Inequalities in realised access to healthcare among recently arrived refugees depending on local access model: study protocol for a quasi-experimental study

Wenner J, Rolke K, Breckenkamp J, Sauzet O, Bozorgmehr K, Razum O. Inequalities in realised access to healthcare among recently arrived refugees depending on local access model: study protocol for a quasi-experimental study. BMJ Open. 2019;9(5): e027357.In many countries, including Germany, newly arriving refugees face specific entitlement restrictions and access barriers to healthcare. While entitlement restrictions apply to all refugees who seek protection in Germany during the first months, the barriers to access depend on the model that the states and the municipalities implement locally. Currently, two different models exist: the healthcare voucher model (HcV) and the electronic health card model (eHC). The aim of the study is to analyse the consequences of these two different access models on newly arrived refugees’ realised access to healthcare. Methods and analysis The random assignment of refugees to municipalities allows for a quasi-experimental design by comparing realised access to healthcare among refugees in six municipalities in North Rhine-Westphalia which have implemented HcV or eHC. We compare realised access to healthcare using ambulatory care sensitive conditions and health expenditure as outcome indicators, and use of emergency care, preventive care, psychotherapeutic or psychiatric care, and of therapeutic devices as process indicators. Results will be adjusted for aggregated information on age, sex, socioeconomic structure of the municipalities and density of general practitioners or specialists. Ethics and dissemination We cooperated with local welfare offices and the statutory health insurance for data collection. Thereby, we were able to avoid recruiting large numbers of refugee patients immediately after arrival while their access and entitlement to healthcare are restricted. We developed an extensive data protection concept and ensured that all data collected are fully anonymised. Results will be published in peer-reviewed journals and summarised in reports to the funding agency.</jats:sec

Zooplankton standing stock and community size structure within the epipelagic zone: a comparison between the central Red Sea and the Gulf of Aden

Standing stock and size composition of the zooplankton comunity (>100 μm) were studied in four depth strata of the upper 200 m of the water column during a “Meteor” cruise to the central Red Sea and Gulf of Aden in spring 1987. The central Red Sea was divided into a northern area of higher salinity and a less saline southern part. Both areas exhibited significant differences in zooplankton abundance and standing stock. The latter increased by the ratio 1:2:3 from the northern central Red Sea to its southern part and further south to the Gulf of Aden. For size structure analysis samples were fractionated into three size classes (100 to 300, 300 to 500, 500 to 5000 μm). In the central Red Sea the smallest size was dominant whereas in the Gulf of Aden the largest size fraction played a greater relative role than in the central Red Sea. This shift in size structure of the zooplankton community from the Red Sea to the Gulf of Aden is apparently primarily related to ecosystem difference between both areas, leading to a change in species composition. In addition, size reduction of individual species common to both seas may be of some significance in the extreme environment of the Red Sea

Safety of thalidomide in newly diagnosed elderly myeloma patients: a meta-analysis of data from individual patients in six randomized trials

Treatment with melphalan-prednisone-thalidomide improves the outcome of patients with multiple myeloma and is now considered a standard of care for patients not eligible for transplantation. However, this treatment is a major source of morbidity. A meta-analysis of data from individual patients (n=1680) in six randomized trials was performed, comparing the effects of melphalan-prednisone-thalidomide versus melphalan-prednisone. The main objective was to estimate the risk of serious adverse events and their impact on outcome. The primary endpoints were the 2-year cumulative incidence of grade 3-4 hematologic and non-hematologic toxicities. At least 75% of the grade 3-4 toxicities occurred during the first 6 months of treatment in both treatment groups. The cumulative incidence of grade 3-4 hematologic toxicities was higher in the melphalan-prednisone-thalidomide group than in the melphalan-prednisone group (28% versus 22%; HR 1.32, 95% CI 1.05-1.66) as was the cumulative incidence of non-hematologic toxicities (39% versus 17%, HR 2.78, 95% CI 2.21-3.50). Grade 3-4 non-hematologic toxicities were significantly increased in patients with poor Performance Status. Occurrence of grade 3-4 non-hematologic toxicities had a negative impact on both progression-free survival (HR 1.24, 95% CI 1.07-1.45) and overall survival, (HR 1.23, 95% CI 1.03-1.47). Besides toxicities, progression-free and overall survival were also negatively affected by advanced International Staging System stage, high creatinine levels and poor Performance Status. Age had a negative impact on survival as well. Although melphalan-prednisone-thalidomide improved outcome, it increased toxicities, especially non-hematologic ones. Serious non-hematologic toxicities, older age, poor Performance Status, and high creatinine levels negatively affected survival