An epidemiological appraisal of Berlin

Background Since the late 1950’s, a steadily increasing immigrant population in Germany is resulting in a subpopulation of aging immigrants. The German health care system needs to adjust its services—linguistically, culturally, and medically–for this subpopulation of patients. Immigrants make up over 20% of the population in Germany, yet the majority receive inadequate medical care. As many of the labor immigrants of the 1960s and 1970s are in need of hospice and palliative care (HPC), little is known about this specialized care for immigrants. This epidemiological study presents utilization of HPC facilities in Berlin with a focus on different immigrant groups. Methods A validated questionnaire was used to collect data from patients at 34 HPC institutions in Berlin over 20 months. All newly admitted patients were recruited. Anonymized data were coded and analyzed by using SPSS and compared with the population statistics of Berlin. Results 4118 questionnaires were completed and included in the analysis. At 11.4% the proportion of immigrants accessing HPC was significantly (p<0,001) below their proportion in the general Berlin population. This difference was especially seen in the age groups of 51–60 (21.46% immigrants in Berlin population, 17.7% immigrants in HPC population) and 61–70 years (16,9% vs. 13,1%). The largest ethnic groups are Turks, Russians, and Poles, with a different weighting than in the general population: Turkish immigrants were 24% of all Berlin immigrants, but only 13.6% of the study immigrant population (OR: 0.23, 95%CI: 0.18–0.29, p<0.001). Russian and Polish immigrants account for 5.6% and 9.2% in the population, but 11.5% and 24.8% in the study population respectively (Russian: OR 0.88, 95%CI: 0.66–1.16; Polish: OR 1.17, 95%CI: 0.97–1.42). Palliative care wards (PC) were used most often (16.7% immigrants of all PC patients); outpatient hospice services were used least often by immigrants (11.4%). Median age at first admission to HPC was younger in immigrants than non-immigrants: 61–70 vs. 71–80, p = 0.03. Conclusions Immigrants are underrepresented in Berlin´s HPC and immigrants on average make use of care at a younger age than non- immigrants. In this regard, Turkish immigrants in particular have the poorest utilization of HPC. These results should prompt research on Turkish immigrants, regarding access barriers, since they represent the largest immigrant group. This may be due to a lack of cultural sensitivity of the care-providers and a lack of knowledge about HPC among immigrants. In the comparison of the kinds of institutions, immigrants are less likely to access outpatient hospice services compared to PC. Apparently, PC appear to be a smaller hurdle for utilization. These results show a non-existent, but oft- cited “healthy immigrant effect” of the first generation of work immigrants, now entering old age. These findings correspond with studies suggesting increased health concerns in immigrants. Focused research is needed to promote efforts in providing adequate and fair access to HPC for all people in Berlin

Indikatoren und Methoden zur Erfassung und Bewertung von Ökosystemleistungen in metropolitanen Räumen

In diesem Beitrag wird am Beispiel eines ausgewählten metropolitanen Raums ein wissenschaftlich fundierter und zugleich praxisrelevanter Vorschlag für Indikatoren und Methoden zur Erfassung und Bewertung von Ökosystemleistungen mit Relevanz für die Flächennutzungs- und Landschaftsplanung unterbreitet. Die Forschungsfragen zielen auf geeignete Ökosystemleistungen, Indikatoren und Methoden sowie auf eine Bewertung der vorgeschlagenen Ökosystemleistungsindikatoren hinsichtlich der Datenverfügbarkeit und des Erhebungsaufwandes. Als Fallbeispiel dient der Ballungsraum Frankfurt/Rhein-Main. Das methodische Vorgehen besteht aus der Erarbeitung einer angepassten Indikatorenliste auf der Basis relevanter Vorarbeiten und einer expertenbasierten, anwendungsorientierten Evaluation. Die entwickelte Vorschlagsliste für den Ballungsraum Frankfurt/Rhein-Main umfasst insgesamt 27 Ökosystemleistungen mit jeweils einem oder mehreren Indikatoren. Die anwendungsorientierte Evaluation zeigt, dass in metropolitanen Räumen üblicherweise für fast alle Ökosystemleistungsindikatoren geeignete Daten vorliegen, die mit insgesamt moderatem, aber individuell unterschiedlichem Aufwand erhoben und bewertet werden können. Abschließend werden Empfehlungen für die Umsetzung in der Praxis gegeben.This paper presents a scientifically credible and practically relevant set of indicators and methods to assess and evaluate ecosystem services of relevance for land use and landscape planning. The research questions are (i) to identify suitable ecosystem services, indicators, and methods, and (ii) to assess the proposed indicators regarding the respective data availability and assessment effort. The region of Frankfurt/Rhein-Main (Germany) serves as the case study. The methods include the synthesis of a specifically adapted list of ecosystem services indicators based on relevant prior research and an expert-based and application-oriented evaluation. The proposed list for the region of Frankfurt/Rhein-Main contains 27 ecosystemservices, with one or more associated indicators each. The evaluation reveals that metropolitan regions in Germany usually provide sufficient data to assess almost all ecosystem services. The assessment effort differs, but is generally moderate. The paper concludes with recommendations for practical application in the Frankfurt region and beyond

Impact of process temperature and organic loading rate on cellulolytic/hydrolytic biofilm microbiomes during biomethanation of ryegrass silage revealed by genome-centered metagenomics and metatranscriptomics

Background: Anaerobic digestion (AD) of protein-rich grass silage was performed in experimental two-stage two-phase biogas reactor systems at low vs. increased organic loading rates (OLRs) under mesophilic (37 °C) and thermophilic (55 °C) temperatures. To follow the adaptive response of the biomass-attached cellulolytic/hydrolytic biofilms at increasing ammonium/ammonia contents, genome-centered metagenomics and transcriptional profiling based on metagenome assembled genomes (MAGs) were conducted. Results: In total, 78 bacterial and archaeal MAGs representing the most abundant members of the communities, and featuring defined quality criteria were selected and characterized in detail. Determination of MAG abundances under the tested conditions by mapping of the obtained metagenome sequence reads to the MAGs revealed that MAG abundance profiles were mainly shaped by the temperature but also by the OLR. However, the OLR effect was more pronounced for the mesophilic systems as compared to the thermophilic ones. In contrast, metatranscriptome mapping to MAGs subsequently normalized to MAG abundances showed that under thermophilic conditions, MAGs respond to increased OLRs by shifting their transcriptional activities mainly without adjusting their proliferation rates. This is a clear difference compared to the behavior of the microbiome under mesophilic conditions. Here, the response to increased OLRs involved adjusting of proliferation rates and corresponding transcriptional activities. The analysis led to the identification of MAGs positively responding to increased OLRs. The most outstanding MAGs in this regard, obviously well adapted to higher OLRs and/or associated conditions, were assigned to the order Clostridiales (Acetivibrio sp.) for the mesophilic biofilm and the orders Bacteroidales (Prevotella sp. and an unknown species), Lachnospirales (Herbinix sp. and Kineothrix sp.) and Clostridiales (Clostridium sp.) for the thermophilic biofilm. Genome-based metabolic reconstruction and transcriptional profiling revealed that positively responding MAGs mainly are involved in hydrolysis of grass silage, acidogenesis and/or acetogenesis. Conclusions: An integrated-omics approach enabled the identification of new AD biofilm keystone species featuring outstanding performance under stress conditions such as increased OLRs. Genome-based knowledge on the metabolic potential and transcriptional activity of responsive microbiome members will contribute to the development of improved microbiological AD management strategies for biomethanation of renewable biomass. © 2020 The Author(s)

Impairment of Immunoproteasome Function by β5i/LMP7 Subunit Deficiency Results in Severe Enterovirus Myocarditis

Proteasomes recognize and degrade poly-ubiquitinylated proteins. In infectious disease, cells activated by interferons (IFNs) express three unique catalytic subunits β1i/LMP2, β2i/MECL-1 and β5i/LMP7 forming an alternative proteasome isoform, the immunoproteasome (IP). The in vivo function of IPs in pathogen-induced inflammation is still a matter of controversy. IPs were mainly associated with MHC class I antigen processing. However, recent findings pointed to a more general function of IPs in response to cytokine stress. Here, we report on the role of IPs in acute coxsackievirus B3 (CVB3) myocarditis reflecting one of the most common viral disease entities among young people. Despite identical viral load in both control and IP-deficient mice, IP-deficiency was associated with severe acute heart muscle injury reflected by large foci of inflammatory lesions and severe myocardial tissue damage. Exacerbation of acute heart muscle injury in this host was ascribed to disequilibrium in protein homeostasis in viral heart disease as indicated by the detection of increased proteotoxic stress in cytokine-challenged cardiomyocytes and inflammatory cells from IP-deficient mice. In fact, due to IP-dependent removal of poly-ubiquitinylated protein aggregates in the injured myocardium IPs protected CVB3-challenged mice from oxidant-protein damage. Impaired NFκB activation in IP-deficient cardiomyocytes and inflammatory cells and proteotoxic stress in combination with severe inflammation in CVB3-challenged hearts from IP-deficient mice potentiated apoptotic cell death in this host, thus exacerbating acute tissue damage. Adoptive T cell transfer studies in IP-deficient mice are in agreement with data pointing towards an effective CD8 T cell immune. This study therefore demonstrates that IP formation primarily protects the target organ of CVB3 infection from excessive inflammatory tissue damage in a virus-induced proinflammatory cytokine milieu

Strengthening Health Literacy: Opportunities for cancer prevention and treatment in Tanzania

Cancer diseases pose a major challenge for countries in sub-Saharan Africa, including Tanza nia. Apart from viral infections, the growing and aging population, an increasing prevalence of risk factors such as smoking, obesity, physical inactivity, and poor nutrition are considered the main reasons for the rapid increase of cancer incidence. Against this background, health literacy (HL), defined as the ability to access, appraise, understand, and apply information for making decisions concerning healthcare, is particular important as an effective approach to cancer prevention and treatment. Low HL negatively influences cancer prevention and treat ment behaviors. This paper shows the findings of two published research papers in the context of health litera cy and cancer prevention in Tanzania and provides implications for future research studies and interventions. The content of this work deals firstly with a questionnaire-based cross sectional survey among participants of a cancer and awareness campaign (PrevACamp) from two regions in northern Tanzania. Secondly, clinical data from the visual inspection of the cervix after acetic acid application (VIA) screening are analyzed and displayed. Thirdly, a three-day cancer education training among 24 community health workers (CHW) and 16 dis pensary health care workers (DHCW) and the impact of their knowledge gain on changes in their work behavior and conduct are reported. 2,192 participants were interviewed and 2,224 received VIA screening. The main findings of the first publication were: The level of nesci ence on cervical cancer (CC) and on the human papillomavirus (HPV) regardless of education level, resident status and the number of children, as markers for HL, was generally high. Ru ral women were less likely (76%) to have attended secondary school and less likely (81%) to be employed than urban women. Over 80% of all participants attended (VIA) screening after receiving cancer education. In the second publication, a mix-method approach was used to examine a three-day cancer education training. Both groups experienced significant im provements in knowledge about CC and breast cancer: CHWs + 10% (CI 95% = 2-18%, p = 0.015) and DHCWs 24.4% (CI 95% = 13-36%, p = 0.002). The results show the association between low education and low cancer knowledge. Strength ening HL in the Tanzanian population is a necessary prerequisite for raising cancer awareness in the community, adopting prevention measures, and ultimately reducing cancer incidence and mortality. Outreach cancer prevention campaigns, oncology training, and supporting the work of multipliers in knowledge transfer are important measures to counteract the rising numbers in SSA.Krebserkrankungen werden die Länder in Sub-Sahara Afrika, einschließlich Tansania, vor eine große Herausforderung stellen. Neben Virusinfektionen gelten Bevölkerungswachstum mit einer älter werdenden Population, eine wachsende Prävalenz von Risikofaktoren wie Rauchen, Übergewicht, Bewegungsmangel und schlechte Ernährung als Hauptgründe für das zügige Ansteigen. Vor diesem Hintergrund kommt der Health Literacy (HL), definiert als die Fähigkeit Gesundheitsinformationen zu suchen, zu bewerten, zu verstehen und anzuwenden als wirksamer Ansatz in der Krebsprävention und Krebsbehandlung eine besondere Bedeutung zu. Eine geringe Health Literacy bei Krebserkrankungen können das Verhalten zur Krebsprävention und zur Krebsbehandlung negativ beeinflussen. Die vorliegende Arbeit stellt die Ergebnisse zweier publizierter Forschungsarbeiten im Kontext zu Health Literacy und Krebsprävention in Tansania vor und gibt Implikationen für weitere Forschungen und Interventionen. Inhaltlich behandelt die Arbeit erstens eine fragebogenbasierte Querschnittserhebung unter Teilnehmerinnen von Krebsvorsorge- und Aufklärungsveranstaltungen (PrevACamps) aus zwei Regionen im Norden Tansanias. Zweitens werden klinische Daten aus dem Visual inspection of the cervix after acetic acid application (VIA)-Screening ausgewertet. Drittens wird über ein dreitägiges Krebsaufklärungstraining unter 24 Community Health Worker (CHW) und 16 Dispensary Health Care Worker (DHCW) und die Auswirkung des Wissenszuwachs und Änderungen des Arbeitsverhalten der Teilnehmer*innen berichtet. Auf den PrevACamps wurden insgesamt 2192 Teilnehmerinnen befragt und 2224 erhielten ein VIA-Screening. Der Grad der Unwissenheit über Cervical Cancer (CC) und über das Humane Papilloma-Virus (HPV) unabhängig von Bildungsniveau, Wohnort und der Anzahl der Kinder als Marker für Health Literacy war hoch. Frauen auf dem Land hatten seltener (76%) eine weiterführende Schule besucht und waren seltener (81%) berufstätig als Frauen aus der Stadt. In beiden Trainingsgruppen (CHWs und DHCWs) konnte das Wissen über CC und Brustkrebs signifikant verbessert werden: CHWs 10% (CI 95% = 2-18%, p = 0,015) und DHCWs 24,4% (CI 95% = 13-36%, p = 0,002). Die Ergebnisse zeigen den Zusammenhang zwischen geringer Schulbildung und geringem Wissen über Krebserkrankungen. Die Stärkung der HL in der tansanischen Bevölkerung ist eine notwendige Voraussetzung, um das Bewusstsein für Krebserkrankungen in der Gesell schaft zu schärfen, Präventionsmaßnahmen anzunehmen und letztlich die Krebsinzidenz und -mortalität zu verringern. Krebsprävention vor Ort, onkologische Aus- und Weiterbildung sowie die Unterstützung der Arbeit von Multiplikator*innen in der Wissensvermittlung sind wichtige Maßnahmen, um den steigenden Zahlen in SSA entgegenzuwirken

End-of-life care for immigrants in Germany. An epidemiological appraisal of Berlin.

Since the late 1950's, a steadily increasing immigrant population in Germany is resulting in a subpopulation of aging immigrants. The German health care system needs to adjust its services-linguistically, culturally, and medically-for this subpopulation of patients. Immigrants make up over 20% of the population in Germany, yet the majority receive inadequate medical care. As many of the labor immigrants of the 1960s and 1970s are in need of hospice and palliative care (HPC), little is known about this specialized care for immigrants. This epidemiological study presents utilization of HPC facilities in Berlin with a focus on different immigrant groups.A validated questionnaire was used to collect data from patients at 34 HPC institutions in Berlin over 20 months. All newly admitted patients were recruited. Anonymized data were coded and analyzed by using SPSS and compared with the population statistics of Berlin.4118 questionnaires were completed and included in the analysis. At 11.4% the proportion of immigrants accessing HPC was significantly (p<0,001) below their proportion in the general Berlin population. This difference was especially seen in the age groups of 51-60 (21.46% immigrants in Berlin population, 17.7% immigrants in HPC population) and 61-70 years (16,9% vs. 13,1%). The largest ethnic groups are Turks, Russians, and Poles, with a different weighting than in the general population: Turkish immigrants were 24% of all Berlin immigrants, but only 13.6% of the study immigrant population (OR: 0.23, 95%CI: 0.18-0.29, p<0.001). Russian and Polish immigrants account for 5.6% and 9.2% in the population, but 11.5% and 24.8% in the study population respectively (Russian: OR 0.88, 95%CI: 0.66-1.16; Polish: OR 1.17, 95%CI: 0.97-1.42). Palliative care wards (PC) were used most often (16.7% immigrants of all PC patients); outpatient hospice services were used least often by immigrants (11.4%). Median age at first admission to HPC was younger in immigrants than non-immigrants: 61-70 vs. 71-80, p = 0.03.Immigrants are underrepresented in Berlin´s HPC and immigrants on average make use of care at a younger age than non-immigrants. In this regard, Turkish immigrants in particular have the poorest utilization of HPC. These results should prompt research on Turkish immigrants, regarding access barriers, since they represent the largest immigrant group. This may be due to a lack of cultural sensitivity of the care-providers and a lack of knowledge about HPC among immigrants. In the comparison of the kinds of institutions, immigrants are less likely to access outpatient hospice services compared to PC. Apparently, PC appear to be a smaller hurdle for utilization. These results show a non-existent, but oft-cited "healthy immigrant effect" of the first generation of work immigrants, now entering old age. These findings correspond with studies suggesting increased health concerns in immigrants. Focused research is needed to promote efforts in providing adequate and fair access to HPC for all people in Berlin

Questionnaire: “Basic Set of Indicators for Mapping Migrant Status”.

<p>Questionnaire: “Basic Set of Indicators for Mapping Migrant Status”.</p

Comparison of the largest immigrant groups in the Berlin population and the study population, stratified to the largest age groups.

<p>Reference group for all OR´s are their portions in the Berlin population.</p

Sociodemographic data for the entire study sample and of the different kind of institutions.

<p>Sociodemographic data for the entire study sample and of the different kind of institutions.</p

Numbers of immigrants in the study population according to land of origin.

<p>Numbers of immigrants in the study population according to land of origin.</p