Is There Migration-Related Inequity in Access to or in the Utilisation of Health Care in Germany?

This paper analyses immigrants' access to health care and utilisation of health care services in Germany. Thereby, it is investigated if there is inequity in access to or in the utilisation of health care services due to a lack of language skills or due to a lack of information about the health care system (approximated by years since migration)among first- and secondgeneration immigrants. The data used are drawn from eleven waves of the SOEP (1995-2006). With regard to the probability to contacta physician (as a proxy for access), German language skills are found to have no significant influence for all groups of immigrants. The hypothesis of inequity in access to health care due to access barriers caused by a lack of German language skills is therefore not supported by the data. However, mother tongue language skillsseem to be important for the contact probability of the first- and secondgeneration: Having only good or poor mother tongue language skills reduces the probability of a doctor contact. The effect is found to be significant for first- and second-generation men. For the frequency of doctor visits (utilisation), poor German language skills are found to exert a significant influence: Those reporting poor language skills have a lower expected number of doctor visits. The effect is found to be significant for first-generation men and for secondgeneration men and women. Hence, there seems to be inequity in health care utilisation due to a lack of German language skills. With the exception of first-generation men - where it is found that poor mother tongue language skills reduce the expected number of doctor visits significantly, no significant effect is found for mother tongue language skills. With regard to the duration of residence, the results indicate that years since migration have an impact on the contact decision of first-generation immigrant women, whereby a significant positive influence is found. Hence, missing knowledge about the health care system could create additional access barriers and yield inequity in access to health care in the group of firstgeneration women. The duration of residence seems to have no influence on the frequency decision.Utilisation of health care, inequity, immigrants, SOEP

Changes in Immigrants' Body Mass Index with Their Duration of Residence in Germany

This paper investigates how immigrants' Body Mass Index (BMI) changes with increasing years since migration in Germany. The data are drawn from three waves (2002, 2004, and 2006) of the German Socio-Economic Panel Study (SOEP). The results indicate a clear increase of the BMI with additional years in Germany for men and women.Body Mass Index, immigrants, SOEP

Return Migration and the "Healthy Immigrant Effect"

According to the "healthy immigrant effect" (HIE), immigrants upon arrival are healthier than locally born residents. However, this health advantage is supposed to diminish or even disappear over a relatively short period and the immigrants' health status is converging to that of the natives. The causes for this gradient of immigrants' health are subject to an ongoing discussion and the underlying trajectories are not yet fully understood. This paper investigates whether return migration can serve as an additional explanation for the declining health of immigrants, and thus aims at shedding some light on the trajectories underlying the HIE. The data used are drawn from 13 waves of the German Socio-Economic Panel. Using a random-effects probit model, this analysis explores the factors influencing re-migration by means of a sample of 4,426 migrants. In line with the existing literature, the study shows that e.g. having spouse and children in the home country, or being non-working or jobless yield a higher return probability, whereas all factors associated with attachment to Germany (e.g. language fluency, German citizenship, house ownership) reduce the probability of re-migration. Additionally, the results indicate that men reporting poorer health ('good', 'satisfactory', 'poor' or 'bad') are significantly less likely to return home relative to male immigrants who describe their health as 'very good'. However, for women, the effects are adverse to that of men, and none of the health coefficients for women is significant. Hence - at least for men - re-migration can be seen as an additional explanation for the HIE.Return migration, healthy immigrant effect, SOEP

Migration und Gesundheit - Empirische Analysen mit dem Sozio-oekonomischen Panel (SOEP)

The so-called 'healthy immigrant effect' (HIE) is one of the most striking findings concerning immigrants and their health status. It is usually said to consist of two parts: According to the first part, immigrants upon arrival are on average healthier than their native peers. This finding is mostly explained by self-selection among their origin population. The idea is that healthier individuals are more likely to migrate as they are more able to reap the reward of the investment ‘migration’ than less healthy individuals. However, according to the second part, this health gap between immigrants and natives closes after a relatively short period of time, and the health of immigrants is converging to that of the natives or is getting even worse. This gradient of immigrants’ health has been found in many countries (e.g., Australia, Canada, and the United States) and for many different measures of health (e.g., self-rated health, chronic diseases). The causes for this decline in immigrants’ health are subject to ongoing research, but the underlying processes are not yet fully understood. In literature, several different explanations are discussed: The adoption of destination-country habits and lifestyles, the structural and material relationship between a low socio-economic status and poor health, additional stress due to the migration process, persistent barriers to access to health care due to cultural or language factors, as well as a kind of 'statistical artefact' due to selection effects caused by return migration. As health is a rather complex concept, one can assume that none of the proposed explanations can solely explain the decline in immigrants’ health, but rather that the health deterioration is a result of different interacting causes. This thesis investigates three of the proposed possible explanations for a decline in immigrants’ health, namely return migration, the adoption of destination-country habits and lifestyles, and immigrants’ access to health care and utilisation of health care services.Obwohl ‚Migration’ seit langem einen wesentlichen wirtschafts- und sozialwissenschaftlichen Forschungsschwerpunkt darstellt, sind die Determinanten des Gesundheitszustandes von Migranten – vor allem in Deutschland – noch weitgehend unerforscht. Eine der bedeutendsten Thesen in der internationalen Literatur in Bezug auf den Gesundheitszustand von Migranten ist der sog. 'healthy immigrant effect' (HIE). Dieser besagt, dass Migranten zu Beginn ihrer Aufenthaltsdauer durchschnittlich gesünder sind als die einheimische Bevölkerung, dieser Gesundheitsvorteil aber mit steigender Aufenthaltsdauer abnimmt und der Gesundheitszustand der Migranten sich dem der einheimischen Bevölkerung annähert oder sogar noch schlechter wird. Während der anfängliche Gesundheitsvorteil in der Literatur weitgehend einstimmig mit positiver Selektion erklärt wird, ist die Verschlechterung des Gesundheitszustandes mit steigender Aufenthaltsdauer noch weitgehend ungeklärt und wird kontrovers diskutiert. Hier knüpft die vorliegende Arbeit an und untersucht empirisch mit Daten des Sozio-oekonomischen Panels (SOEP) drei mögliche Erklärungsfaktoren: (1) Remigration: Die Verschlechterung des Gesundheitszustandes der Migranten könnte ein statistisches Artefakt sein, wenn durchschnittlich gesündere Personen rückwandern. (2) Gesundheitsverhalten: Migranten könnten mit zunehmender Aufenthaltsdauer ihr Gesundheitsverhalten an das vergleichsweise ungesündere Verhalten im Gastland anpassen. (3) Zugang und Inanspruchnahme des Gesundheitssystems: Kulturelle oder sprachliche Barrieren könnten zu Ungleichheit im Zugang oder in der Inanspruchnahme von Gesundheitsleistungen führen

Zadania pielęgniarki w opiece nad seniorem w terminalnej fazie raka gruczołowego płuc

Introduction. Lung cancer is the main cause of death due to cancer in Poland. The most important factors that influence the risk of developing lung cancer are: smoking (active or passive), exposure to carcinogens, genetic factors, lung dieseses and bad diet (eating not enough vegetables) The aim. The aim of this study is to present the tasks of a nurse in the care of a senior in the terminal stage of lung adenocarcinoma. Case presentation. A 74-year-old patient on the 5th day of hospitalization was admitted to the ward diagnosed with lungs adenocarcinoma, which was the cause of significant pain, progressive cachexia, constipation and respiratory problems. Conclusion. In the terminal stage of lung adenocarcinoma, the dominant care problems for seniors are: pain, dyspnea, constipation caused by opioid treatment, malnutrition resulting from the progression of cancer, oral lesions. Main goal of a nurse in the care of a senior in the terminal stage of lung adenocarcinoma is mainly participation in alleviating ailments resulting from disease progression.Wstęp. Rak płuca stanowi w Polsce pierwszą przyczynę zgonów z powodu nowotworów. Najistotniejszymi czynnikami wpływającymi na ryzyko wystąpienia raka płuca są: palenie tytoniu (czynne i bierne), ekspozycja na pierwiastki rakotwórcze, czynniki genetyczne, choroby płuc (zwłóknienie płuc, przewlekła obturacyjna choroba płuc, krzemica) oraz nieodpowiednia dieta (mała ilość spożywanych warzyw i owoców). Cel. Celem niniejszej pracy jest przedstawienie zadań pielęgniarki w opiece nad seniorem w terminalnej fazie raka gruczołowego płuc Prezentacja przypadku. Pacjentka lat 74 w 5-tej dobie hospitalizacji przyjęta w oddział z rozpoznaniem raka gruczołowego płuc, powodu znacznych dolegliwości bólowych, postępującej kacheksji, zaparć oraz problemów z oddychaniem. Wnioski. W terminalnej fazie raka gruczołowego płuc dominującymi problemami pielęgnacyjnymi seniora są: ból, duszność, zaparcia spowodowane leczeniem opioidami, niedożywienie wynikające z postępu choroby nowotworowej, zmiany  w obrębie jamy ustnej. Rolą pielęgniarki w opiece nad seniorem w terminalnej fazie raka gruczołowego płuc jest przede wszystkim udział w łagodzeniu wszystkich dolegliwości wynikających z postępu choroby

Hebammenstudie Sachsen: Studie zur Erfassung der Versorgungssituation mit Hebammenleistungen in Sachsen sowie zur Möglichkeit der kontinuierlichen landesweiten Erfassung von Daten über Hebammenleistungen: Kurzfassung der Studie für das Sächsische Staatsministerium für Soziales und Verbraucherschutz

Die Versorgungssituation in der Hebammenhilfe ist sowohl bundesweit als auch in Sachsen seit mehreren Jahren Gegenstand öffentlicher Diskussionen. Inwiefern in Sachsen ein flächendeckender Versorgungsmangel in der Hebammenhilfe besteht, konnte bislang nicht zuverlässig beurteilt werden. Aus diesem Grund hat das Sächsische Staatsministerium für Soziales und Verbraucherschutz (SMS) eine Studie in Auftrag gegeben, um die erforderlichen Daten- und Informationsgrundlagen für eine objektive Einschätzung der Hebammenversorgung in Sachsen zu erhalten. Redaktionsschluss: 01.04.201

Predicting dementia in primary care patients with a cardiovascular health metric: a prospective population-based study

Background: Improving cardiovascular health possibly decreases the risk of dementia. Primary care practices offer a suitable setting for monitoring and controlling cardiovascular risk factors in the older population. The purpose of the study is to examine the association of a cardiovascular health metric including six behaviors and blood parameters with the risk of dementia in primary care patients. Methods: Participants (N = 3547) were insurants aged >= 55 of the largest German statutory health insurance company, who were enrolled in a six-year prospective population-based study. Smoking, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose were assessed by general practitioners at routine examinations. Using recommended cut-offs for each factor, the patients' cardiovascular health was classified as ideal, moderate, or poor. Behaviors and blood parameters sub-scores, as well as a total score, were calculated. Dementia diagnoses were retrieved from health insurance claims data. Results are presented as hazard ratios (HRs) and 95 % confidence intervals (95 % CIs). Results: Over the course of the study 296 new cases of dementia occurred. Adjusted for age, sex, and education, current smoking (HR = 1.77, 95 % CI 1.09-2.85), moderate (1.38, 1.05-1.81) or poor (1.81, 1.32-2.47) levels of physical activity, and poor fasting glucose levels (1.43, 1.02-2.02) were associated with an increased risk of dementia. Body mass index, blood pressure, and cholesterol were not associated with dementia. Separate summary scores for behaviors and blood values, as well as a total score showed no association with dementia. Sensitivity analyses with differently defined endpoints led to similar results. Conclusions: Due to complex relationships of body-mass index and blood pressure with dementia individual components cancelled each other out and rendered the sum-scores meaningless for the prediction of dementia

Complete genome sequences of two Helicobacter pylori strains from a Canadian Arctic Aboriginal community

We report here the complete genome sequences of two Amerind Helicobacter pylori strains from Aklavik, Northwest Territories, Canada. One strain contains extra iron-cofactored urease genes and ~140 rearrangements in its chromosome relative to other described strains (typically differing from one another by <10 rearrangements), suggesting that it represents a novel lineage of H. pylori

Development of a Sandwich ELISA to Measure Exposure to Occupational Cow Hair Allergens

Background: Cow hair and dander are important inducers of occupational allergies in cattle-exposed farmers. To estimate allergen exposure in farming environments, a sensitive enzyme immunoassay was developed to measure cow hair allergens. Methods: A sandwich ELISA was developed using polyclonal rabbit antibodies against a mixture of hair extracts from different cattle breeds. To assess the specificity of the assay, extracts from other mammalian epithelia, mites, molds and grains were tested. To validate the new assay, cow hair allergens were measured in passive airborne dust samples from the stables and homes of farmers. Dust was collected with electrostatic dust fall collectors (EDCs). Results: The sandwich ELISA was found to be very sensitive (detection limit: 0.1 ng/ml) and highly reproducible, demonstrating intra-and interassay coefficients of variation of 4 and 10%, respectively. The assay showed no reactivity with mites, molds and grains, but some cross-reactivity with other mammalian epithelia, with the strongest reaction with goat. Using EDCs for dust sampling, high concentrations of bovine allergens were measured in cow stables (4,760-559,400 mu g/m(2)). In addition, bovine allergens were detected in all areas of cattle farmer dwellings. A large variation was found between individual samples (0.3-900 mu g/m(2)) and significantly higher values were discovered in changing rooms. Conclusion: The ELISA developed for the detection of cow hair proteins is a useful tool for allergen quantification in occupational and home environments. Based on its low detection limit, this test is sensitive enough to detect allergens in passive airborne dust. Copyright (C) 2011 S. Karger AG, Base