Over-indebtedness as a marker of socioeconomic status and its association with obesity: a cross-sectional study

BACKGROUND: The recent credit crunch will have implications for private households. Low socioeconomic status is associated to various diseases. While income, education and occupational status is frequently used in definitions of socioeconomic status, over-indebtedness of private households is usually not considered. Over-indebtedness is currently increasing in high-income countries. However, its association with health – particularly with obesity – remains unknown. Therefore, the aim of this study was to assess an association between over-indebtedness and overweight or obesity. METHODS: A cross-sectional study on over-indebtedness and health including 949 over-indebted subjects from 2006 and 2007 in Rhineland-Palatinate and Mecklenburg-Western Pomerania (Germany) and the telephonic health survey 2003 of the Robert Koch-Institute including 8318 subjects, who are representative for the German population, were analysed with adjusted logistic regression considering overweight (BMI ≥25.0 kg/m(2)) and obesity (BMI ≥30 kg/m(2)) as response variable. RESULTS: After adjusting for socio-economic (age, sex, education, income) and health factors (depression, smoking habits) an independent effect of the over-indebt situation on the probability of overweight (aOR 1.97 95%-CI 1.65–2.35) and obesity (aOR 2.56 95%-CI 2.07–3.16) could be identified. CONCLUSION: Over-indebtedness was associated with an increased prevalence of overweight and obesity that was not explained by traditional definitions of socioeconomic status. Over-indebtedness should be additionally considered when assessing health effects of socioeconomic status

The PinK Study - Methodology of the Baseline Survey of a Prospective Cohort Study of Couples Undergoing Fertility Treatment

Der Methodenbericht beschreibt die Basiserhebung der PinK-Studie "Paare in Kinderwunschbehandlung". Ziel der Studie ist ein besseres Verständnis der Situation von Paaren mit unerfülltem Kinderwunsch und umfassende Erkenntnisse über die Wege in die Kinderwunschbehandlung. Der Ansatz der Studie ist interdisziplinär. Sie ist als prospektive Kohortenstudie in einem klinischen Umfeld angelegt. Zielgruppe der Studie sind Paare mit unerfülltem Kinderwunsch, die zwischen Juli 2012 und Mai 2013 ein Kinderwunschzentrum in Rheinland-Pfalz oder in der hessischen Landeshauptstadt aufgesucht haben. Als Erhebungsinstrument kamen schriftliche Fragebögen zum Einsatz, die den Patienten durch das Personal der Kinderwunschzentren übergeben wurden. Der finale Datensatz enthält alle bis Ende Juli 2013 zurückgesendete Fragebögen. Es haben 323 Frauen und 242 Männer an der Befragung teilgenommen, darunter 234 Paare, für die vollständige Informationen zu beiden Partnern vorliegen. Der Datensatz ermöglicht damit neben Geschlechtervergleichen auch Paaranalysen. Die Gesamtrücklaufquote liegt bei 31% mit teilweise erheblichen Unterschieden zwischen den Kliniken - mögliche Ursachen und Folgen werden diskutiert. Die Studienpopulation wird hinsichtlich zentraler soziodemografischer Merkmale beschrieben.This paper describes the realization of the baseline survey of the study ‘PinK- Paare in Kinderwunschbehandlung’ (couples undergoing fertility treatment). The study aims at a broader and better understanding of the situation of couples with an unfulfilled desire to have a child and of pathways leading couples to the fertility clinic. The approach of the study is interdisciplinary. It is designed as a prospective cohort study in a clinical setting. The study population consists of couples with an unfulfilled desire to have a child who presented themselves in a fertility clinic in the German state of Rhineland-Palatinate (RP) or in the capital city of the state of Hesse between July 2012 and May 2013. Self-administered questionnaires were used to gather information from patients at fertility clinics. These were handed out to the patients by the staff at the fertility clinics. Questionnaires returned by the end of July 2013 were included in the data set. The final sample consists of 323 female and 242 male respondents. In 234 couples, both partners participated. The overall response rate is 31%, with considerable variation across the clinics - reasons for and consequences of this are discussed. The final sample is described in terms of the distribution of core socio-demographic variables

End-of-life care in Germany: Study design, methods and first results of the EPACS study (Establishment of Hospice and Palliative Care Services in Germany)

<p>Abstract</p> <p>Background</p> <p>In order to tackle the deficits in the provision of palliative home care, profound structural changes in the outpatient sector were introduced by law in Germany in 2007. The EPACS study was carried out (Research Accompanying the <b>E</b>stablishment of Hospice and <b>Pa</b>lliative <b>C</b>are <b>S</b>ervices in Rhineland-Palatinate, Germany) to document the quality of inpatient and outpatient end-of-life care in Rhineland-Palatinate, Germany, before the implementation of these changes. With this article we focus on the study design and methods of the EPACS-Study. We further report first results regarding several aspects of outpatient end-of-life care.</p> <p>Methods</p> <p>The cross-sectional survey was based on a random sample of 5000 inhabitants of Rhineland-Palatinate that had died from May 25 until August 24 of the year 2008. Relatives of these randomly drawn deceased persons were interviewed by means of a written survey.</p> <p>Results</p> <p>The overall response proportion considering only those questionnaires that actually were delivered (n = 3833) was 36.0%. Factors influencing participation were age, sex, and marital status. 355 (25.8%) deceased persons had used professional home care in the four weeks prior to their death, but only very few persons had used a specialised palliative home care service (n = 30; 8.5%). There was a clear gap between the need for specialised outpatient care and the actual utilisation of these services.</p> <p>Conclusions</p> <p>Satisfaction with professional home care was relatively high, but physicians were rated less favourable than nurses. There were deficits especially with respect to physicians' communicative and supportive skills. Further analyses are necessary to provide more detailed information about quality of care in different care settings and for distinct groups. Predictors of good care, as well as obstacles to it, must be further investigated. In the long run, a follow-up survey must be conducted to compare quality of home care before and after the structural changes in Germany.</p

The PinK Study - Methodology of the Follow-up Survey of a Cohort Study of Couples Undergoing Fertility Treatment

The paper describes the follow-up survey of the PinK study 'Paare in Kinderwunschbehandlung' (couples undergoing fertility treatment). This interdisciplinary study aims at a broader and better understanding of the situation of couples with an unfulfilled desire to have a child. The focus in the follow-up survey is on the situation of the couples one year after their first visit to a fertility clinic in Rhineland-Palatinate or in the capital of Hesse, Wiesbaden. Approximately one year after the baseline survey, self-administered questionnaires were sent to respondents who had signed a written agreement to remain in the study. The field period lasted from June 2013 to August 2014. The final sample consists of 140 women and 93 men. In 89 couples both partners participated. The longitudinal data set includes 224 respondents. The share of baseline survey participants who also participated in the follow-up is 39.6 %. This report describes the study design and materials for the follow-up as well as the sample and analyses the selectivity of dropouts from the baseline sample

THE DETERMINATION OF MAXIMUM MOMENTS IN A CONTINUOUS BEAM BY GENETIC ALGORITHMS

Genetik Algoritma, bilgisayar üzerinde oluşan bir evrim şeklidir. Genetik Algoritmalar ile oluşturulan seleksiyon, doğal topluluklara benzer bir şekilde bilgisayar hafızasına depo edilmiş kromozomlar üzerinde icra edilmektedir. Evrim teorisi, biyolojik sistemleri doğal seleksiyon işleminin devamlı üretimi olarak tanımlamaktadır. Buna benzer olarak, Genetik Algoritmalar el ile yapıldığında uzun süren hesaplamalar yerine bilgisayar üzerinde oluşturulan evrimle mühendislik problemlerinin çözümünde etkili olmaktadır. Bu çalışmada altı açıklıklı sürekli bir kirişte maksimum açıklık ve mesnet momentlerini veren hareketli yük kombinezonlarının Genetik Algoritmalarla otomatik bir şekilde düzenlenmesi incelenmiştir. Sunulan metodun hesaplama hızı tesir çizgileri yöntemi gibi klasik yöntemlerle yapılan çözüme kıyasla oldukça yüksektir. Genetic Algorithm is a form of evolution that takes place in a computer. The selection by Genetic Algorithm operates on strings of binary digits stored in the computer's memory in much the same way that natural populations of individuals evolve. The evolution theory describes the biological systems as the continuous process of the natural selections. Similar to that, since computations made by hand are time consuming, Genetic Algorithms are effective for solving engineering problems by forming evaluation in computer. In this study, the live load arrangements for maximum bending and support moments on a continuous sixspan beam are obtained automatically by Genetic Algorithms. Computation speed of presented method is higher as compared to that of conventional methods like influence line method

Nanoparticle-based rifampicin delivery system development

The alkaline milieu of chronic wounds severely impairs the therapeutic effect of antibiotics, such as rifampicin; as such, the development of new drugs, or the smart delivery of existing drugs, is required. Herein, two innovative polyelectrolyte nanoparticles (PENs), composed of an amphiphilic chitosan core and a polycationic shell, were synthesized at alkaline pH, and in vitro performances were assessed by H-1 NMR, elemental analysis, FT-IR, XRD, DSC, DLS, SEM, TEM, UV/Vis spectrophotometry, and HPLC. According to the results, the nanostructures exhibited different morphologies but similar physicochemical properties and release profiles. It was also hypothesized that the simultaneous use of the nanosystem and an antioxidant could be therapeutically beneficial. Therefore, the simultaneous effects of ascorbic acid and PENs were evaluated on the release profile and degradation of rifampicin, in which the results confirmed their synergistic protective effect at pH 8.5, as opposed to pH 7.4. Overall, this study highlighted the benefits of nanoparticulate development in the presence of antioxidants, at alkaline pH, as an efficient approach for decreasing rifampicin degradation.Ministry of Education, Youth and Sport of the Czech Republic-DKRVO [RP/CPS/2020/005

Feasibility of a cohort study on health risks caused by occupational exposure to radiofrequency electromagnetic fields

Breckenkamp J, Berg-Beckhoff G, Muenster E, et al. Feasibility of a cohort study on health risks caused by occupational exposure to radiofrequency electromagnetic fields. Environmental Health. 2009;8(1):23.Background: The aim of this study was to examine the feasibility of performing a cohort study on health risks from occupational exposure to radiofrequency electromagnetic fields (RF-EMF) in Germany. Methods: A set of criteria was developed to evaluate the feasibility of such a cohort study. The criteria aimed at conditions of exposure and exposure assessment (level, duration, preferably on an individual basis), the possibility to assemble a cohort and the feasibility of ascertaining various disease endpoints. Results: Twenty occupational settings with workers potentially exposed to RF-EMF and, in addition, a cohort of amateur radio operators were considered. Based on expert ratings, literature reviews and our set of predefined criteria, three of the cohorts were identified as promising for further evaluation: the personnel (technicians) of medium/short wave broadcasting stations, amateur radio operators, and workers on dielectric heat sealers. After further analyses, the cohort of workers on dielectric heat sealers seems not to be feasible due to the small number of exposed workers available and to the difficulty of assessing exposure (exposure depends heavily on the respective working process and mixture of exposures, e.g. plastic vapours), although exposure was highest in this occupational setting. The advantage of the cohort of amateur radio operators was the large number of persons it includes, while the advantage of the cohort of personnel working at broadcasting stations was the quality of retrospective exposure assessment. However, in the cohort of amateur radio operators the exposure assessment was limited, and the cohort of technicians was hampered by the small number of persons working in this profession. Conclusion: The majority of occupational groups exposed to RF-EMF are not practicable for setting up an occupational cohort study due to the small numbers of exposed subjects or due to exposure levels being only marginally higher than those of the general public

A novel haemocytometric covid-19 prognostic score developed and validated in an observational multicentre european hospital-based study

COVID-19 induces haemocytometric changes. Complete blood count changes, including new cell activation parameters, from 982 confirmed COVID-19 adult patients from 11 European hospitals were retrospectively analysed for distinctive patterns based on age, gender, clinical severity, symptom duration and hospital days. The observed haemocytometric patterns formed the basis to develop a multi-haemocytometric-parameter prognostic score to predict, during the first three days after presentation, which patients will recover without ventilation or deteriorate within a two-week timeframe, needing intensive care or with fatal outcome. The prognostic score, with ROC curve AUC at baseline of 0.753 (95% CI 0.723-0.781) increasing to 0.875 (95% CI 0.806-0.926) on day 3, was superior to any individual parameter at distinguishing between clinical severity. Findings were confirmed in a validation cohort. Aim is that the score and haemocytometry results are simultaneously provided by analyser software, enabling wide applicability of the score as haemocytometry is commonly requested in COVID-19 patients

Determinants of having no general practitioner in Germany and the influence of a migration background: results of the German health interview and examination survey for adults (DEGS1)

Background: It is aspired in the German healthcare system that general practitioners (GPs) act as initial contact for patients and guide through at all steps of medical treatment. This study aims at identifying factors associated with the odds of having no GP within the general population and especially among people with migration background. Methods: This cross-sectional analysis was based on the “German Health Interview and Examination Survey for Adults” (DEGS1) conducted by the Robert Koch Institute. Descriptive analyses as well as multiple logistic regression models were performed to analyse the impact of a migration background, age, gender, residential area, socioeconomic status (SES) and other factors on having no GP among 7755 participants. Results: 9.5% of the total study population and 14.8% of people with a migration background had no GP, especially men, adults living in big cities and without chronic diseases. The odds of not having a GP were higher for people with a two-sided migration background (aOR: 1.90, 95% CI: 1.42–2.55). Among the population with a migration background, particularly young adults, men, people living in big cities and having a private health insurance showed higher odds to have no GP. Conclusions: It is necessary to investigate the causes of the differing utilization of healthcare of people with a migration background and, if necessary, to take measures for an equal access to healthcare for all population groups. Further research needs to be done to evaluate how to get young people into contact with a GP.Peer Reviewe