at the micro and meso level, however with some gender differences. The identified factors at the micro and meso level appear largely modifiable and can inform about possible interventions to reduce obesity in preschool children.
Objectives The main objective was to systematically map evidence regarding the emergence of health inequalities in individuals aged 16–24 years during school-to-work and school-to-university transition (STWT). Second, we aimed to summarise the evidence on potential effects of contextual and compositional characteristics of specific institutional contexts entered during STWT on health and health behaviours.
Design Scoping review.
Study selection Relevant literature was systematically searched following the methodological framework proposed by Arksey and O’Malley. Ovid MEDLINE and Web of Science, and websites of the International Labour Organization and National Institute for Occupational Safety and Health were searched, using a predetermined search strategy. Articles in English or German published between 1 January 2000 and 3 February 2020 were considered.
Data extraction To collect the main information from the selected studies, a data extraction spreadsheet was created. Data were summarised and grouped into five health outcomes and five institutional contexts (school, vocational training, university, work, unemployment).
Results A total of 678 articles were screened for inclusion. To be able to draw a picture of the development of various health outcomes over time, we focused on longitudinal studies. Forty-six prospective studies mapping health-related outcomes during STWT were identified. Higher family socioeconomic position (SEP) was associated with higher levels of health behaviour and lower levels of health-damaging behaviour, but there was also some evidence pointing in the opposite direction. Disadvantaged family SEP negatively impacted on mental health and predicted an adverse weight development. There was limited evidence for the outcomes physical/somatic symptoms and self-rated health. Meso-level characteristics of the institutional contexts identified were not systematically assessed, only individual-level factors resulting from an exposure to these contexts, rendering an analysis of effects of contextual and compositional characteristics on health and health behaviours impossible.
Conclusions This scoping review demonstrated a wide range of health inequalities during STWT for various health outcomes. However, knowledge on the role of the core institutional contexts regarding the development of health inequalities is limited.
Background:
Clinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from:
• Kidney Disease Improving Global Outcomes (KDIGO,2012)
• National Institute for Health and Care Excellence (NICE,2014)
• German Society of Nephrology/German Society of Internal Medicine (DGfN/DGIM,2015)
• German College of General Practitioners and Family Physicians (DEGAM,2019)
• Kidney failure risk equation (NICE,2021)
Methods:
Data of the population-based cohort Study of Health in Pomerania were matched with claims data. Proportion of subjects meeting referral criteria and corresponding health care expenditures were calculated and projected to the population of Mecklenburg-Vorpommern.
Results:
Data from 1927 subjects were analysed. Overall proportion of subjects meeting referral criteria ranged from 4.9% (DEGAM) to 8.3% (DGfN/DGIM). The majority of patients eligible for referral were ≥ 60 years. In subjects older than 60 years, differences were even more pronounced, and rates ranged from 9.7% (DEGAM) to 16.5% (DGfN/DGIM). Estimated population level costs varied between €1,432,440 (DEGAM) and €2,386,186 (DGfN/DGIM). From 190 patients with eGFR < 60 ml/min, 15 had a risk of end stage renal disease > 5% within the next 5 years.
Conclusions:
Applying different referral criteria results in different referral rates and costs. Referral rates exceed actually observed consultation rates. Criteria need to be evaluated in terms of available workforce, resources and regarding over- and underutilization of nephrology services.
Predictors and prevalence of hazardous alcohol use in middle-late to late adulthood in Europe
(2022)
Objectives: Even low to moderate levels of alcohol consumption can have detrimental health consequences, especially in older adults (OA). Although many studies report an increase in the proportion of drinkers among OA, there are regional variations. Therefore, we examined alcohol consumption and the prevalence of hazardous alcohol use (HAU) among men and women aged 50+ years in four European regions and investigated predictors of HAU.
Methods: We analyzed data of N = 35,042 participants of the European SHARE study. We investigated differences in alcohol consumption (units last week) according to gender, age and EU-region using ANOVAs. Furthermore, logistic regression models were used to examine the effect of income, education, marital status, history of a low-quality parent–child relationship and smoking on HAU, also stratified for gender and EU-region. HAU was operationalized as binge drinking or risky drinking (<12.5 units of 10 ml alcohol/week).
Results: Overall, past week alcohol consumption was 5.0 units (±7.8), prevalence of HAU was 25.4% within our sample of European adults aged 50+ years. Male gender, younger age and living in Western Europe were linked to both higher alcohol consumption and higher risks of HAU. Income, education, smoking, a low-quality parent–child relationship, living in Northern and especially Eastern Europe were positively associated with HAU. Stratified analyses revealed differences by region and gender.
Conclusions: HAU was highly prevalent within this European sample of OA. Alcohol consumption and determinants of HAU differed between EU-regions, hinting to a necessity of risk-stratified population-level strategies to prevent HAU and subsequent alcohol use disorders.
Atherosclerotic coronary artery disease (CAD) is the leading cause of mortality worldwide.1 In this context, the burden of CAD shows considerable regional heterogeneity at the national level. For example, age-standardized mortality rates varied between 106 and 178 deaths per 100 000 at the level of German federal states in 2019.2 The regional heterogeneity of cardiovascular mortality suggests that the residential environment should be considered as an important determinant for successful secondary prevention. Environmental features that were frequently drawn upon to explain regional inequalities of cardiovascular outcomes are spatial socioeconomic deprivation (SSD) and rurality.3 Rurality may impact cardiovascular health due to impaired access to healthcare services. Socioeconomically deprived neighbourhoods, on the other hand, exhibit restricted opportunities to eat healthy, exercise regularly, utilize health care, and avoid environmental hazards such as air pollution.
Objective
Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining the association between the family’s socioeconomic position and adolescents’ self-rated health. The current study aimed to explore whether the association between socioeconomic position and self-rated health was mediated by familial determinants.
Methods
Using data from wave 2 of the”German Health Interview and Examination Survey for Children and Adolescents” (KiGGS) (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of income, education, occupational status, socioeconomic position index and adolescents’ subjective social status on self-rated health into direct effects and indirect effects through familial determinants (family cohesion, parental well-being, parental stress, parenting styles, parental obesity, smoking and sporting activity).
Results
A significant total effect of all socioeconomic position indicators on self-rated health was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations between income, parental education, the socioeconomic position index and subjective social status were also mediated by familial determinants (family cohesion, parental smoking, obesity and living in a single-mother family). However, a significant direct effect of subjective social status remained.
Conclusion
The analysis revealed how a family’s position of socioeconomic disadvantage can lead to poorer health in adolescents through different family practices. The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions (macro-level), community-based strategies (meso-level) and programs to improve parenting and family functioning (micro-level).
Background
From birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family’s socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration.
Method
We used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children’s school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high).
Results
Family SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation.
Conclusion
Family SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course.
Background: By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children’s health through various characteristics. These include family processes,
family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries.
Methods: This review followed the methodology of “Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews”. To identify German and English scientific peer-reviewed literature published from January 1st, 2000, to December 19th,
2019, the following search term blocks were linked with the logical operator “AND”: (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus.
Results: The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent–child conflicts) are identified to have mediating or moderating effects. While families’ living conditions (i.e., TVs in children’s bedrooms) are suggested as
mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities. Conclusion: Family characteristics contribute to health inequalities in early childhood. The results provide overall
support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children’s health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.
Objectives: To synthesise the evidence on the role of compositional or contextual characteristics of schools in the association between students' socioeconomic position and their health in primary and secondary education in developed economies.
Design: Scoping review. We included studies examining the role of at least one school or class characteristic on students' health inequalities and was published since 1 January 2000, in English or German. We searched PubMed/Medline, Web of Science and Education Resources Information Center. We provided a narrative synthesis and an overview of findings. School characteristics were grouped into five broad categories: school composition, school climate, school policies and organisation, food environment and facilities.
Results: Of 8520 records identified, 26 studies were included. Twelve studies found a moderating and 3 a mediating effect. The strongest evidence came from studies examining the moderating effect of school composition, that is, the negative impact of a low individual socioeconomic position on mental health and well-being was aggravated by a low average socioeconomic position of schools. Evidence concerning the role of school climate, school stratification (eg, performance base tracking) and sponsorship, food environment and sport facilities and equipment was generally weak or very weak and mostly based on singular findings. Overall, favourable meso-level characteristics mitigated the negative impact of low individual socioeconomic position on health outcomes.
Conclusions: School characteristics affect health inequalities in children and adolescents to some degree, but future research is necessary to strengthen the existing evidence and address under-represented aspects in school characteristics and health outcomes.
Der Zusammenhang zwischen Migration und Gesundheit ist vielschichtig. In aktuellen Erklärungsmodellen werden verschiedene Determinanten und Dimensionen angeführt, die über den Lebenslauf von Migranten zu gesundheitlichen Vor- und Nachteilen führen können. Gesundheitsversorgung und Public Health in einem Einwanderungsland wie Deutschland müssen diese gesundheitlichen Unterschiede beachten und – neben den bei besonderen Risikokonstellationen notwendigen gezielten Maßnahmen für Migranten – sich insgesamt so ausrichten, dass sie der Diversität der Bevölkerung gerecht werden. Besondere Chancen bieten dabei Ansätze, die im Rahmen von integrierten kommunalen Strategien zur Gesundheitsförderung die Bedarfe der Menschen in ihren Lebenswelten aufgreifen.
Kernaussagen
- Menschen mit Migrationshintergrund sind nicht per se kränker oder gesünder als die Bevölkerung ohne Migrationshintergrund. Expositionen vor, während und nach der Migration können aber unterschiedliche Gesundheitsressourcen und Krankheitsrisiken mit sich bringen.
- Über das Merkmal „Migrationshintergrund“ hinaus variiert eine Vielzahl an Krankheitsrisiken abhängig vom sozioökonomischen Status (SES), dem Alter, Geschlecht und der Aufenthaltsdauer im Zielland.
- Bei 11 bis 17-jährigen Kindern und Jugendlichen mit und ohne Migrationshintergrund bestehen kaum Unterschiede in der Selbsteinschätzung der körperlichen Gesundheit.
- Erwachsene mit Migrationshintergrund aus spezifischen Herkunftsländern weisen statistisch ein geringeres Risiko für bösartige Neubildungen wie Brust-, Haut- oder Lungenkrebs sowie für Herz-Kreislauf-Erkrankungen auf. Erhöhte Risiken bestehen für Arbeitsunfälle, psychsiche Erkrankungen sowie in einzelnen Sub-Gruppen für Infektionskrankheiten wie Tuberkulose, Hepatitis und HIV.
- Ausländische Säuglinge, Kinder und Jugendliche in Deutschland weisen eine höhere Mortalitätsrate auf als deutsche Gleichaltrige. Zugewanderte Menschen im Alter von 20 bis 60 Jahren haben eine geringere, im Alter von 65 bis 69 Jahren eine höhere Mortalitätsrate als die nicht-migrierte Bevölkerung.
- Die Sterblichkeit ausländischer Personen gleicht sich mit zunehmender Aufenthaltsdauer in Deutschland an das Mortalitätsmuster der einheimischen Bevölkerung an.
Do families have moderating or mediating effects on early health inequalities? A scoping review
(2021)
Background
During early childhood, families have a crucial impact on children's health behaviour, health, and development (bhd). However, a family's socioeconomic position (SEP) determines both the parental behaviour, living conditions, and child health. To understand how family characteristics may influence the development of health inequalities, this scoping review synthesised research on their mediating and moderating effects.
Methods
The review followed the guidelines of the PRISMA Extension for Scoping Reviews. The search included German and English peer-reviewed articles published between January 1st, 2000 and December 19th, 2019. The search in PubMed, PsycINFO, and Scopus used both free text terms in the title/abstract and index terms within linked keyword blocks: (1) family characteristics, (2) inequalities, (3) income, education, occupation, (4) bhd, (5) newborn, infant, toddler, preschooler. Two researchers independently examined eligibility for inclusion in two rounds (title/abstract; full-text).
Results
Of 7,089 articles identified, ten sources were included that studied family characteristics and health inequalities among 0-6 years olds. Parental rules, stress, and screentime, and TV in bedroom showed mediating effects on inequalities in behaviour problems or children's screentime. Families' negativity, single parenthood, and the number of children in the household moderated differences in impairment, health, behaviour problems, development or breastfeeding initiation.
Conclusions
The effect of family characteristics on early health inequalities has been sparsely investigated. The evidence supported models of family stress and investment. Further research is needed to comprehensively understand this association.
Key messages
Family characteristics contribute to health inequalities.
Taking families’ stress and investment into account could improve targeted prevention efforts aimed at reducing health inequalities.
Issue/problem
In 2020, several German reception centers and asylum camps were imposed mass quarantine after single residents had been infected with SARS-CoV-2. Civil and research networks criticized this measure, as crowded housing conditions limited the implementation of infection protection measures, and mass quarantine further increased the risk of infection. This raised the question why public health (PH) measures in these settings differed from those implemented in the general population, and which implications for future PH approaches can be identified.
Problem description
Considering the epidemiological evidence and ethical perspectives on the PH strategies described above, we applied the concepts of “Exclusionary Othering” and “Inclusionary Othering” to PH. We further discussed the Covid-19 management in German reception centers and asylum camps.
Results
We identified three conceptual approaches: 1) exclusionary, 2) inclusionary, and 3) diversity-sensitive approaches to PH. Exclusionary PH is characterized by an exclusion of less powerful groups despite negative health consequences. Inclusive approaches seek to empower less powerful groups in order to understand each other's needs, build cooperations, protect everyone and to prevent the development of “hot spots”. Diversity-sensitive PH approaches avoid othering and seek to implement measures for everyone, taking into account diverse needs, conditions, and resources.
Lessons
We propose a paradigm shift towards inclusionary and diversity-sensitive PH that benefits the entire population, including those forced to flee other countries. This requires a critical reflection of power dynamics and discrimination. The proposed concepts can be transferred to other social groups, regions, and areas of PH.
Key messages
Public health needs to shift its perspective from exclusion and subordination to inclusion and involvement.
Inclusionary and diversity-sensitive PH approaches promote health equity.
Healthcare workers (HCW) play a vital role in the SARS-CoV-2 pandemic control. The aim of this study was to assess the prevalence of SARS-CoV-2 antibodies and the risk of COVID-19 infections in a cohort of HCW from four different risk groups (from intensive care unit to administration) of a hospital of a primary care level in rural Germany. The outcomes were monthly measures of antibody seroprevalence over a period of 6 months. Overall, a seroprevalence of 13.41% was determined, with significantly higher prevalence rates among HCW working in areas with more frequent contact to confirmed or suspected cases (30.30%, p = 0.003). The group specific differences in the risk of infection from COVID-19 were detected, as HCW groups with frequent exposure seemed to have an increased risk (RR = 3.18, p = 0.02; CI95 1.09–9.24). The findings contribute to the epidemiological understanding of the virus spread in an unvaccinated population group, which is highly relevant for the pandemic management.
Soziale Ungleichheit führt bereits im Kindesalter zu gesundheitlicher Benachteiligung. Gesundheitsfördernde Angebote in Deutschland sind noch unzureichend miteinander verknüpft und erreichen sozialbenachteiligte Familien nur bedingt. International ist Community Child Health Nursing (CCHN) verbreitet und bietet einen möglichen Ansatz, um die gesundheitliche Chancengleichheit von Kindern zu stärken. Dieser Beitrag diskutiert das Berufsbild der CCH-Nurses und konzeptionelle Aspekte für die Implementierung in Deutschland.
Objective: Official German recommendations advise women to start taking folic acid supplementation (FAS) before conception and continue during the first pregnancy trimester to lower the risk of birth defects. Women from lower socioeconomic background and ethnic minorities tend to be less likely to take FAS in other European countries. As little is known about the determinants of FAS in Germany, we aimed to investigate the association between FAS and formal education and migration background, adjusting for demographic factors.
Design: We used data (2013-2016) on nutrition and socioeconomic and migration background from the baseline questionnaire of the BaBi cohort study. We performed multivariate regressions and mediation analyses.
Setting: Bielefeld, Germany.
Participants: 947 women (pregnant or who had given birth in the past two months).
Results: 16.7% of the participants (158/947) didn't use FAS. Migration-related variables (e.g. language, length of stay) were not associated with FAS in the adjusted models. FAS was lower in women with lower level of formal education and in unplanned pregnancies. Reasons given by women for not taking FAS were unplanned pregnancy and lack of knowledge of FAS.
Conclusions: Health practitioners may be inclined to see migrant women as an inherently at-risk group for failed intake of FAS. However, it is primarily women who did not plan their pregnancy, and women of lower formal education level, who are at risk. Different public health strategies to counter low supplementation rates should be supported, those addressing the social determinants of health (i.e. education) and those more focussed on family planning.
This scoping review systematically mapped evidence of the mediating and moderating effects of family characteristics on health inequalities in school-aged children and adolescents (6–18 years) in countries with developed economies in Europe and North America. We conducted a systematic scoping review following the PRISMA extension for Scoping Reviews recommendations. We searched the PubMed, PsycINFO and Scopus databases. Two reviewers independently screened titles, abstracts and full texts. Evidence was synthesized narratively. Of the 12,403 records initially identified, 50 articles were included in the synthesis. The included studies were conducted in the United States (n = 27), Europe (n = 18), Canada (n = 3), or in multiple countries combined (n = 2). We found that mental health was the most frequently assessed health outcome. The included studies reported that different family characteristics mediated or moderated health inequalities. Parental mental health, parenting practices, and parent-child-relationships were most frequently examined, and were found to be important mediating or moderating factors. In addition, family conflict and distress were relevant family characteristics. Future research should integrate additional health outcomes besides mental health, and attempt to integrate the complexity of families. The family characteristics identified in this review represent potential starting points for reducing health inequalities in childhood and adolescence.
Introduction: The neighbourhood in which one lives affects health through complex pathways not yet fully understood. A way to move forward in assessing these pathways direction is to explore the spatial structure of health phenomena to generate hypotheses and examine whether the neighbourhood characteristics are able to explain this spatial structure. We compare the spatial structure of two cardiovascular disease risk factors in three European urban areas, thus assessing if a non-measured neighbourhood effect or spatial processes is present by either modelling the correlation structure at individual level or by estimating the intra-class correlation within administrative units. Methods: Data from three independent studies (RECORD, DHS and BaBi), covering each a European urban area, are used. The characteristics of the spatial correlation structure of cardiovascular risk factors (BMI and systolic blood pressure) adjusted for age, sex, educational attainment and income are estimated by fitting an exponential model to the semi-variogram based on the geo-coordinates of places of residence. For comparison purposes, a random effect model is also fitted to estimate the intra-class correlation within administrative units. We then discuss the benefits of modelling the correlation structure to evaluate the presence of unmeasured spatial effects on health. Results: BMI and blood pressure are consistently found to be spatially structured across the studies, the spatial correlation structures being stronger for BMI. Eight to 22% of the variability in BMI were spatially structured with radii ranging from 100 to 240 m (range). Only a small part of the correlation of residuals was explained by adjusting for the correlation within administrative units (from 0 to 4 percentage points). Discussion: The individual spatial correlation approach provides much stronger evidence of spatial effects than the multilevel approach even for small administrative units. Spatial correlation structure offers new possibilities to assess the relevant spatial scale for health. Stronger correlation structure seen for BMI may be due to neighbourhood socioeconomic conditions and processes like social norms at work in the immediate neighbourhood.
The economic and health consequences of the COVID-19 pandemic pose a particular threat to vulnerable groups, such as migrants, particularly forcibly displaced populations. The aim of this review is (i) to synthesise the evidence on risk of infection and transmission among migrants, refugees, asylum seekers and internally displaced populations, and (ii) the effect of lockdown measures on these populations. We searched MEDLINE and WOS, preprint servers, and pertinent websites between 1st December 2019 and 26th June 2020. The included studies showed a high heterogeneity in study design, population, outcome and quality. The incidence risk of SARS-CoV-2 varied from 0•12% to 2•08% in non-outbreak settings and from 5•64% to 21•15% in outbreak settings. Migrants showed a lower hospitalisation rate compared to non-migrants. Negative impacts on mental health due to lockdown measures were found across respective studies. However, findings show a tenuous and heterogeneous data situation, showing the need for more robust and comparative study designs.
Background
Health disparities in children of immigrants are prevalent from birth and are hypothesized to – in part – emerge as a biological consequence of migration’s unfavorable social and psychological sequelae. The aim of this study was to examine whether maternal migrant background is associated with inflammation during pregnancy - a key pathway by which maternal states and conditions during pregnancy may influence fetal development and subsequent pregnancy, birth, and child developmental and health outcomes.
Material and Methods
Data was available from 126 pregnant women who participated in a population based multi-site prospective birth cohort study in Bielefeld and Berlin, Germany. The study included two study visits in mid- and late pregnancy. At each visit, a composite maternal pro-inflammatory score was derived from circulating levels of plasma inflammatory markers (IL-6, CRP). Migrant background was defined by country of origin of participants and their parents’ (Turkey or other) and generation status (1st or 2nd generation). We applied hierarchical linear models (HLM) in order to quantify the relationship between different migrant background variables and inflammation during pregnancy after adjustment for potential confounders (including socioeconomic status).
Results
Migrant background was significantly associated with inflammation during pregnancy. When compared to women without migrant background, levels of inflammation were increased in 1) pregnant women with migrant background in general (B = 0.35, SE = 0.12, p < .01); 2) 1st (B = 0.28, SE = 0.15, p < .10) and 2nd generation (B = 0.40, SE = 0.15, p < .01); 3) women with a Turkish migrant background (B = 0.28, SE = 0.14, p < .10) and women with another migrant background (B = 0.42, SE = 0.15, p <.01); and 4) 2nd generation Turkish origin women (B = 0.38, SE = 0.20, p <.10), 1st generation women with other migrant background (B = 0.44, SE = 0.26, p <.10), and 2nd generation women with other migrant background (B=0.43, SE = 0.17, p <.05).
Discussion
Our findings support a role for maternal inflammation as a pathway of intergenerational transmission of migration-related health inequalities, suggest that the effect seems to persist in 2nd generation immigrants, and highlight the need for future research and targeted interventions in this context.
Dieser Sammelband soll Lehrende in den Gesundheitsfachberufen in ihrer Arbeit unterstützen, indem er kompakte Einführungen in zentrale gesundheitswissenschaftliche Themen anbietet. Mit diesem Ziel im Blick haben Masterstudierende der Berufspädagogik für Gesundheitsfachberufe der Brandenburgischen TU Cottbus-Senftenberg im Herbst/Winter 2020 im Modul „Gesundheitswissenschaftliche Grundlagen II“ die Beiträge in diesem Band erarbeitet. Entstanden sind Einführungstexte zu verschiedenen gesundheitswissenschaftlichen Themen von Pädagog*innen für Pädagog*innen: Die Autor*innen suchen in ihren Texten immer wieder den Bezug zur berufspädagogischen Praxis und schlagen Hilfestellungen für die Gestaltung von Lehr-Lern-Situationen vor. Dazu zählen neben möglichen Reflexionsfragen auch Hinweise zur curricularen Einbindung relevanter Gesundheitsthemen und Überblicke zu vertiefender Literatur. Zentrale Aussagen sind am Ende der Kapitel unter dem Punkt „Wichtig zu wissen“ zusammen gefasst. Die fachliche Diversität der Autor*innen schlägt sich auch in den gewählten Beispielen nieder. So erörtern einige Autor*innen die Relevanz theoretischer Ansätze für die Pflege, andere beziehen Beispiele aus der Hebammenkunde und Physiotherapie ein.
Kinder von Migrant*innen zeigen bereits in frühen Lebensjahren häufig Gesundheitsdisparitäten, die mit mütterlicher Gesundheit und migrationsbezogenen Faktoren eng zusammenhängen. Zur Erklärung dieses Phänomens der intergenerationalen Transmission von Gesundheitsdisparitäten schlagen wir ein Modell vor, das eine Lebensverlaufsperspektive mit dem Konzept der fetalen Programmierung von Gesundheit und Krankheitsvulnerabilität zusammenbringt.
Characteristics of early childhood education and care (ECEC) centers might be relevant for children’s health. This scoping review aims to provide an overview of the association between meso-level characteristics (MLCs) of ECEC centers with children’s health, health behavior, and wellbeing. Five databases were searched for quantitative and qualitative research articles published in English or German since 1 January 2000 on health, health behavior, and wellbeing of children aged 0 to 6 years considering MLCs of ECEC centers. Two authors screened 10,396 potentially eligible manuscripts and identified 117 papers, including 3077 examinations of the association between MLCs and children’s health indicators (Kappas > 0.91). Five categories of MLCs were identified: (1) structural characteristics, (2) equipment/furnishings, (3) location, (4) facilities/environment, (5) culture/activities/policies/practices, and 6) staff. Only very few studies found an association of MLCs with body weight/obesity, and general health and wellbeing. Especially physical activity and mental health were related to MLCs. In general, the location (rural vs. urban, neighborhood status) seemed to be a relevant health aspect. MLCs of ECEC centers appeared relevant for child health indicators to different degrees. Future research should focus on these associations, in detail, to identify concrete ECEC indicators that can support health promotion in early childhood.
Dieses Kapitel stellt theoretische und empirische Grundlagen der Gesundheit, ihrer Determinanten und der gesundheitlichen Ungleichheit als Gegenstand eines systematischen Gesundheitsunterrichts vor (Goldfriedrich/Hurrelmann in diesem Band, Kern-Wert 2 des Gesundheitsunterrichtes). Das Wissen um die Komplexität menschlicher Vielfalt und deren Einfluss auf die gesundheitliche Situation bildet die Grundlage für das Verständnis zentraler Gesundheitsdimensionen (u. a. Müller/Porges in diesem Band) sowie die didaktische Schwerpunktsetzung in verschiedenen Institutionen im Entwicklungsverlauf, wie dem Gymnasium (Schwegmann in diesem Band), der Berufsschule (Trumpa/Dorn in diesem Band) oder in Hochschulen (Sprenger in diesem Band). In diesem Kontext erläutert das Kapitel die Problematik ungleich verteilter Gesundheitschancen und stellt die Bandbreite relevanter Einflussfaktoren am Beispiel der sozialen Lage, des Migrationshintergrunds und des Geschlechts bei Kindern und
Jugendlichen vor. Es zeigt auf, wie dieses Wissen im Bildungskontext curricular implementiert werden kann, um bereits im Kindes- und Jugendalter einen Beitrag zur gesundheitlichen Chancengleichheit leisten zu können.
Die Bevölkerungsgruppe der Menschen mit Migrationshintergrund umfasst fast ein Viertel der Gesamtbevölkerung in Deutschland und ist höchst heterogen. Pauschalisierende Aussagen zum Gesundheitsstatus dieser Gruppe sind daher nicht möglich. Menschen mit Migrationshintergrund sind nicht grundsätzlich gesünder oder kränker als die Mehrheitsbevölkerung. Allerdings können sie sich aufgrund von Expositionen vor, während und nach der Migration in ihren Gesundheitschancen und -risiken von der Mehrheitsbevölkerung unterscheiden. Prävention und Gesundheitsförderung sollten daraus resultierende spezifische Bedarfe ebenso berücksichtigen wie die Diversität der Bevölkerung insgesamt. Erfolgversprechend ist eine Kombination aus diversitätssensiblen, für die Gesamtbevölkerung zugänglichen Angeboten und migrationsspezifischen Ansätzen in besonders risikoreichen Situationen. Kommunale, settingorientierte sowie soziokulturell angepasste Angebote verbessern die Erreichbarkeit der Zielgruppen maßgeblich.
Research on the psychosocial care (PSC) of unaccompanied minor refugees (UMRs) has mainly taken a socioepidemiological approach and has focused on the perspectives of experts in the field. In contrast, the knowledge concerning the differing context factors and the underlying mechanisms of current PSC which could inform policy recommendations is scant. The study aims at unravelling the contexts, mechanisms and outcomes of PSC for UMRs. For a realist review (RR), scientific evidence and gray literature were synthesised consistent with the RAMESES publication standards for realist synthesis. Based on an iterative keyword search in electronic databases (e.g., PubMed) and screening, 34 works from 2005 to 2019 were included in a realist synthesis. Theory-informed context-mechanism-outcome configurations (CMOs) were extracted, to explain underlying processes and mechanisms. Characterised by their interrelatedness, the dominant CMOs included the UMRs' intersections of transitions (e.g., adolescence and migration), their needs for culture-, and gender-sensitive PSC, and the undersupply of PSC. These contexts and outcomes are mediated by pre-, peri- and post-migratory stressors as well as care structures and are moreover influenced by overarching discourses and concepts. They comprise adverse and beneficial mechanisms in the PSC of UMRs. The existing literature grasps the PSC of UMRs by different disciplines and approaches but does not offer a comprehensive overview on micro-macro intersections and included discourses. The inclusion of lay perspectives and an intersectional approach could inform health service research. The reflection of UMR-related categorical constructs of resilience and vulnerability, discourses of othering, as well as restrictive health policies may guide policy recommendations.
Othering beschreibt die Markierung von Menschen als „anders“ oder „nicht zugehörig“. Ausgehend von den Konzepten des exclusionary und inclusionary Othering diskutiert dieser Beitrag drei Ansätze zu i) exclusionary Public Health, ii) inclusionary Public Health und iii) diversitätssensiblem Public Health. Die Implikationen der Ansätze werden am Beispiel des Umgangs mit der COVID-19 Pandemie bei schutzsuchenden Menschen in Aufnahmeeinrichtungen und Sammelunterkünften in Deutschland aufgezeigt.
Die Diversität der Auszubildenden, Lehrkräfte und Praxisanleiter*innen in der Pflegeausbildung nimmt zu. Interkulturelle Kompetenzen sollten deshalb bereits in die pflegepädagogische und pflegerische Ausbildung integriert werden.
Eine kulturell kompetente Pflegeausbildung basiert auf der Wertschätzung aller Beteiligten in ihrer kulturellen Vielfalt. Sie bedarf der steten Reflexion "eigener" un "fremder" Prägungen und der eigenen kulturellen Befangenheit und Begrenztheit.
Machtasymmetrien, Kollektiverfahrungen, Fremdbilder und differente Kulturmuster können zu kommunikativen Herausforde-rungen in der interkulturellen Begegnung führen. Über die individuelle Selbstreflexion hinaus ist es entscheidend, die sozialen, rechtlichen, ökonomischen, institutionel-len und organisationalen Rahmenbedingungen des Lernens und Lehrens zu verbessern.
Für die Pflegeausbildung empfehlenswert sind
- die Integration interkultureller Kompetenzen in die Ausbildung von Lehrenden,
- die Entwicklung kultursensibler Pflege-curricula,
- die Förderung von (Selbst-)reflexion in kollegialen Fallberatungen,
- das Antworten auf Vielfalt durch entsprechende Leitungs- und Anstellungsstrategien,
- der reflektierte und verständnisvolle Umgang mit unterschiedlichen Sprachkennt-nissen,
- das Nutzen entzerrter, dialogischer und kooperativer Lernstrukturen sowie
- die Begleitung von Lernenden durch So-zialarbeiter*innen.
Migration beeinflusst die Gesundheit.
Ob sich Migration gesundheitlich positiv oder negativ auswirkt, hängt von einer Vielzahl von Faktoren ab, die in verschiedenen Erklärungsmodellen in einen Zusammenhang gebracht werden.
Wichtig bei der Beschreibung des Zusammenhangs sind eine zeitliche Komponente und die Einbeziehung der individuellen Lebensläufe der Migrant*innen mit ihren Lebensabschnitten vor, während und nach der Migration.
Gesundheitsdisparitäten manifestieren sich in der Nachkommengeneration von Migrant*innen teilweise schon in frühen Lebensjahren. Viele dieser Gesundheits-disparitäten werden durch sozioökonomische Benachteiligung und Akkulturation vermittelt.
Anhand des Konzeptes der fetalen Pro-grammierung kann erklärt werden, dass das mütterliche Stresserleben – vermittelt über endokrine und immunologische Prozesse – die spätere Gesundheit und Krank-heitsvulnerabilität der Nachkommen bereits in der Schwangerschaft beeinflusst.
Es gibt aus der internationalen Forschung zahlreiche Belege dafür, dass endokrine und immunologische Prozesse den Zusam-menhang zwischen mütterlichen migrationsbezogenen Stressoren und Schwangerschafts-, Geburts- und späteren Gesundheitsoutcomes des Kindes vermitteln. Bei Migrant*innen in Deutschland sind diese Zusammenhänge weitestgehend unterforscht.