The Montreal Cognitive Assessment (MoCA) in a population-based sample of Turkish migrants living in Germany.

OBJECTIVES: Data on cognitive testing in migrants in Germany are scarce. We aimed to evaluate the Montreal Cognitive Assessment (MoCA) in Turkish migrants in Berlin and its association with demographics and health-related variables. METHOD: For this cross-sectional study, a random sample of persons with Turkish names was drawn from the registration-office. Cognitive function was assessed using the MoCA; 0 = worst, 30 = best total score. Multivariable linear regression models were calculated to determine associated factors with the total MoCA-score. RESULTS: In our analyses we included 282 participants (50% female), mean age 42.3 ± 11.9 years (mean ± standard deviation (SD)). The mean ± SD MoCA score was 23.3 ± 4.3. In the multivariable analysis, higher education (ß = 2.68; p < 0.001), and chosing the German version of the MoCA (ß = -1.13; p = 0.026), were associated with higher MoCA-scores, whereas higher age (ß = -0.08; p = 0.002) was associated with lower MoCA scores. CONCLUSION: In our study, a higher educational level, lower age, and German as the preferred test language (as compared to Turkish) were positively associated with the cognitive performance of Berliners with Turkish roots. To examine neurocognitive health of migrants, longitudinal population-based and clinical cohort studies that specifically compare migrants and their descendants with the original population of their home countries are required.

Participation of Turkish Migrants in an Epidemiological Study: Does the Recruitment Strategy Affect the Sample Characteristics?

Migrants are often poorly represented in epidemiological studies which limits the generalizability of the results of population-based studies. This study aimed to assess whether a community-based sampling (CBS) of persons of Turkish origin leads to differences in the participants' characteristics compared to a register-based sampling (RBS). The two sampling strategies were used to recruit participants in three cities in Germany (CBS: n = 641; RBS: n = 578). We compared sociodemographic, migration- and health-related characteristics. Census data were used as an external reference. Lower German language skills and a lower acculturation status were more prevalent in the CBS than in the RBS. While age and sex adjusted obesity prevalence differed [CBS: 37.8 (33.6-42.4); RBS 30.0 (26.3-34.0); census data 19.1 (18.2-20.1)], most other health indicators were similar across the samples. In conclusion, the CBS approach led to a greater representation of persons of Turkish origin with lower language skills and lower acculturation status. Nevertheless, both recruitment strategies provided similar estimates of health status indicators.

Improving the inclusion and participation of children and adolescents with a migration background in KiGGS Wave 2.

In the context of health monitoring at the Robert Koch Institute, the baseline study of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) surveyed a sample of children and adolescents with a migration background according to their share within the general population through extensive measures. Owing to less comprehensive efforts, this was not accomplished in the follow-up KiGGS Wave 1 study. For KiGGS Wave 2, the objective therefore was, through targeted measures, to increase the willingness of children and adolescents with a migration background to participate in the survey. This article describes the approaches to include children and adolescents with a migration background, the operationalisation of migration-specific variables and the effectiveness of field visits prior to the actual survey as a tool to increase the willingness of these groups to participate in the survey. Furthermore, data on participation and the sample of children and adolescents with a migration background in the cross-sectional KiGGS Wave 2 study is presented. Overall, 2,994 children with a migration background aged 0 to 17 years took part in KiGGS Wave 2. In the weighted sample this corresponds to 11.8% (n=1,436) with a one-sided and 17.0% (n=1,558) with a two-sided migration background. In sum, the share of children and adolescents surveyed with a migration background (28.8%) is almost that of their share in Microcensus 2013 (31.2%). Compared to children and adolescents without a migration background, barely any differences exist in age and gender distribution, while differences are seen regarding social status; children with a two-sided migration background are significantly more often found in the low social status group. In the sample, the most often represented countries of origin were the countries of Central and South Europe, of the former Soviet Union and Turkey. Regarding the length of time parents had lived in Germany, around 40.1% of migrant families have been living in the country for over 20 years, whereas nearly one in five families has been in Germany for less than five years. A total of 12.2% of children and adolescents with a migration background migrated themselves. By implementing a comprehensive set of measures, the degree after weighting to which children and adolescents with a migration background were included in KiGGS Wave 2 is nearly commensurate to their share in the overall population.

Health and healthcare provision to asylum seekers and refugees in Germany.

The wars and devastation of recent years have driven many people to flee their homes. Great numbers of asylum seekers and refugees have sought protection in Europe. In 2015 and 2016 alone, over one million people applied for asylum in Germany. This has posed a great challenge for Germany's healthcare provision facilities. The health of asylum seekers and refugees and the provision of their healthcare is therefore an important issue in terms of public health. The first part of this article describes the extent and legal framework of immigration to Germany during the past two years. The second part then discusses the issue of health and medical care for asylum seekers and refugees. Until now, no representative data on the health of this population exists. Studies so far have all relied on a small number of cases and been limited to particular regions and are therefore hard to compare. Moreover, there are no sufficiently standardised medical examinations during initial reception across all German federal states. Relevant findings suggest an urgent need to take action in the fields of mental health, chronic diseases and the provision of care to children of asylum seekers. A review of the data available proves the need for a national and systematic collection of valid data as a basis for adequate preventive and medical care. Different initiatives currently aim to improve the data collection basis in Germany. Over time, these new initiatives will significantly improve the data available on the health situation of asylum seekers and refugees in Germany. Once politics and broader society take these findings into account, this should contribute to an objective debate and evidence-based decisions.

Comparing sampling strategies to recruit migrants for an epidemiological study. Results from a German feasibility study.

BACKGROUND: In 2011, almost 20.0% of the population of Germany had a migration background. Studies on their health tend to have low participation rates. The aim of our study was to compare different sampling strategies and to test different approaches to recruit migrants for an epidemiological study. METHODS: Four recruitment centres of the German National Cohort recruited persons of Turkish origin and ethnic German immigrants from former Soviet Union countries. A register-based (random samples from residents' registration offices) and a community-orientated strategy were applied. Participants underwent a medical examination and self-completed a questionnaire. RESULTS: Used approaches: The community-orientated strategies comprised the acquisition of key persons from migrant networks to support the recruitment, invitation talks and distribution of study materials in migrant settings, etc. The identifying variables in the registry data were name, nationality or country of birth. All but one centres used bilingual study material and study staff. PARTICIPATION: When comparing the two strategies, the register-based participation rates ranged from 10.1 to 21.0% (n = 668 participants) and the community-oriented recruitment resulted in 722 participants. CONCLUSION: Register-based recruitment should use a combination of name, nationality and country of birth in order not to be limited to identifying persons with a foreign nationality. However, according to the study staff, the community-oriented approach involving key persons of the same cultural background leads to a better acceptance by the participants. Also, it covers a more heterogeneous group. Yet, it is time-consuming and needs considerably more staff. Further research should establish the effectiveness of a combination of both strategies.