[Utilization of outpatient medical services and satisfaction with care in children and adolescents with a migration background-results of the KiGGS study]. / Inanspruchnahme ambulant ärztlicher Leistungen und Zufriedenheit mit der Versorgung bei Kindern und Jugendlichen mit Migrationshintergrund ­ Ergebnisse der KiGGS-Studie.

BACKGROUND AND AIM: Reasons for lower use of medical services by children and adolescents with migration background have not yet been investigated. The aim is therefore to identify factors that are related to the utilization of outpatient medical care and subjective patient satisfaction as well as explain differences according to migration background. METHODS: On the basis of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS, baseline study: 2003-2006), in which 17,640 children and adolescents participated, prevalences with 95% confidence intervals as well as multivariate binary logistic regression analyzes on the relationship between migration background, country of origin, the use of outpatient medical care services in the last 12 months, and satisfaction with the last medical treatment were calculated. RESULTS: Children up to age 13 with two-sided migration background had lower utilization of specialist doctors compared to those without migration background (OR = 0.64 [0.56-0.74]). However, among the 14- to 17-year-olds, the utilization did not differ significantly (OR = 0.79 [0.60-1.03]). The lower use of outpatient medical care is associated with a shorter length of stay and limited German language skills. In addition, parents from Poland and the former Soviet Union are less likely to be very satisfied with the last outpatient treatment of their 0­ to 13-year-old child, even after adjustments for German language skills and length of stay. CONCLUSION: To make it easier for children with migration background to access specialist services, it is important to reduce language barriers in outpatient medical care and to promote processes of intercultural opening.

[The health status of children and adolescents with migration background in Germany : Results from KiGGS Wave 2]. / Zur gesundheitlichen Lage von Kindern und Jugendlichen mit Migrationshintergrund in Deutschland : Ergebnisse aus KiGGS Welle 2.

BACKGROUND: Even though 36.5% of children and adolescents living in Germany have a migration background (MB), data on the health of this population is scarce. With population-based data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), reliable statements can be given. METHODS: Data from KiGGS Wave 2 is used in order to report on general health status, mental health, and the distribution of allergic diseases among children and adolescents aged 3-17 years (n = 13,568). To determine overweight, standardized measurements of body weight and height (n = 3463) were used. In addition to the MB (none/one-sided/two-sided), the socioeconomic status (SES) is considered. In multivariate analyses among children and adolescents with MB, SES and the parents' duration of stay in Germany were included. RESULTS: Participants with a two-sided MB show lower prevalence of neurodermatitis (3.5% vs. 6.9%) and ADHS (2.0% vs. 5.1%) than those without a migration background and higher prevalence of fair to poor general health status (6.1% vs. 3.9%). Children and adolescents with a two-sided migration background are more often affected by overweight than those without migration background (22.1% vs. 12.2%). After considering SES, the chances of a diagnosed neurodermatitis and ADHS remain higher and the chances for overweight are lower in children and adolescents with a migration background than among those without migration background. If only children with MB are considered, SES and partially the parents' duration of stay in Germany are associated with health outcomes. CONCLUSION: Differences in the general health status of children and adolescents with and without MB vary depending on the observed indicators. The heterogeneity of children and adolescents with MB, e.g. regarding SES and parents' duration of stay, should be considered when planning and implementing measures of health promotion.

Determinants of having no general practitioner in Germany and the influence of a migration background: results of the German health interview and examination survey for adults (DEGS1).

BACKGROUND: It is aspired in the German healthcare system that general practitioners (GPs) act as initial contact for patients and guide through at all steps of medical treatment. This study aims at identifying factors associated with the odds of having no GP within the general population and especially among people with migration background. METHODS: This cross-sectional analysis was based on the "German Health Interview and Examination Survey for Adults" (DEGS1) conducted by the Robert Koch Institute. Descriptive analyses as well as multiple logistic regression models were performed to analyse the impact of a migration background, age, gender, residential area, socioeconomic status (SES) and other factors on having no GP among 7755 participants. RESULTS: 9.5% of the total study population and 14.8% of people with a migration background had no GP, especially men, adults living in big cities and without chronic diseases. The odds of not having a GP were higher for people with a two-sided migration background (aOR: 1.90, 95% CI: 1.42-2.55). Among the population with a migration background, particularly young adults, men, people living in big cities and having a private health insurance showed higher odds to have no GP. CONCLUSIONS: It is necessary to investigate the causes of the differing utilization of healthcare of people with a migration background and, if necessary, to take measures for an equal access to healthcare for all population groups. Further research needs to be done to evaluate how to get young people into contact with a GP.

Hemoglobin: a gas transport molecule that is hormonally regulated in the ovarian follicle in mice and humans.

An increasing number of nonerythroid tissues are found to express hemoglobin mRNA and protein. Hemoglobin is a well-described gas transport molecule, especially for O2, but also for NO, CO2, and CO, and also acts as a reactive oxygen species scavenger. We previously found Hba-a1 and Hbb mRNA and protein at high levels within mouse periovulatory cumulus cells, but not in cumulus following in vitro maturation. This led us to investigate the temporal and spatial regulation in follicular cells during the periovulatory period. Cumulus-oocyte complexes were collected from equine chorionic gonadotropin/human chorionic gonadotropin-treated peripubertal SV129 female mice and collected and analyzed for gene expression and protein localization at a variety of time points over the periovulatory period. A further cohort matured in vitro with different forms of hemoglobin (ferro- and ferrihemoglobin) under different O2 atmospheric conditions (2%, 5%, and 20% O2) were subsequently fertilized in vitro and cultured to the blastocyst stage. Murine mRNA transcripts for hemoglobin were regulated by stimulation of the ovulatory cascade, in both granulosa and cumulus cells, and expression of HBA1 and HBB was highly significant in human granulosa and cumulus, but erythrocyte cell marker genes were not. Several other genes involved in hemoglobin function were similarly luteinizing hormone-regulated, including genes for heme biosynthesis. Immunohistochemistry revealed a changing localization pattern of HBA-A1 protein in murine cumulus cells and oocytes following the ovulatory signal. Significantly, no positive staining for HBA-A1 protein was observed within in vitro-matured oocytes, but, if coincubated with ferro- or ferrihemoglobin, cytoplasmic HBA-A1 was observed, similar to in vivo-derived oocytes. Addition of ferro-, but not ferrihemoglobin, had a small, positive effect on blastocyst yield, but only under either 2% or 20% O2 gas atmosphere. The identification of hemoglobin within granulosa and cumulus cells poses many questions as to its function in these cells. There are several possible roles, the most likely of which is either an O2 or NO sequestering molecule; perhaps both roles are engaged. The strong endocrine regulation during the periovulatory period suggests to us that one potential function of hemoglobin is to provide a short-lived hypoxic environment by binding very tightly any available O2. This, in turn, facilitates the differentiation of the follicle towards corpus luteum formation by enabling the stabilization of a key transcription factor known to initiate such differentiation: hypoxia inducible factor.

Oxygen-regulated gene expression in murine cumulus cells.

Oxygen is an important component of the environment of the cumulus-oocyte complex (COC), both in vivo within the ovarian follicle and during in vitro oocyte maturation (IVM). Cumulus cells have a key role in supporting oocyte development, and cumulus cell function and gene expression are known to be altered when the environment of the COC is perturbed. Oxygen-regulated gene expression is mediated through the actions of the transcription factors, the hypoxia-inducible factors (HIFs). In the present study, the effect of oxygen on cumulus cell gene expression was examined following in vitro maturation of the murine COC at 2%, 5% or 20% oxygen. Increased expression of HIF-responsive genes, including glucose transporter-1, lactate dehydrogenase A and BCL2/adenovirus E1B interacting protein 3, was observed in cumulus cells matured at 2% or 5%, compared with 20% oxygen. Stabilisation of HIF1α protein in cumulus cells exposed to low oxygen was confirmed by western blot and HIF-mediated transcriptional activity was demonstrated using a transgenic mouse expressing green fluorescent protein under the control of a promoter containing hypoxia response elements. These results indicate that oxygen concentration influences cumulus cell gene expression and support a role for HIF1α in mediating the cumulus cell response to varying oxygen.

Effect of epidermal growth factor-like peptides on the metabolism of in vitro- matured mouse oocytes and cumulus cells.

Oocyte in vitro maturation (IVM) is an assisted reproductive technology that involves the maturation of cumulus-oocyte complexes (COCs) that are then capable of normal development. We have shown that epidermal growth factor (EGF)-like peptide signaling is perturbed in mouse COCs undergoing IVM when matured with follicle-stimulating hormone (FSH) and/or EGF, but supplementation of IVM with EGF-like peptides amphiregulin or epiregulin improves oocyte developmental competence. Here we aimed to determine whether EGF-like peptides regulate COC metabolism. Immature 129/Sv mouse COCs underwent IVM with FSH, EGF, amphiregulin, epiregulin, betacellulin, or no treatment (control). Epiregulin significantly increased intraoocyte flavin adenine dinucleotide (FAD) and REDOX (reduction and oxidation) ratio compared to FSH and control. Amphiregulin and epiregulin significantly increased the proportion of J aggregates (from JC-1) in oocyte mitochondria compared to control, FSH, or EGF, and this coupled with FAD and REDOX measures indicates greater mitochondrial activity. There were no differences in glucose consumption, lactate production, or glycolysis between COCs matured with FSH, EGF, and EGF-like peptides. COCs matured with EGF or EGF-like peptides exhibited significantly higher mRNA expression of the hexosamine biosynthesis pathway (HBP) rate-limiting enzyme gene Gfpt2, Has2 expression, and global beta-O-linked glycosylation of proteins, compared to control or FSH, suggesting greater HBP activity. Our findings suggest that 1) EGF-like peptides, particularly epiregulin, induce more oocyte mitochondrial activity than EGF or FSH and 2) EGF-like peptides and EGF induce greater HBP activity, enabling more hyaluronic acid synthesis and protein beta-O-linked glycosylation. These metabolic alterations may be a mechanism by which EGF-like peptides increase oocyte developmental competence.

The effect of peri-conception hyperglycaemia and the involvement of the hexosamine biosynthesis pathway in mediating oocyte and embryo developmental competence.

The environment that the oocyte is exposed to during the peri-conception period can have a significant impact on oocyte developmental competence (the ability of the oocyte to support fertilisation and subsequent embryo development) and the long-term health of the resulting offspring. This is particularly true for maternal hyperglycaemia. While maternal hyperglycaemia during early pregnancy through term development has been extensively studied, the effects on the oocyte itself, and the underlying mechanisms, remain largely unknown. There is increasing evidence, however, for the role of the fuel-sensing hexosamine biosynthesis pathway in mediating the effects of hyperglycaemia in many different cell types. In this review, we will focus on the reproductive consequences of maternal hyperglycaemia during the peri-conceptual period and the role of the hexosamine pathway in mediating these processes.

Dietary patterns in urban Ghana and risk of type 2 diabetes.

There is epidemiological evidence for associations between dietary patterns and type 2 diabetes. However, for sub-Saharan Africa, information on dietary patterns and their contribution to diabetes is lacking. The aim of the present study was to identify dietary patterns and their associations with type 2 diabetes in an urban Ghanaian population. In a hospital-based case-control study on risk factors for type 2 diabetes in Kumasi, a FFQ was administered to 675 controls and 542 cases. Dietary patterns were identified by using factor analysis including thirty-three food items. Logistic regression was used to evaluate the associations of dietary patterns with type 2 diabetes. Overall, two dietary patterns were identified: (1) a 'purchase' dietary pattern which positively correlated with the consumption of sweets, rice, meat, fruits and vegetables and (2) a 'traditional' dietary pattern that correlated with the intake of fruits, plantain, green leafy vegetables, fish, fermented maize products and palm oil. In the highest quintile of the 'purchase' dietary pattern, participants were younger, leaner and of higher socio-economic status than those in the lower quintiles. In contrast, participants in the highest quintile of the 'traditional' dietary pattern were older, heavier and more deprived compared with those in the lower quintiles. In the multivariate model, the 'purchase' dietary pattern was inversely associated with type 2 diabetes (OR per 1 sd 0·41, 95% CI 0·33, 0·50); the 'traditional' dietary pattern increased the odds of diabetes per 1 sd by 54% (95% CI 1·35, 1·81). In conclusion, two diverse dietary patterns were identified and associated with type 2 diabetes in urban Ghana. The determinants of pattern adherence require further investigation.

The TCF7L2 rs7903146 (T) allele is associated with type 2 diabetes in urban Ghana: a hospital-based case-control study.

BACKGROUND: Type 2 diabetes mellitus is increasing dramatically in sub-Saharan Africa, and genetic predisposition is likely involved in that. Yet, genetic variants known to confer increased susceptibility among Caucasians are far from being established in African populations. In Ghanaian adults, we examined associations of several of these polymorphisms with type 2 diabetes. METHODS: A hospital-based case-control study on type 2 diabetes (and hypertension) was conducted in Kumasi, Ghana. TCF7L2 rs7903146, KCNJ11 rs5219, PPARγ rs1801282 and CAPN10 rs3842570, rs3792267, and rs5030952 were typed and associations with type 2 diabetes and phenotypic traits examined. RESULTS: 675 patients with type 2 diabetes and 377 controls were compared. The minor allele frequency of the TCF7L2 (T) allele was 0.33. In the multivariate model, this allele increased the risk of type 2 diabetes by 39% (95% confidence interval (CI), 1.07-1.81; p = 0.014). The minor alleles KCNJ11 (G) and PPARγ (G) were practically absent (each, 0.001). Minor allele frequencies of CAPN10 were for -43 (A) 0.11 and for -63 (C) 0.46. These variants showed no significant associations with type 2 diabetes. Two CAPN10 haplotypes tended to protect against type 2 diabetes: 211 (aOR, 0.32; 95% CI, 0.03-1.92; p = 0.31) and 221 (aOR, 0.73; 95% CI, 0.48-1.10; p = 0.13). CONCLUSIONS: In urban Ghana, the frequency of the TCF7L2 rs7903146 (T) allele is comparable to the one in Caucasians; the association with type 2 diabetes is slightly weaker. The risk allele KCNJ11 (G) and the protective allele PPARγ (G) are virtually absent. The potential influence of comparatively rare CAPN10 haplotypes on type 2 diabetes risk in this population requires further evaluation. Large-scale genetic studies among native Africans aiming at fine-mapping the candidate genes are needed to identify the actual factors involved in their increased susceptibility to type 2 diabetes.

Measures of general and central obesity and risk of type 2 diabetes in a Ghanaian population.

OBJECTIVE: The epidemic of obesity and type 2 diabetes is evident in sub-Saharan Africa (SSA). However, their associations have hardly been examined in this region. METHODS: A hospital-based case-control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population-specific cut-off points for diabetes were identified by receiver operating characteristic curves. RESULTS: The strongest association with diabetes was observed for waist-to-hip ratio: age-adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64-2.31) in women and 1.40 [1.01-1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17-1.57]) and waist-to-height ratio (1.29 [1.12-1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50-0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88-1.15]) nor in men (0.74 [0.52-1.04]). Among both genders, waist-to-hip ratio showed the best discriminative ability for diabetes in this population and the optimal cut-off points were ≥ 0.88 in women and ≥ 0.90 in men. Recommended cut-off points for body mass index and waist circumference had a poor predictive ability. CONCLUSION: Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population-based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries.

The Three-Phase Contact Potential Difference Modulates the Water Surface Charge.

The surface charge of an open water surface is crucial for solvation phenomena and interfacial processes in aqueous systems. However, the magnitude of the charge is controversial, and the physical mechanism of charging remains incompletely understood. Here we identify a previously overlooked physical mechanism determining the surface charge of water. Using accurate charge measurements of water microdrops, we demonstrate that the water surface charge originates from the electrostatic effects in the contact line vicinity of three phases, one of which is water. Our experiments, theory, and simulations provide evidence that a junction of two aqueous interfaces (e.g., liquid-solid and liquid-air) develops a pH-dependent contact potential difference Δϕ due to the longitudinal charge redistribution between two contacting interfaces. This universal static charging mechanism may have implications for the origin of electrical potentials in biological, nanofluidic, and electrochemical systems and helps to predict and control the surface charge of water in various experimental environments.

Esophageal cancer characterization with pneumo-64-MDCT.

Early diagnosis and accurate staging of esophageal cancer are both essential for therapeutic strategy planning. Endoscopic ultrasound, CT, and positron emission tomography have all been used in the preoperative staging of esophageal cancer separately or in various combinations. Each imaging method has its strengths and weaknesses. Depiction of the tumor's anatomic location conditions the surgical strategy. Endoscopic ultrasound and PET have important advantages but neither provides information for surgical planning. CT scans have some limitations for hollow organ assessment in the absence of lumen distension, since the organ wall may be collapsed. Therefore, optimal esophageal distension could be very useful to overcome these limitations. This potential drawback is crucial at the level of the GE junction, a typically difficult region to evaluate. In order to optimize tumor visualization in the esophageal wall and in the GE junction, we developed a technique named pneumo-64-MDCT. We achieve maximum lumen distension, which better highlights the thickened areas in relation to the normal esophageal wall. At the present time, we have performed 200 studies with this technique and it proved useful, safe and accurate to identify esophageal wall thickening and to stage esophageal cancer. The additional stomach distension led to an adequate definition of both the upper and lower borders of the lesion in tumors located in the GE junction, which in turn was helpful to design the surgical approach.

"Free food on campus!": Using instructional technology to reduce university food waste and student food insecurity.

ObjectivesAs food insecurity among college students in the United States continues to rise, large quantities of food are wasted on college campuses. This paper presents a simple, low-cost approach to address both issues, using an electronic learning management system to connect college students with good quality excess food. Participants: Students at a small East Coast urban university. Methods: Using the MAP-IT framework, a university-wide food rescue system was developed to alert students to obtain food. Results: During the first twelve months of implementation, 451 students enrolled to receive announcements. 78% of students reported satisfaction with the food obtained. Conclusions: This program was successful in providing students with access to desirable food that would otherwise have been wasted.

Broadband Microwave Electroporation Device for the Analysis of the Influence of Frequency, Temperature and Electrical Field Strength.

In this paper, a broadband microwave device for cell poration is presented, that enables the analysis of the relation between frequency, electrical field strengths and temperature for a successful cell poration. Electromagnetic-thermal coupled simulations in the frequency range from 1 GHz to 10 GHz show that the device reaches electrical field strengths of 100 V/cm and temperatures lower then 40°C. Electroporation experiments with adherent C2C12 mouse myoblast cells show successful uptake of an anti-histone γ -H2A.X nanobody at a frequency of 10 GHz. This MWP device allows the fast electro-poration of adherent cells. After 15 min, the cells show uptake of γ -H2A.X-specific nanobody while most of them survived.

Systematic review with meta-analysis: dietary intake in adults with inflammatory bowel disease.

BACKGROUND: Poor dietary intake is associated with the development of malnutrition, micronutrient deficiencies, anaemia and osteoporosis in individuals with inflammatory bowel disease. While trials are underway to manipulate the diet of people with IBD, there has been no comprehensive systematic review of the dietary intake of adults with IBD. AIMS: To conduct a systematic evaluation and meta-analysis of the dietary intake of adults with IBD, including macronutrients, micronutrients and food group data. METHODS: CINAHL, Embase, Medline and Scopus were searched from 1 January 2000 to 25 September 2020 for cohort, case-control or cross-sectional studies that reported usual dietary intake in adults. Data were pooled and reported as weighted mean intake for: all adults with IBD; Crohn's disease; ulcerative colitis; active disease; remission; males; females. A random-effects meta-analysis model compared intake with healthy individuals. RESULTS: Forty studies were identified and 19 were included in the meta-analysis. All subgroups of adults with IBD consumed inadequate energy (mean intake in adults with IBD 1980 ± 130 kcal), fibre (14 ± 4 g), folate (246 ± 33 mg) and calcium (529 ± 114 mg) per day. Intake of breads and cereals, legumes, fruit, vegetables and dairy were inadequate. Compared to healthy individuals, adults with IBD consume significantly less dietary fibre (SMD -0.59; 95% CI: -0.73, -0.46). CONCLUSIONS: This review provides improved clarity about the dietary intake of adults with IBD. Future attention is required to improve diet quality and increase understanding of factors influencing dietary intake in IBD.

Household Chaos Moderates Indirect Pathways Involving Domestic Violence, Parenting Practices, and Behavior Problems among Preschool Children.

PURPOSE: This study examined the moderating role of household chaos in indirect pathways involving domestic violence (DV), parenting practices (punitive discipline and responsive), and preschool children's internalizing and externalizing symptoms. We hypothesized that high levels of household chaos would amplify links between domestic violence and parenting difficulties, and that parenting difficulties would in turn predict child behavior problems. METHOD: Participants in this multimethod (survey, semi-structured interview, child protection records) study included 274 preschool children (M age = 50.86 months) and their primary caregivers who were assessed in the home at two time-points spaced 6 months apart. Child welfare documentation of moderate-severe maltreatment within the last 6 months was present for 52% of children, 44% were in households characterized by DV, and most families qualified for public assistance. Hypotheses were tested using path analysis with manifest variables within a structural equation modeling framework. RESULTS: All models provided excellent fit to the data. DV was associated with punitive discipline practices only when household chaos was high. Punitive discipline practices in turn predicted greater child externalizing symptoms 6 months later. Follow-up analyses revealed that the moderating role of chaos was specific to DV, rather than general to other forms of adversity (child maltreatment, lifetime contextual stressors, traumatic events). This interaction between DV and chaos was salient even when controlling for exposure to other adversities and demographic covariates. CONCLUSIONS: Results point to multiple potential targets of intervention that may ultimately buffer children from the risk posed by experiencing DV in the home.

Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Usability and Association With Outcomes.

Malnutrition has been documented in approximately one-third of patients in developed countries on hospital admission and is associated with negative clinical outcomes. The need to identify and intervene in at-risk patients is critical to minimize these negative outcomes. A consensus approach for diagnosing and documenting malnutrition in hospitalized adult and pediatric patients was published jointly by the Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) in 2012 and 2014, respectively. The purpose of this paper is to review the available literature on the usability, feasibility, validity, and reliability of both the adult and pediatric consensus malnutrition diagnostic approaches, as well as to evaluate their use in studying clinical outcomes. In adults, abstracts and published studies have shown the diagnostic tool is a usable, feasible, and reliable method for the identification of severe and non-severe or moderate malnutrition. In pediatrics, only 1 published study to date used the pediatric malnutrition indicators, indicating the need to demonstrate that the tool is feasible, valid, and reliable. Both the adult and pediatric tools have shown significant correlation with negative clinical outcomes in malnourished patients, including increased mortality, increased hospital length of stay (adults), increased complications (pediatrics), and increased hospital readmissions. Further large-scale studies are needed to evaluate the feasibility, usability, validity, and reliability of both the adult and pediatric malnutrition diagnostic approaches.

Delay in Treatment After Cancer Diagnosis in Adolescents and Young Adults: Does Facility Transfer Matter?

Background: Timeliness is one of the fundamental yet understudied quality metrics of cancer care. Little is known about cancer treatment delay among adolescent and young adult (AYA) cancer patients. This study assessed cancer treatment delay, with a specific focus on facility transfer and diagnosis/treatment interval. Methods: Based on MultiCare Health System's (MHS's) institutional cancer registry data of AYA patients diagnosed during 2006-2015, this study analyzed patient demographics, insurance, clinical characteristics, and time of diagnosis and treatment initiation. Chi-squared tests, cumulative hazard estimates, and Cox proportional regression were used for univariable analysis. Multivariate regression models were used to test the association between care transfer and days of interval or prolonged delay, controlling for baseline parameters. Results: Of 840 analytic AYA cases identified, 457 (54.5%) were both diagnosed and treated within MHS. A total of 45.5% were either diagnosed or treated elsewhere. Mean and median intervals for treatment initiation were 27.03 (95% CI = 21.94-33.14) and 8.00 days (95% CI = 5.00-11.00), respectively, with significant differences between patients with and without facility transfer. Transfer was significantly correlated with longer length of diagnosis-to-treatment interval. Treatment delay, ≥1 week, was associated with transfer, female sex, older age, no surgery involvement, and more treatment modalities. Treatment delay, ≥4 weeks, was associated with transfer, female sex, no insurance, and no surgery involvement. Conclusion: In a community care setting, the diagnosis-to-treatment interval is significantly longer for transferred AYA cancer patients than for patients without a transfer. Future studies are warranted to explore the prognostic implications and the reasons for delays within specific cancer types.

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.