Surveying Immigrants: The Role of Language Attrition and Language Change in the Application of Questionnaires

Quantitative questionnaires are increasingly applied across different languages and cultures. They play an important role in research on immigrant communities as well as in surveys of the general population of which immigrants are a significant part. Because immigrants have often limited proficiency of the language of the host country, usually questionnaires in their first language ("mother tongue") are needed. For this purpose, it is common to use questionnaires developed or adapted for the population of the respective countries which immigrants originate from. The applicability of these questionnaires, however, may be limited because of differences between both populations in terms of language usage, amongst others resulting from language attrition. This, for example, can be illustrated by means of the Revised Illness Perception Questionnaire (IPQ-R) applied to Turks in Turkey and Turkish immigrants residing in Germany. Questionnaires, therefore, must be thoroughly tested and often re-adapted to the language style and level of language proficiency of immigrants to avoid different forms of bias. An analytical framework of questionnaire equivalence can guide the process of testing and re-adaptation

Oral health behaviour in migrant and non-migrant adults in Germany: the utilization of regular dental check-ups

Background Migrants in many European countries including Germany tend to utilize preventive measures less frequently than the majority population. Little is known about the dental health of migrants as well as about their oral health behaviour, particularly in the adult population. The aim of this study was to examine differences in the uptake of annual dental check-ups in adult migrants and non-migrants in Germany. Methods We used data from the cross-sectional survey ‘German Health Update 2010’ conducted by the Robert Koch Institute (n = 22,050). Data from 21,741 German-speaking respondents with information on the use of dental check-ups was available, of which 3404 (15.7%) were migrants. Multiple logistic regression models were applied to adjust for demographic and socioeconomic confounders, including the place of residence as well as type of health insurance. Results Migrants were generally younger, had a lower socioeconomic status and showed a lower utilization of dental check-ups. The unadjusted odds ratio (OR) for utilization was 0.67 (95%-CI = 0.61–0.73). After adjusting for demographic and socioeconomic confounders the chance only increased slightly (adjusted OR = 0.71; 95%-CI = 0.65–0.77). Conclusions The analysis shows that migration status is associated with a reduced chance of attending dental check-ups, independently of demographic and socioeconomic factors. The influence of other factors, such as type of health insurance and place of residence had also no influence on the association. Migrants are exposed to different barriers in the health care system, comprising the patient, provider and system level. Further studies need to examine the relevant barriers for the uptake of preventive dental services in order to devise appropriate migrant- sensitive measures of dental prevention

Lay perspectives on social distancing and other official recommendations and regulations in the time of COVID-19: a qualitative study of social media posts.

Olcer S, Yilmaz-Aslan Y, Brzoska P. Lay perspectives on social distancing and other official recommendations and regulations in the time of COVID-19: a qualitative study of social media posts. BMC public health. 2020;20(1): 963.BACKGROUND: COVID-19 caused by a new form of coronavirus (SARS-CoV-2) first appeared in China end of 2019 and quickly spread to all counties of the world. To slow down the spread of the virus and to limit the pressure on the health care systems, different regulations and recommendations have been implemented by authorities, comprising amongst others the closure of all entertainment venues and social distancing. These measures have received mixed reactions, particularly from young individuals, with many not following available advice. Drawing on the information in social media discussion forums, the present study explores the reasons why people ignore the orders and recommendations of the authorities and why the authorities are unable to produce a shared sense of inclusion concerning protective measures against the COVID-19 outbreak.; METHODS: Three open-access social media forums (Reddit, Twitter, and YouTube comments) were systematically searched with respect to COVID-19-related beliefs, attitudes, and behaviours of individuals. The data was retrieved in the first 3 weeks of March 2020. Qualitative document analysis and qualitative content analysis were used as the methodical approach. The data was reviewed by all authors and jointly interpreted to minimise inconsistencies.; RESULTS: The study reveals that reasons such as information pollution on social media, the persistence of uncertainty about the rapidly spreading virus, the impact of the social environment on the individual, and fear of unemployment associated with inequality in the distribution of income lead people to ignore the orders and recommendations of the authorities. The findings suggest that government representatives and politicians could not produce a shared sense of inclusion concerning protective measures against the COVID-19 outbreak, due to not building trust among the public and taking concrete economic steps to satisfy them.; CONCLUSION: In uncertain crises, transparency in the presentation of information and government policies emerge as influential determinants in creating social susceptibility and solidarity. The differences between social classes constitute one of the important factors that affect the decision-making mechanisms of individuals in determining the necessary steps to be undertaken in times of crisis

Indirect consequences of extreme weather and climate events and their associations with physical health in coastal Bangladesh: a cross-sectional study

Beier D, Brzoska P, Khan MH. Indirect consequences of extreme weather and climate events and their associations with physical health in coastal Bangladesh: a cross-sectional study. Global Health Action. 2015;8(1): 29016.Background: Bangladesh is one of the countries in the world which is most prone to natural disasters. The overall situation is expected to worsen, since extreme weather and climate events (EWCE) are likely to increase in both frequency and intensity. Indirect consequences caused in the events' aftermath widen the range of possible adverse health outcomes. Objective: To assess the association of indirect consequences of EWCE and physical health. Design: We used recent cross-sectional self-reported data from 16 coastal villages in Bangladesh. A total of 980 households were surveyed using a structured questionnaire. The outcome of physical health was categorized into three groups, reflecting the severity of reported diseases by the respective source of treatment as a proxy variable (hospital/clinic for severe disease, other source/no treatment for moderate disease, and no disease). The final statistical analysis was conducted using multinomial logistic regression. Results: Severe diseases were significantly associated with drinking water from open sources [odds ratio (OR): 4.26, 95% confidence interval (CI): 2.25-8.09] and tube wells (OR: 2.39, 95% CI: 1.43-4.01), moderate harm by river erosion (OR: 6.24, 95% CI: 2.76-14.11), food scarcity (OR: 1.98, 95% CI: 1.16-3.40), and the perception of increased employment problems (OR: 2.19, 95% CI: 1.18-4.07). Moderate diseases were significantly associated with moderate harm by river erosion (OR: 2.65, 95% CI: 1.28-5.48) and fully experienced food scarcity (OR: 1.75, 95% CI: 1.16-2.63). For both categories, women and the elderly had higher chances for diseases. Conclusions: Indirect consequences of EWCE were found to be associated with adverse health outcomes. Basic needs such as drinking water, food production, and employment opportunities are particularly likely to become threatened by EWCE and, thus, may lead to a higher likelihood of ill-health. Intervention strategies should concentrate on protection and provision of basic needs such as safe drinking water and food in the aftermath of an event

Two-Part Models and Quantile Regression for the Analysis of Survey Data With a Spike. The Example of Satisfaction With Health Care

Sauzet O, Razum O, Widera T, Brzoska P. Two-Part Models and Quantile Regression for the Analysis of Survey Data With a Spike. The Example of Satisfaction With Health Care. Frontiers in Public Health. 2019;7: 146.Background: Results of patient satisfaction questionnaires can contain a spike at the value corresponding to a complete satisfaction. A possible interpretation is that there are two types of respondents, those who are willing to provide a negative evaluation to one or more items proposed in the questionnaire and those who will always provide a completely positive evaluation irrespective of the item. The aim of the present study is to compare various statistical approaches to the analysis of such data using data from a rehabilitation patient survey of the German Statutory Pension Insurance Scheme as an example. Method: We used data from 272,806 respondents who participated in the survey from 2008 to 2011. We illustrate four models: linear regression, logistic regression, a two-part model based on the assumption of two underlying populations and quantile regression, which does not require any distributional assumptions. For each model we consider the relationship of the satisfaction score with two covariates. Results: While providing correct estimates of the mean values (marginal effects), the assumptions of the linear model are violated which can lead to false interpretations. A two-part regression which consists of a logistic regression followed by a linear regression conditional on not being fully satisfied is a useful alternative. For research questions focusing on specific parts of the distribution, logistic regression as well as quantile regression are to be considered. Discussion: Data with a spike represents a statistical challenge but a range of modeling approaches is available to provide sound interpretations and correct answers to research questions

Multi-target regressor chains with repetitive permutation scheme for characterization of built environments with remote sensing

Multi-task learning techniques allow the beneficial joint estimation of multiple target variables. Here, we propose a novel multi-task regression (MTR) method called ensemble of regressor chains with repetitive permutation scheme. It belongs to the family of problem transformation based MTR methods which foresee the creation of an individual model per target variable. Subsequently, the combination of the separate models allows obtaining an overall prediction. Our method builds upon the concept of so-called ensemble of regressor chains which align single-target models along a flexible permutation, i.e., chain. However, in order to particularly address situations with a small number of target variables, we equip ensemble of regressor chains with a repetitive permutation scheme. Thereby, estimates of the target variables are cascaded to subsequent models as additional features when learning along a chain, whereby one target variable can occupy multiple elements of the chain. We provide experimental evaluation of the method by jointly estimating built-up height and built-up density based on features derived from Sentinel-2 data for the four largest cities in Germany in a comparative setup. We also consider single-target stacking, multi-target stacking, and ensemble of regressor chains without repetitive permutation. Empirical results underline the beneficial performance properties of MTR methods. Our ensemble of regressor chain with repetitive permutation scheme approach achieved most frequently the highest accuracies compared to the other MTR methods, whereby mean improvements across the experiments of 14.5% compared to initial single-target models could be achieved

Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study

Brzoska P, Sauzet O, Yilmaz-Aslan Y, Widera T, Razum O. Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study. BMC HEALTH SERVICES RESEARCH. 2016;16(1): 105.Background: In many European countries, foreign nationals experience, on average, less favorable treatment outcomes in rehabilitative care than the respective majority population. In Germany, this for example is reflected in a lower occupational performance and a higher risk of disability retirement after rehabilitation as analyses of routine data show. However, little is known about the perspective of health care users. The aim of the present study was to compare self-rated treatment outcomes between German and non-German nationals undergoing in-patient medical rehabilitation in Germany. Methods: We analyzed data from a cross-sectional representative rehabilitation patient survey of 239,811 patients from 642 clinics in Germany who completed about 3 weeks of in-patient rehabilitative treatment. The self-rating of the treatment outcome was based on a dichotomized Likert scale consisting of three items. A multilevel logistic regression analysis adjusted for various demographic, socio-economic, health and other covariates was conducted to examine differences in the self-rated treatment outcome between German and non-German nationals. Results: Of the 239,811 respondents 0.9 % were nationals from Turkey, 0.8 % had a nationality from a former Yugoslavian country, 0.9 % held a nationality from the South European countries Portugal, Spain, Italy or Greece and 1.9 % were nationals from other countries. Non-German nationals reported a less favorable self-rated outcome than Germans. Adjusted odds ratios [OR] for reporting a less favorable treatment outcome were 1.24 (95 %-confidence interval [95 %-CI]: 1.12-1.37) for nationals from the South European countries Portugal/Spain/Italy/Greece, 1.62 (95 %-CI: 1.45-1.80) for Turkish nationals and 1.68 (95 %-CI: 1.52-1.85) for nationals from Former Yugoslavia. Conclusions: Knowledge on health outcomes from the patients' point of view is important for the provision of patient-centered health care. Our study showed that non-German nationals report less favorable outcomes of rehabilitative care than Germans. This may be due to cultural and religious needs not sufficiently addressed by health care providers. In order to improve rehabilitative care for non-German nationals, rehabilitative services must become sensitive to the needs of this population group. Diversity management can contribute to this process

Probing shells against buckling: a non-destructive technique for laboratory testing

This paper addresses testing of compressed structures, such as shells, that exhibit catastrophic buckling and notorious imperfection sensitivity. The central concept is the probing of a loaded structural specimen by a controlled lateral displacement to gain quantitative insight into its buckling behaviour and to measure the energy barrier against buckling. This can provide design information about a structure's stiffness and robustness against buckling in terms of energy and force landscapes. Developments in this area are relatively new but have proceeded rapidly with encouraging progress. Recent experimental tests on uniformly compressed spherical shells, and axially loaded cylinders, show excellent agreement with theoretical solutions. The probing technique could be a valuable experimental procedure for testing prototype structures, but before it can be used a range of potential problems must be examined and solved. The probing response is highly nonlinear and a variety of complications can occur. Here, we make a careful assessment of unexpected limit points and bifurcations, that could accompany probing, causing complications and possibly even collapse of a test specimen. First, a limit point in the probe displacement (associated with a cusp instability and fold) can result in dynamic buckling as probing progresses, as demonstrated in the buckling of a spherical shell under volume control. Second, various types of bifurcations which can occur on the probing path which result in the probing response becoming unstable are also discussed. To overcome these problems, we outline the extra controls over the entire structure that may be needed to stabilize the response.Comment: as accepted in International Journal of Bifurcation and Chaos (18 pages

Are there disparities in different domains of physical activity between school-aged migrant and non-migrant children and adolescents? Insights from Germany

Background Large proportions of the populations in many European countries, including Germany, are migrants. Migrant children and adolescents tend to be less physically active than their non-migrant peers. However, current research is limited as it does not sufficiently consider different domains of physical activity. Using a representative dataset, the present study examines the patterns of sports participation and other domains of physical activity among migrant and non-migrant children and adolescents residing in Germany. Methods Nationwide data from the Motorik-Modul (MoMo) Study is used. Five different domains of physical activity participation (sports clubs, outside of sports clubs, extra-curricular physical activity, physical activity, outdoor play and active commuting to school) were compared between children and adolescents with no, one-sided and two-sided migration background using logistic regression adjusted for demographic factors. Interaction terms were included in order to examine whether difference between the three groups differ by age and gender. Results Information on n = 3,323 children and adolescents was available. As compared to non-migrants, children and adolescents with a two-sided migration background had a 40% (adjusted odds ratio [aOR] = 0.60, 95%-CI: 0.44–0.81), those with a one-sided migration background a 26% (aOR = 0.74, 95%-CI: 0.55-<1.00) lower chance of participating in sport club activities. In contrast, children and adolescents with a two-sided migration background were at 65% higher chance of participating in extra-curricular physical activity than non-migrants (OR = 1.65, 95%-CI: 1.15–2.36). Conclusion The study shows that differences in levels of physical activity between migrant and non-migrant children and adolescents are less pronounced than previous research has suggested. In particular, it reveals that migrants are only disadvantaged regarding participation in sports clubs whereas they fare better with respect to extra-curricular physical activity. Interventions should therefore address barriers migrant children and adolescents encounter in the access to sport clubs while maintaining their high level of extra-curricular physical activity