Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study.

BACKGROUND: Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. METHODS: In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. RESULTS: Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups. CONCLUSIONS: Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.

[Postal Survey Among Women With Turkish Migration Background in Germany - Identification, Sample Revision and Response in the InEMa Study]. / Postalische Befragung von Frauen mit türkischem Migrationshintergrund ­ Identifizierung, Stichprobenbereinigung und Response im Rahmen der InEMa-Studie.

AIM OF THE STUDY: Migrants are an important target group for mailed surveys but also difficult to reach. For planning these surveys and invitational health measures, we assessed response figures for women with and without Turkish migration background. METHODS: Women aged 50 years living in Westphalia-Lippe were invited to a postal survey at 2 time points about mammography screening. Turkish migrant women were identified in the contact database by a name-based algorithm. Possible differences in sample revision and response among women with and without Turkish migration background were assessed. RESULTS: Women with Turkish migration background had unknown addresses significantly more often (4.6 vs. 1.7%) and responded to the questionnaires less often (first questionnaire: 14.3 vs. 35.9%; second questionnaire: 70.7 vs. 85.6%). CONCLUSIONS: For postal invitation to participate in healthcare measures, or recruitment of Turkish migrants for studies, differences in current address and readiness to respond must be taken into consideration.

Determinants of mammography screening participation among Turkish immigrant women in Germany--a qualitative study reflecting key informants' and women's perspectives.

Mammography screening programmes aiming to reduce mortality from breast cancer are implemented in most European countries. Immigrant women are less likely to participate than women of the respective autochthonous populations in several European countries but not in Germany. Qualitative, semi-structured interviews were conducted with 16 key informants and 10 Turkish immigrant women aged 50-69 years to analyse the factors influencing their screening participation in Germany. Interviews were analysed using summarising content analysis. The Theory of Planned Behaviour was used for structuring the results. Key informants stated poor German language skills and insufficient knowledge about breast cancer and screening as factors influencing screening participation. Immigrant women demonstrated basic knowledge about screening, but their attitudes towards screening varied. Information from the invitation letter of the screening programme was often filtered by family members. Key informants tended to emphasise barriers and system-related factors while the Turkish women focused more on factors on the individual level. Contrasting both perspectives is helpful for health professionals to critically assess their own views. Measures to improve screening participation need to address not only barriers but also take women's attitudes and norms into account, thus helping women to make an informed decision.

[Identification and characterisation of health behaviours in 11- to 17-year-old adolescents: a cluster analysis based on the german health interview and examination survey for children and adolescents]. / Identifizierung und Charakterisierung von Gesundheitsverhaltenstypen bei 11- bis 17-Jährigen Jungen und Mädchen--Eine Clusteranalyse auf Basis der Daten des Kinder- und Jugendgesundheitssurveys (KiGGS).

BACKGROUND: Negative patterns of health behaviour regarding health are developed and solidified internalised in adolescence. In later years, they can lead to diseases which contribute to a high burden of disease, reduced quality of life and premature mortality in later years. The purpose of this analysis is the identification of clusters with different health behavioural types and the characterisation of cluster membership on the basis of different socio-economic and socio-demographic factors. METHODS: Based on the dataset of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), 6,813 adolescents aged between 11 and 17 years were included in the identification of the clusters by a 2-step cluster analysis. Subsequent to the discriminant analysis for testing the stability and validity of the cluster solutions, the associations between cluster membership and possible determinants were evaluated by binary logistic analysis. RESULTS: After that adolescents aged 11-13 years could be merged to 5 clusters, whilst adolescents aged 14-17 years could be merged to 3 clusters. In both age groups, clusters manifesting tendencies conducive to and clusters manifesting tendencies not conducive to health promotion could be identified. In these clusters, the strongest association between cluster membership and the determining factors (e. g., smoking status of friends, health status) could be found. Primarily responsible for cluster generation were physical activity as well as tobacco and alcohol consumption. CONCLUSION: The results of this analysis--especially the identification of clusters based on adolescents with behavioural patterns unconducive to long-term health--represent a contribution to creating interventions specific to target groups with regard to preventative education and health promotion.

[Improved opportunities for the identification of people with a migrant background for mortality research using the example of Bremen]. / Verbesserte Möglichkeiten zur Identifikation von Menschen mit Migrationshintergrund für die Mortalitätsforschung am Beispiel Bremens.

BACKGROUND: 19.6% of Germany's population has a "migrant" background. Comprehensive epidemiological research on health and health development of this large, heterogeneous and increasingly important population group in Germany is still deficient. There is a lack of results on mortality and morbidity, particularly concerning chronic diseases and disease processes. OBJECTIVE: The aim of this paper is to combine and to compare already applied methods with new methodological approaches for determining the vital status and the mortality of immigrants from Turkey and the former Soviet Union. METHODS: For this purpose we used data from the state of Bremen (666 709 residents, last update 2010). We examined 2 methodological aspects: (i) possibilities for identifying immigrant background in the data of residents' registration office with different methods (onomastic, toponomastic, etc.) and (ii) opportunities for record linkage of the obtained data with the Bremen mortality index. RESULTS: Immigrants from Turkey and the former Soviet Union were successfully identified in databases of the residents' registration office by a combination of different methods. The combination of different methodological approaches proved to be considerably better than using one method only. Through the application of a name-based algorithm we found that Turkish immigrants comprise 6.9% of the total population living in Bremen. By combining the variables "citizenship" and "country of birth" the total population proportion of immigrants from the former Soviet Union was found to be 5%. We also identified the deceased immigrant population in Bremen. The information obtained from residents' registration office could be successfully linked by death register number with the data of the Bremen mortality index. This information can be used in further detailed mortality analyses. CONCLUSION: The results of this analysis show the existing opportunities to consider the heterogeneity of the German population in mortality research, especially by means of combination of different methods to identify the immigrant background.

[Identification and sampling of people with migration background for epidemiological studies in Germany]. / Identifizierung und Rekrutierung von Menschen mit Migrationshintergrund für epidemiologische Studien in Deutschland.

In 2009, 19.6% of the population of Germany either had migrated themselves or were the offspring of people with migration experience. Migrants differ from the autochthonous German population in terms of health status, health awareness and health behaviour. To further investigate the health situation of migrants in Germany, epidemiological studies are needed. Such studies can employ existing databases which provide detailed information on migration status. Otherwise, onomastic or toponomastic procedures can be applied to identify people with migration background. If migrants have to be recruited into an epidemiological study, this can be done register-based (e. g., data from registration offices or telephone lists), based on residential location (random-route or random-walk procedure), via snowball sampling (e. g., through key persons) or via settings (e. g., school entry examination). An oversampling of people with migration background is not sufficient to avoid systematic bias in the sample due to non-participation. Additional measures have to be taken to increase access and raise participation rates. Personal contacting, multilingual instruments, multilingual interviewers and extensive public relations increase access and willingness to participate. Empirical evidence on 'successful' recruitment strategies for studies with migrants is still lacking in epidemiology and health sciences in Germany. The choice of the recruitment strategy as well as the measures to raise accessibility and willingness to participate depend on the available resources, the research question and the specific migrant target group.

[The use of routine data to study rehabilitative care in populations with a migrational background: potential and limitations]. / Die Nutzung von Routinedaten in der rehabilitationswissenschaftlichen Versorgungsforschung bei Menschen mit Migrationshintergrund: Möglichkeiten und Grenzen.

OBJECTIVE: Little is known about the rehabilitative care of populations with a migrational background. Using the assessment of rehabilitation effectiveness as an example, we outline the potentials and limitations routine data from social security carriers has for this research field. METHODS: We draw on an 80% random sample of all completed medical rehabilitations in the year 2006 funded by the German Statutory Pension Insurance Scheme (n=634 529). The assessment of rehabilitation effectiveness was based on the occupational performance at the time the rehabilitation was completed. Migrational background was defined by nationality. By means of logistic regression adjusted for socio-economic/-demographic and health-related variables, we examine whether rehabilitation effectiveness differs between German and non-German nationals. RESULTS AND DISCUSSION: Non-German nationals have a higher chance of completing medical rehabilitation with a lower occupational performance - irrespective of differences in socio-economic/-demographic and health-related variables. Odds ratios for a lower rehabilitation effectiveness were 1.23 [95%-CI=1.16;1.30] for Turkish nationals and 1.47 [95%-CI=1.38;1.56] for persons from the former Yugoslavia. Different aspects limit the validity of the analysis. (1) By using nationality, only a selection of all persons with a migrational background can be identified. (2) Important covariates cannot be considered. (3) The assessment of rehabilitation effectiveness is inaccurate, because valid data on occupational performance prior to rehabilitation is missing. CONCLUSION: Similar to routine data from other social security carriers, data from the German Statutory Pension Insurance Scheme has limitations for health services research on populations with a migrational background. Solutions comprise the application of computer-aided procedures for an accurate operationalisation of migrational background and the use of survey data for a valid assessment of rehabilitation effectiveness.

[Need for nursing care among infants of Turkish and non-Turkish origin. An analysis of registry data of the medical service of the statutory health insurance in Westphalia-Lippe, Germany, 2004-2008]. / Pflegebedürftigkeit bei türkischstämmigen und -nicht-türkischstämmigen Säuglingen. Eine Analyse der Pflegegutachten des MDK Westfalen-Lippe von 2004 bis 2008.

BACKGROUND AND AIM: Infants of mothers with an immigrant background experience poorer health outcomes than infants in Germany as a whole. The aim of this study was to investigate whether differences exist in diagnoses leading to long-term nursing care among infants of Turkish vs. non-Turkish background. METHODS: We analysed records of the medical service of the statutory health insurance of the region Westphalia-Lippe, 2004-2008. We used a name algorithm to identify cases with Turkish migrant background. RESULTS: There were 1 107 applications for long-term nursing care, 141 of which concerned infants of Turkish origin. "Inborn malformations, deformities and chromosomal abnormities" was more often the reason for application among non-Turkish infants, "Certain conditions which have their origin in the perinatal period" were twice as common among Turkish as compared to non-Turkish infants. CONCLUSIONS: Our results do not support the -assumption that mothers of Turkish origin more often apply for long-term nursing care due to malformations of their infant than other mothers.

[Linkage of data of the medical service of the health insurances with data of a cancer registry]. / Abgleich von Verwaltungsdaten des Medizinischen Dienstes der Krankenversicherung mit Krebsregisterdaten.

BACKGROUND: The aim of this study was to examine whether a linkage of data sets of the Epidemiological Cancer Registry North Rhine-Westphalia (EKR-NRW) and the Medical Service of the Health Insurances (MDK WL) is feasible, which problems may occur during execution and what could be a solution strategy. METHODS: Data of the EKR-NRW were used to identify all cancer cases in the district of Munster, for which an expert opinion regarding nursing needs from the period 2004-2008 was available at the MDK WL. For this purpose factually anonymised data of the EKR-NRW and the MDK WL were linked by means of a semi-automatic probabilistic record linkage. RESULTS: Data linkage yielded 18 877 cancer cases but required great technical and temporal input. The processing of management data and the use of "routine channels" (ISDN connection), which provide the necessary safety for data transfer, but are designed for a considerably smaller amount of data, accounted for this. The interface problem (converting data from text format to a hierarchical XML format) can be solved with Excel or SAS. CONCLUSION: A record linkage with factually anonymised data from the MDK WL and the EKR-NRW is feasible. This allows, among other things, quantifying the needs for nursing care in persons with a cancer diagnosis.

[Socioeconomic aspects of primary obesity prevention for children and adolescents. A life-course perspective on obesity development and prevention]. / Sozioökonomische Aspekte der Primärprävention von Adipositas bei Kindern und Jugendlichen. Ansatzpunkte vor dem Hintergrund eines lebenslaufbasierten Ansatzes der Adipositasentstehung.

Socioeconomic inequalities in obesity have been reported in a variety of studies. Social determinants and processes affecting the development of obesity need to be investigated to better explain these socioeconomic differences. In this context, a life-course perspective on health inequalities particularly in critical or sensitive periods of obesity development is conducive. Socioeconomic-sensitive primary prevention of obesity might allow obesity risks to be influenced by adequate, target group-specific and setting-based interventions in specific critical time periods from pregnancy to adolescence. Future research is necessary to gain a deeper understanding of the mechanisms of health inequalities and obesity risks, resulting in prevention programs which aim at a sustainable and long-term reduction of obesity risk and include obesity-relevant social factors during the life-course.

[Name-based identification of cases of Turkish origin in the childhood cancer registry in Mainz]. / Namensbasierte Identifizierung von Fällen mit türkischer Herkunft im Kinderkrebsregister Mainz.

Until now few analyses of routine data relating to the health of migrants have been conducted in Germany. A major obstacle is that most data sources do not provide reliable information on the origin of migrants. While some sources contain the nationality of persons registered, this information does not allow one to identify migrants who have taken up German citizenship, i.e., a substantial part of second-generation migrants. In this paper we demonstrate how a computer-aided, name-based algorithm can be used to identify persons of Turkish origin in the German Childhood Cancer Registry in Mainz, Germany. The performance of the algorithm, as assessed against the gold standard of assessing names manually, was very good (sensitivity and specificity > or = 0.975). In total, we identified 1774 of the 37,259 cases in the registry as being of Turkish origin. The name algorithm proved to be a useful tool to identify Turkish migrants in routine data sources, thus avoiding potential bias due to changes in citizenship. This approach aims at improving migrant-sensitive health reporting and research in Germany. In future, additional information on migrant status should be obtained already during primary data collection so that health data for all migrant groups can be provided.

3D Printing of Intracranial Aneurysms Using Fused Deposition Modeling Offers Highly Accurate Replications.

BACKGROUND AND PURPOSE: As part of a multicenter cooperation (Aneurysm-Like Synthetic bodies for Testing Endovascular devices in 3D Reality) with focus on implementation of additive manufacturing in neuroradiologic practice, we systematically assessed the technical feasibility and accuracy of several additive manufacturing techniques. We evaluated the method of fused deposition modeling for the production of aneurysm models replicating patient-specific anatomy. MATERIALS AND METHODS: 3D rotational angiographic data from 10 aneurysms were processed to obtain volumetric models suitable for fused deposition modeling. A hollow aneurysm model with connectors for silicone tubes was fabricated by using acrylonitrile butadiene styrene. Support material was dissolved, and surfaces were finished by using NanoSeal. The resulting models were filled with iodinated contrast media. 3D rotational angiography of the models was acquired, and aneurysm geometry was compared with the original patient data. RESULTS: Reproduction of hollow aneurysm models was technically feasible in 8 of 10 cases, with aneurysm sizes ranging from 41 to 2928 mm(3) (aneurysm diameter, 3-19 mm). A high level of anatomic accuracy was observed, with a mean Dice index of 93.6% ± 2.4%. Obstructions were encountered in vessel segments of <1 mm. CONCLUSIONS: Fused deposition modeling is a promising technique, which allows rapid and precise replication of cerebral aneurysms. The porosity of the models can be overcome by surface finishing. Models produced with fused deposition modeling may serve as educational and research tools and could be used to individualize treatment planning.

Differences in the Incidence of Gestational Diabetes between Women of Turkish and German Origin: An Analysis of Health Insurance Data From a Statutory Health Insurance in Berlin, Germany (AOK), 2005-2007.

Background: Gestational diabetes increases the risk of maternal and infant complications and long-term health effects. A study of differences in the incidence of gestational diabetes between women of Turkish and German origin can identify high risk groups and may indicate the need for culturally sensitive diabetes information and treatment during pregnancy. Method: We analysed all pregnancy related health insurance data from the AOK Berlin (a statutory health insurance in Berlin) based on data from 2005 to 2007, using a name algorithm to identify cases with Turkish migrant background. A group of German women insured with the AOK Berlin served as a comparison group. Results: After exclusion of miscarriages and multiple births the data set comprised 3338 pregnancies in total. The incidence of gestational diabetes was significantly higher in women of Turkish origin with 183 per 1000 pregnancies than in German women (138 per 1000 pregnancies). Regression analyses showed that women of Turkish origin with obesity were at the highest risk of gestational diabetes (OR = 2.67; 95 % confidence interval 1.97-3.60). Conclusion: Obesity is an important factor in explaining the higher incidence of gestational diabetes in women of Turkish origin, especially among young Turkish women. These findings should stimulate discussion as to whether or not information about risk factors such as diabetes within the scope of prenatal care adequately addresses the needs of migrant women. Further research is needed to identify potential differences in undetected and primarily in insufficiently treated gestational diabetes between Turkish and German women.