Measurement of the 171Tm beta spectrum.

The beta spectrum of the main transition of the ß- decay of 171Tm was measured using a double focalizing spectrometer. The instrument was lately improved in order to reduce its low energy threshold to 34 keV. We used the spectrometer to measure the beta spectrum end-point energy of the main transition of 171Tm decay using the Kurie plot formalism. We report a new value of 97.60(38) keV, which is in agreement with previous measurements. In addition, the spectrum shape was compared with the ξ-approximation calculation where the shape factor is equal to 1 and good agreement was found between the theory and the measurement at the 1% level.

Interventions to Increase the Reachability of Migrants in Germany With Health Interview Surveys: Mixed-Mode Feasibility Study.

BACKGROUND: Germany is a popular destination for immigrants, and migration has increased in recent years. It is therefore important to collect reliable data on migrants' health. The Robert Koch Institute, Berlin, Germany, has launched the Improving Health Monitoring in Migrant Populations (IMIRA) project to sustainably integrate migrant populations into health monitoring in Germany. OBJECTIVE: One of IMIRA's objectives is to implement a feasibility study (the IMIRA survey) that focuses on testing various interventions to increase the reachability of migrants with health interview surveys. Possible causes of nonresponse should be identified so as to increase participation in future surveys. METHODS: The survey target populations were Turkish, Polish, Romanian, Syrian, and Croatian migrants, who represent the biggest migrant groups living in Germany. We used probability sampling, using data from the registration offices in 2 states (Berlin and Brandenburg); we randomly selected 9068 persons by nationality in 7 sample points. We applied age (3 categories: 18-44, 45-64, and ≥65 years) and sex strata. Modes and methods used to test their usability were culturally sensitive materials, online questionnaires, telephone interviews, personal contact, and personal interviews, using multilingual materials and interviewers. To evaluate the effectiveness of the interventions, we used an intervention group (group A) and a control group (group B). There were also focus groups with the interviewers to get more information about the participants' motivation. We used the European Health Interview Survey, with additional instruments on religious affiliation, experience of discrimination, and subjective social status. We evaluated results according to their final contact result (disposition code). RESULTS: We collected data from January to May 2018 in Berlin and Brandenburg, Germany. The survey had an overall response rate of 15.88% (1190/7494). However, final disposition codes varied greatly with regard to citizenship. In addition to the quantitative results, interviewers reported in the focus groups a "feeling of connectedness" to the participants due to the multilingual interventions. The interviewers were particularly positive about the home visits, because "if you are standing at the front door, you will be let in for sure." CONCLUSIONS: The IMIRA survey appraised the usability of mixed-mode or mixed-method approaches among migrant groups with a probability sample in 2 German states. When conducting the survey, we were confronted with issues regarding the translation of the questionnaire, as well as the validity of some instruments in the survey languages. A major result was that personal face-to-face contact was the most effective intervention to recruit our participants. We will implement the findings in the upcoming health monitoring study at the Robert Koch Institute.

Interventions to Increase the Reachability of Migrants in Germany With Health Interview Surveys: Mixed-Mode Feasibility Study.

BACKGROUND: Germany is a popular destination for immigrants, and migration has increased in recent years. It is therefore important to collect reliable data on migrants' health. The Robert Koch Institute, Berlin, Germany, has launched the Improving Health Monitoring in Migrant Populations (IMIRA) project to sustainably integrate migrant populations into health monitoring in Germany. OBJECTIVE: One of IMIRA's objectives is to implement a feasibility study (the IMIRA survey) that focuses on testing various interventions to increase the reachability of migrants with health interview surveys. Possible causes of nonresponse should be identified so as to increase participation in future surveys. METHODS: The survey target populations were Turkish, Polish, Romanian, Syrian, and Croatian migrants, who represent the biggest migrant groups living in Germany. We used probability sampling, using data from the registration offices in 2 states (Berlin and Brandenburg); we randomly selected 9068 persons by nationality in 7 sample points. We applied age (3 categories: 18-44, 45-64, and ≥65 years) and sex strata. Modes and methods used to test their usability were culturally sensitive materials, online questionnaires, telephone interviews, personal contact, and personal interviews, using multilingual materials and interviewers. To evaluate the effectiveness of the interventions, we used an intervention group (group A) and a control group (group B). There were also focus groups with the interviewers to get more information about the participants' motivation. We used the European Health Interview Survey, with additional instruments on religious affiliation, experience of discrimination, and subjective social status. We evaluated results according to their final contact result (disposition code). RESULTS: We collected data from January to May 2018 in Berlin and Brandenburg, Germany. The survey had an overall response rate of 15.88% (1190/7494). However, final disposition codes varied greatly with regard to citizenship. In addition to the quantitative results, interviewers reported in the focus groups a "feeling of connectedness" to the participants due to the multilingual interventions. The interviewers were particularly positive about the home visits, because "if you are standing at the front door, you will be let in for sure." CONCLUSIONS: The IMIRA survey appraised the usability of mixed-mode or mixed-method approaches among migrant groups with a probability sample in 2 German states. When conducting the survey, we were confronted with issues regarding the translation of the questionnaire, as well as the validity of some instruments in the survey languages. A major result was that personal face-to-face contact was the most effective intervention to recruit our participants. We will implement the findings in the upcoming health monitoring study at the Robert Koch Institute.

The concept of acculturation in epidemiological research among migrant populations: A systematic review.

•Acculturation is a widely used concept in epidemiological research.•There are various ways to measure acculturation using proxies or scales; often an acculturation score is calculated.•Studies often show inconsistencies in operationalization and measurement of the concept of acculturation.•The exact outcome is often unclear; this creates a lack of comparability, generalizability and transferability of the results.•Health relevant proxies such as language skills or feeling of belonging should be measured without calculating a score.

Improving the information base regarding the health of people with a migration background.Project description and initial findings from IMIRA.

Germany is an immigration country and nearly a quarter of its population has a migration background. Thus, there is increasingly a need for reliable information on the health situation of people with a migration background. The Robert Koch Institute is in charge of expanding its health monitoring to improve the representation of people with a migration background in interview and examination surveys. Studies adequately need to reflect the health status of people with a migration background and currently the Robert Koch Institute's representative interview and examination surveys for adults do not fully achieve this. At the end of 2016, therefore, the Improving Health Monitoring in Migrant Populations (IMIRA) project was initiated aiming to expand the Robert Koch Institute's health monitoring to people with migration background and improve their involvement in health surveys in the long-term. This includes carrying out two feasibility studies to test strategies to reach and recruit people with migration background for interview surveys and develop measures to overcome language barriers in examination surveys. In order to expand health reporting on migration and health, a reporting concept and a core indicator set will be developed and the potential of (secondary) data sources will be tested. Furthermore, plans foresee the testing and further development of relevant specific migration sensitive survey instruments and indicators, as well as increasing networking with relevant stakeholders.

Concepts for migration-sensitive health monitoring.

According to microcensus data, nearly one quarter of the German population has a migration background. This means that either themselves or at least one parent was born without German citizenship. Based on the currently available data and due to the underrepresentation of specific population groups, representative findings on the health of the total population residing in Germany are only possible to a limited degree. Against this backdrop, the Robert Koch Institute initiated the Improving Health Monitoring in Migrant Populations (IMIRA) project. The project aims to establish a migration-sensitive health monitoring system and to better represent people with a migration background in health surveys conducted by the Robert Koch Institute. In this context it is crucial to review and further develop relevant migration-sensitive concepts and appropriate surveying instruments. To achieve this, the concepts of acculturation, discrimination, religion and subjective social status were selected. This article theoretically embeds these concepts. Furthermore, we describe their application in epidemiology as well as provide a proposal on how to measure and operationalise these concepts. Moreover, recommendations for action are provided regarding the potential application of these concepts in health monitoring at the Robert Koch Institute.

[Time trends of occupational differences in smoking behaviour of employed men and women in Germany : Results of the 1999-2013 microcensus]. / Zeitliche Entwicklung berufsgruppenspezifischer Unterschiede im Rauchverhalten von erwerbstätigen Männern und Frauen in Deutschland : Ergebnisse des Mikrozensus 1999­2013.

BACKGROUND: Studies show that people with a low occupational status are more likely to smoke than those with a high occupational status. Against the background of a general decline in tobacco consumption, time trends of occupational differences in smoking behaviour of employed men and women in Germany were examined. METHODS: The analyses were based on the last five waves of the German microcensus that included questions about smoking (1999, 2003, 2005, 2009 and 2013), taking only employed men and women aged 18-64 years into account (n = 688,746). Information on occupational position was summarised using international classifications of occupation (ISEI-08 and ISCO-08). Raw and model-based standardized prevalence estimates of current smoking were calculated. RESULTS: Between 1999 and 2013, the proportion of smokers in the working population fell from 39.9 to 34.4% (men) and from 30.6 to 26.8% (women). Differences between occupational status groups increased significantly: while the prevalence of smoking among employees with high occupational status decreased, it remained largely stable in the low status group. In 2013, the occupations with the highest proportion of smokers were waste disposal workers, cleaning staff, unskilled workers, truck and bus drivers, salespeople and cashiers, and employees in the catering industry. CONCLUSION: Since the beginning of the 2000s, the prevalence of smoking in the working population has declined. The strengthened tobacco control policy - e. g. the establishment of smoke-free workplace laws - might have contributed to this trend. In the context of workplace health promotion, tobacco prevention and cessation measures should be targeted at those professions in which smoking is still particularly common.

[Potentials in the regionalization of health indicators using small-area estimation methods : Exemplary results based on the 2009, 2010 and 2012 GEDA studies]. / Möglichkeiten der Regionalisierung von Gesundheitsindikatoren mit Small-Area-Estimation : Exemplarische Ergebnisse auf Basis der GEDA-Studien 2009, 2010 und 2012.

Nationwide health surveys can be used to estimate regional differences in health. Using traditional estimation techniques, the spatial depth for these estimates is limited due to the constrained sample size. So far - without special refreshment samples - results have only been available for larger populated federal states of Germany. An alternative is regression-based small-area estimation techniques. These models can generate smaller-scale data, but are also subject to greater statistical uncertainties because of the model assumptions. In the present article, exemplary regionalized results based on the studies "Gesundheit in Deutschland aktuell" (GEDA studies) 2009, 2010 and 2012, are compared to the self-rated health status of the respondents. The aim of the article is to analyze the range of regional estimates in order to assess the usefulness of the techniques for health reporting more adequately. The results show that the estimated prevalence is relatively stable when using different samples. Important determinants of the variation of the estimates are the achieved sample size on the district level and the type of the district (cities vs. rural regions). Overall, the present study shows that small-area modeling of prevalence is associated with additional uncertainties compared to conventional estimates, which should be taken into account when interpreting the corresponding findings.

Corrigendum: Regional health differences - developing a socioeconomic deprivation index for Germany.

[This corrects the article on p. 98-114 in vol. 2.].

Regional health differences - developing a socioeconomic deprivation index for Germany.

For Germany, regional differences for various health indicators, which are also associated with socioeconomic factors, have been documented. This article aims to develop a regional socioeconomic deprivation index for Germany that (1) can be used to analyse regional socioeconomic inequalities in health and (2) provides a basis for explaining regional health differences in Germany. The core data stem from the INKAR (indicators and maps on spatial and urban development in Germany and Europe) database compiled by Germany's Federal Institute for Research on Building, Urban Affairs and Spatial Development. Factor analysis is used for indexing and the weighting of indicators for the three dimensions of education, occupation and income. The German Index of Socioeconomic Deprivation (GISD) is generated at the levels of associations of municipalities, administrative districts and administrative regions for the years 1998, 2003, 2008 and 2012. Aggregate data and individual data from the German Health Update 2014/2015-EHIS (GEDA 2014/2015-EHIS) study are used to analyse associations between the index and selected health indicators. For around two thirds of the causes of death, the German Index of Socioeconomic Deprivation reveals significant socioeconomic inequalities at the level of Germany's administrative regions. At district level, life expectancy in the bottom fifth of districts presenting the highest levels of deprivation is, depending on the observation period, 1.3 years lower for women and 2.6 years lower for men in comparison to the upper fifth of districts presenting the lowest levels of deprivation. The index can explain 45.5% and 62.2% of regional differences in life expectancy for women and men, respectively. Moreover, the population in regions characterised by high levels of deprivation has significantly higher rates of smokers, engages less frequently in leisure-time physical activities and is more often obese. The German Index of Socioeconomic Deprivation illustrates regional socioeconomic differences at different spatial levels and contributes to explaining regional health differences. This index is intended for use in research as well as by federal and federal state health reporting systems and should enable access to new sources of data for investigating the links between social inequalities and health in Germany.

Perceived exposure to hazardous working conditions in Germany.

Data on the prevalence of perceived exposure to hazardous working conditions were gathered for the GEDA 2014/2015-EHIS study using a simple graduated question. Approximately one-fifth of people in employment state that they face serious or very serious occupational health hazards. However, women (18.6%) are significantly less likely to have this perception than men (27.0%). The differences between women and men can be explained by the variation in working hours and by the continued gender specific division of the labour market (segregation). There are pronounced differences among men with regard to educational and vocational qualifications, with lower qualified men viewing their employment as posing a higher risk to their health than higher qualified men; no similar differences exist between women. Finally, perceived health risks are highest among women and men in the passenger and freight transport sectors. The results of this study underline the importance of occupational safety and workplace health promotion.

Time course of skeletal muscle regeneration after severe trauma.

BACKGROUND AND PURPOSE: Animal models of skeletal muscle injury should be thoroughly described and should mimic the clinical situation. We established a model of a critical size crush injury of the soleus muscle in rats. The aim was to describe the time course of skeletal muscle regeneration using mechanical, histological, and magnetic resonance (MR) tomographic methods. METHODS: Left soleus muscles of 36 Sprague-Dawley rats were crushed in situ in a standardized manner. We scanned the lower legs of 6 animals by 7-tesla MR one week, 4 weeks, and 8 weeks after trauma. Regeneration was evaluated at these times by in vivo measurement of muscle contraction forces after fast-twitch and tetanic stimulation (groups 1W, 4W, 8W; 6 per group). Histological and immunohistological analysis was performed and the amount of fibrosis within the injured muscles was determined histomorphologically. RESULTS: MR signals of the traumatized soleus muscles showed a clear time course concerning microstructure and T1 and T2 signal intensity. Newly developed neural endplates and myotendinous junctions could be seen in the injured zones of the soleus. Tetanic force increased continuously, starting at 23% (SD 4) of the control side (p < 0.001) 1 week after trauma and recovering to 55% (SD 23) after 8 weeks. Fibrotic tissue occupied 40% (SD 4) of the traumatized muscles after the first week, decreased to approximately 25% after 4 weeks, and remained at this value until 8 weeks. INTERPRETATION: At both the functional level and the morphological level, skeletal muscle regeneration follows a distinct time course. Our trauma model allows investigation of muscle regeneration after a standardized injury to muscle fibers.