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Search Results: 1 - 10 of 4644 matches for " Oliver Razum "
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Deteriorating health satisfaction among immigrants from Eastern Europe to Germany
Ulrich Ronellenfitsch, Oliver Razum
International Journal for Equity in Health , 2004, DOI: 10.1186/1475-9276-3-4
Abstract: We compared data from 1995 and 2000 for immigrants from Eastern Europe (n = 353) and a random sample of age-matched Germans (n = 2, 824) from the German Socioeconomic Panel. We tested H1-3 using health satisfaction, as a proxy for health status, and socioeconomic indicators. We compared changes over time within groups, and between immigrants and Germans. We assessed effects of socio-economic status and being a migrant on declining health satisfaction in a regression model.In 1995, immigrants under 55 years had a significantly higher health satisfaction than Germans. Above age 54, health satisfaction did not differ. By 2000, immigrants' health satisfaction had declined to German levels. Whereas in 1995 immigrants had a significantly lower SES, differences five years later had declined. In the regression model, immigrant status was much stronger associated with declining health satisfaction than low SES.In contrast to H1, younger immigrants had an initial health advantage. Immigrants were initially socio-economically disadvantaged (H2), but their SES improved over time. The decrease in health satisfaction was much steeper in immigrants and this was not associated with differences in SES (H3). Immigrants from Eastern Europe have a high risk of deteriorating health, in spite of socio-economic improvements.The breakdown of the "Iron Curtain" at the end of the 1980s and the opening of borders between Eastern and Western Europe marked the beginning of a large migration process affecting Europe as a whole. In the 1990s, an average of about 600,000 people migrated annually from the former Communist states to Western Europe [1]. Germany was one of the main countries of destination. Between 1989 and 2002, almost 2.9 million persons of ethnic German origin, so called "Aussiedler" (resettlers), mainly from the former Soviet Union, Poland and Romania, arrived in the country[2]. In addition, 1.7 million people with a citizenship of an Eastern European country reside in Germany. To
Health inequalities in Germany: do regional-level variables explain differentials in cardiovascular risk?
Juergen Breckenkamp, Andreas Mielck, Oliver Razum
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-132
Abstract: Individual-level explanatory variables (age, socio-economic status) and outcome data (body mass index, blood pressure, cholesterol level) as well as the regional-level variable (proportion of relative poverty) were taken from the baseline survey of the German Cardiovascular Prevention Study, a cross-sectional, community-based, multi-center intervention study, comprising six socio-economically diverse intervention regions, each with about 1800 participants aged 25–69 years. Multilevel modeling was used to examine the effects of individual and regional level variables.Regional effects are small compared to individual effects for all risk factors analyzed. Most of the total variance is explained at the individual level. Only for diastolic blood pressure in men and for cholesterol in both men and women is a statistically significant effect visible at the regional level.Our analysis does not support the assumption that in Germany cardiovascular risk factors were to a large extent associated with income inequality at regional level.It is well established that employment grade, educational level, and household income are important predictors of mortality [1], cardiovascular risk factor levels and morbidity [2,3]. The international research supports an inverse association between socioeconomic status and cardiovascular disease [4-6]. More recently, the impact of socioeconomic factors throughout life course has been examined [7,8].An ongoing debate in the field of inequality and health focuses on two as yet unproven extensions of this association, which can be phrased as research questions:1. Is individual health status associated with individual income and (particularly) with income inequality at aggregate (e. g. regional) level? [9]2. If there is indeed an association between income inequality and health status, does it operate via a psychosocial pathway (stress due to perceptions of relative disadvantage and the psychological consequences of inequality) [9,10]; or via a ?
What do we have to know from migrants' past exposures to understand their health status? a life course approach
Jacob Spallek, Hajo Zeeb, Oliver Razum
Emerging Themes in Epidemiology , 2011, DOI: 10.1186/1742-7622-8-6
Abstract: The incorporation of a life course perspective into a conceptual framework of migrant health enables the consideration of risk factors and disease outcomes over the different life phases of migrants, which is necessary to understand the health situation of migrants and their offspring. Comparison populations need to be carefully selected depending on the study questions under consideration within the life course framework.Migrant health research will benefit from an approach using a life course perspective. A critique of the theoretical foundations of migrant health research is essential for further developing both the theoretical framework of migrant health and related empirical studies.Both the absolute numbers of migrants as well as their proportion of the total population are increasing in western European countries and the USA. In 2005, western and central European countries hosted more than 44 million foreign-born persons [1]. The health of migrants has been extensively studied. However, studies about health differences between migrants and majority populations face a fundamental problem: a broadly accepted comprehensive and conclusive model on migrants and their health is lacking [2]. Existing concepts of migrant health, such as the healthy migrant model [3,4], the health transition model [5] or the model developed by Schenk [6], include several important factors, but do not offer a life course perspective that takes into account the influence of health-related factors acting in the different life periods of migrants [7]. In other words, they lack an explicit time axis. The question arising from this lack of a time axis is: Which factors and exposures in the life course of migrants do we have to consider in migrant studies in order to understand adequately the current health situation of migrants? To answer this question, we use the approach of life course epidemiology. Our focus is on developing a framework for epidemiological migrant studies. Other forms of
Prevention among immigrants: the example of Germany
Jacob Spallek, Hajo Zeeb, Oliver Razum
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-92
Abstract: As for example studies on children's participation in routine prevention activities have shown, these differences can have a relevant impact on the access of migrants to the health care system and are likely to lower their participation in prevention programs compared to the autochthonous population. To increase the uptake of prevention programs, barriers to access must be identified and approaches to reduce them must be developed.Taking the example of Germany, a need exists for prevention programs that include (migrant sensitive) and specifically address (migrant specific) migrants. These should be of sufficient scale, evidence-based, sustainable and evaluated at regular intervals.Migration is a phenomenon affecting all European countries, and having an influence on the health of the migrants as well as of populations of the host countries. Infectious diseases are still relevant in the context of migration. In addition, experiences during travel and in the host countries may negatively affect the health of migrants. Still, migrants largely suffer from similar health problems as the populations of the host countries. In consequence, today's discussion on migrant health is focusing more and more on equity and equality issues. For example, it is being investigated in many countries whether migrants have equal access to health care and social services. Observed health differentials serve as indicators for equity in access. A pertinent question in this context is whether migrants can access preventive services appropriately, and whether they benefit from preventive offers in the same way as the autochthonous population does. This question is understudied, as we show in this article, using the example of Germany.There are different definitions of the term immigration. According to international definitions, immigration occurs when a person (in this paper always men and women unless otherwise stated) moves his or her centre of living over a socially meaningful distance, a
The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study
Sven Voigtl?nder, Ursula Berger, Oliver Razum
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-403
Abstract: Using 2004 data from the German Socio-Economic Panel Study (SOEP) merged with regional and neighbourhood characteristics, we fitted multilevel linear regression models with subjective physical health, as measured by the SF-12, as the dependent variable. The models include regional and neighbourhood proxies of deprivation (i.e. regional unemployment quota, average purchasing power of the street section) as well as specific neighbourhood exposures (i.e. perceived air pollution). Individual characteristics including socioeconomic status and health behaviour have been controlled for.This study finds a significant association between area deprivation and physical health which is independent of compositional factors and consistent across different spatial scales. Furthermore the association between neighbourhood deprivation and physical health can be partly explained by specific features of the neighbourhood environment. Among these perceived air pollution shows the strongest association with physical health (-2.4 points for very strong and -1.5 points for strong disturbance by air pollution, standard error (SE) = 0.8 and 0.4, respectively). Beta coefficients for perceived air pollution, perceived noise and the perceived distance to recreational resources do not diminish when including individual health behaviour in the models.This study highlights the difference regional and in particular neighbourhood deprivation make to the physical health of individuals in Germany. The results support the argument that specific neighbourhood exposures serve as an intermediary step between deprivation and health. As people with a low socioeconomic status were more likely to be exposed to unfavourable neighbourhood characteristics these conditions plausibly contribute towards generating health inequalities.Research concerned with contextual influences on health, that is the effect of regional and neighbourhood factors on individual health outcomes, and their interplay with compositional
Expert Delphi survey on research and development into drugs for neglected diseases
Angela Fehr, Petra Thürmann, Oliver Razum
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-312
Abstract: An international online-Delphi survey was conducted with 117 (first round) and 56 (second round) experts of different professional backgrounds and professional affiliations who formulated and ranked causes and solutions related to the treatment deficit for neglected diseases.In both rounds of survey, the majority of the participating experts (88.4% first round, 86.8% second round) advocated the development of a regulatory instrument to promote R&D for neglected diseases. Most experts (77.9% first round, 79.3% second round) also considered this to be a feasible option. With the exception of market exclusivity, which was viewed critically, key provisions contained in orphan drug regulations were judged favorably also for neglected diseases. A majority (87.1% first round, 77.2% second round) supported national funding obligations for neglected diseases which are proposed by the Medical Research and Development Treaty draft.While not all features of orphan drug regulations and of the MRDT draft received equal support, the view was expressed that a regulatory instrument would be a desirable and feasible measure to promote R&D for neglected diseases.About one billion people worldwide suffer from so-called neglected diseases (NDs). Neglected diseases are a heterogeneous [1] group of predominantly, but not exclusively, tropical infectious diseases, such as Buruli ulcer, Blinding Trachoma, Dengue and Dengue Hemorrhagic Fever, Lymphatic Filariasis, Human African Trypanosomiasis, Onchocerciasis, or Schistosomiasis (a list of 15 NDs is available on http://www.who.int/neglected_diseases/diseases/en/ webcite). Common features of neglected diseases include their prevalence in poor populations in developing countries, their cause for stigma and discrimination, their high impact on morbidity and mortality and their relative neglect in terms of research and development activities. For some neglected diseases, tools are available to control, prevent or possibly eliminate them. For oth
Self-help: What future role in health care for low and middle-income countries?
KR Nayar, Catherine Kyobutungi, Oliver Razum
International Journal for Equity in Health , 2004, DOI: 10.1186/1475-9276-3-1
Abstract: Self-help groups are voluntary unions of peers, formed for mutual assistance in accomplishing a health-related purpose. In Europe, self-help groups developed out of dissatisfaction with a de-personalised health care system. They successfully complement existing social and health services but cannot be instrumentalized to improve health outcomes while reducing health expenditure.In South Asia, with its hierarchical society, instrumental approaches towards self-help prevail in Non-governmental Organizations and government. The utility of this approach is limited as self-help groups are unlikely to be sustainable and effective when steered from outside. Self-help groups are typical for individualistic societies with developed health care systems – they are less suitable for hierarchical societies with unmet demand for regulated health care. We conclude that self-help groups can help to achieve some degree of synergy between health care providers and users but cannot be prescribed to partially replace government health services in low-income countries, thereby reducing health care expenditure and ensuring equity in health care.The paradigm of health sector reforms currently undertaken at the global level, and especially in structurally adjusting countries like India and elsewhere in the developing world, enforces a move towards privatization of medical care services. The State is often characterized as inefficient and considered ill equipped to handle social sectors such as health. This inefficiency argument is applied to both issues of financing as well as the implementation of health programs. The alternative suggested is a mix of private and public, the primary care to the government and the lucrative curative care to the private sector [1]. There are also certain options which fall between completely state-oriented services and privatized care. One of the early such options was the Non-governmental Organization. However, a number of recent impact studies have shown
'Imported risk' or 'health transition'? Smoking prevalence among ethnic German immigrants from the Former Soviet Union by duration of stay in Germany - analysis of microcensus data
Katharina Reiss, Jacob Spallek, Oliver Razum
International Journal for Equity in Health , 2010, DOI: 10.1186/1475-9276-9-15
Abstract: To estimate the smoking prevalence we used the scientific-use-file (n = 477,239) of the German 2005 microcensus, an annual census representing 1% of all German households. Participation in the microcensus is obligatory (unit-nonresponse <7%). We stratified the prevalence of smoking among resettlers and the comparison group (population of Germany without resettlers) by age, sex, educational level and duration of stay. In total, 14,373 (3% of the total) persons were identified as resettlers.Female resettlers with short duration of stay had a significantly lower smoking prevalence than women in the comparison group. With increasing duration of stay their smoking prevalence appears to converge to that of the comparison group (e.g.: high educational level, age group 25-44 years: short duration of stay 15%, long duration of stay 24%, comparison group 28%). In contrast, the smoking prevalence among male resettlers with short duration of stay was significantly higher than that among men in the comparison group, but also with a trend towards converging (e.g.: high educational level, age group 25-44 years: short duration of stay 44%, long duration of stay 35%, comparison group 36%). Except for female resettlers with short duration of stay, the participants with low educational level had on average a higher smoking prevalence than those with a high educational level.This is the first study estimating the smoking prevalence among resettlers by duration of stay. The results support the hypothesis that resettlers brought different smoking habits from their countries of origin shortly after migration. The observed convergence of the smoking habits with increasing duration of stay is in line with the hypothesis of migration as 'health transition'. However, due to the cross-sectional design of the study, further research is needed to confirm these findings.Germany is one of the countries with the highest number of immigrants in Europe [1]. In 2007, 15.4 million persons or 18.7% of t
Changes in smoking prevalence among first- and second-generation Turkish migrants in Germany – an analysis of the 2005 Microcensus
Anna Reeske, Jacob Spallek, Oliver Razum
International Journal for Equity in Health , 2009, DOI: 10.1186/1475-9276-8-26
Abstract: We estimated the prevalence of smoking based on the representative 2005 Mikrozensus, an annual survey including 1% of Germany's households. The 2005 Microcensus was the first to provide information that makes it possible to differentiate between first- and second-generation Turkish migrants. In total, 12,288 Turkish migrants and 421,635 native-born Germans were included in our study. The unit non-response is generally low (about 6% in 2005) because participation in the Microcensus is obligatory.We found the prevalence of smoking in second-generation male Turkish migrants to be lower than in the first-generation group: 47.0% of first-generation Turkish migrants with a high level of education were smokers, in contrast to only 37.6% in the second generation. Within the German reference population, 29.9% were smokers. The percentage of Turkish women in our sample who smoked was generally smaller, but was not significantly lower in the second generation. In fact, the prevalence of smoking was highest among Turkish women of the second generation with a low level of education (40.9%), similar to younger second-generation German women with the same level of education.We present the first representative data on changes in the prevalence of a risk factor for many chronic diseases among Turkish migrants in Germany. Male Turkish migrants (with a high level of education) showed a decrease over the generations while smoking prevalences of female Turkish migrants increased. In the second generation, prevalences partly converged with those of the German reference population or were even higher. Our hypothesis – that migration can be interpreted as a "health transition" – was thus partly confirmed.The prevalence of smoking, an important risk factor for cardiovascular diseases and several types of cancer, differs between countries. A Turkish-German study, which compared smoking prevalences in Turkey and Germany, has shown that smoking prevalence among men in Turkey is higher than in
Stillbirth differences according to regions of origin: an analysis of the German perinatal database, 2004-2007
Anna Reeske, Marcus Kutschmann, Oliver Razum, Jacob Spallek
BMC Pregnancy and Childbirth , 2011, DOI: 10.1186/1471-2393-11-63
Abstract: We used the BQS dataset routinely compiled to examine perinatal outcomes in Germany nationwide. Participation of hospitals and completeness of data has been about 98% in recent years. Data on all live births and stillbirths were obtained for the period 2004 to 2007 (N = 2,670,048). We calculated crude and stratified mortality rates as well as corresponding relative mortality risks.A significantly elevated stillbirth rate was found for women from the Middle East and North Africa (incl. Turkey) (RR 1.34, CI 1.22-1.55). The risk was slightly attenuated for low SES. An elevated risk was also found for women from Asia (RR 1.18, CI 1.02-1.65) and from Mediterranean countries (RR 1.14, CI 0.93-1.28). No considerable differences either in use and timing of antenatal care or preterm birth and low birthweight were observed between migrant and non-migrant women. After stratification for light for gestational age, the relative risk of stillbirth for women from the Middle East/North Africa increased to 1.63 (95% CI 1.25-2.13). When adjusted for preterm births with low birthweight, women from Eastern Europe and the Middle East/North Africa experienced a 26% (43%) higher risk compared with women from Germany.We found differences in risk of stillbirth among women from Middle East/North Africa, especially in association with low SES and low birthweight for gestational age. Our findings suggest a need for developing and evaluating socially and culturally sensitive health promotion and prevention programmes for this group. The findings should also stimulate discussion about the quality and appropriateness of antenatal and perinatal care of pregnant women and newborns with migrant backgrounds.Although stillbirth occurs rather rarely it is one of the more devastating events in obstetrics and a sensitive indicator for the quality of health care, living conditions and inequity in a society. If a particular population group, such as migrants experiences higher rates of stillbirth than the
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