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Bohland HK, Kimbel R, Kegel P, Dietz P, Koestner C, Letzel S, Kurmeyer C, Jesuthasan J, Schouler-Ocak M, Zier U. Depression and anxiety in female refugees from East Africa and the Middle East displaced to Germany: cross-sectional results of the female refugee study, taking sociodemographic and migration-related factors into account. Front Psychiatry 2024; 14:1303009. [PMID: 38239899 PMCID: PMC10794566 DOI: 10.3389/fpsyt.2023.1303009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024] Open
Abstract
At the end of 2022, 108.4 million people around the world were forcibly displaced, the highest number ever recorded. Of these, 50% were women. Despite this situation, little is known about the mental health of female refugees. The first aim of this study was to examine the prevalence of depression and anxiety symptoms among female refugees in Germany. The second aim was to examine which sociodemographic and migration-related variables have an impact on refugees' mental health, and the third aim was to assess the potential predictors of their mental health. A sample of 92 female refugees from East Africa and the Middle East living in Germany were interviewed. Symptoms of depression and anxiety were assessed using the Hopkins Symptom Checklist (HSCL-25). The experience of potentially traumatic events (PTEs) was assessed using the Posttraumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ). In our sample of female refugees, 65.2% reported symptoms of depression, and 60.9% reported symptoms of anxiety. Symptoms of depression or anxiety were associated with being from the Middle East, having a higher level of education, and reporting more PTEs. The multiple regression model for anxiety was able to explain 32.4% of the variance in anxiety symptoms. The findings highlight the high burden of mental health problems that female refugees bear. The identified predictors of depressive and anxiety symptoms should sensitize medical and refugee professionals to identify vulnerable individuals and groups, refer them to appropriate psychological treatment, and, where possible, modify the identified predictors.
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Affiliation(s)
- Helena Katharina Bohland
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Renate Kimbel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter Kegel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Pavel Dietz
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Clemens Koestner
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stephan Letzel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christine Kurmeyer
- Women and equal opportunities office, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jenny Jesuthasan
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Ulrike Zier
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
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Moran JK, Jesuthasan J, Schalinski I, Kurmeyer C, Oertelt-Prigione S, Abels I, Stangier U, Starck A, Gutermann J, Zier U, Wollny A, Richter K, Krüger A, Schouler-Ocak M. Traumatic Life Events and Association With Depression, Anxiety, and Somatization Symptoms in Female Refugees. JAMA Netw Open 2023; 6:e2324511. [PMID: 37471088 PMCID: PMC10359962 DOI: 10.1001/jamanetworkopen.2023.24511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/04/2023] [Indexed: 07/21/2023] Open
Abstract
Importance Different types of traumatic life events have varying impacts on symptoms of depression, anxiety, and somatization. For women from areas of the world experiencing war and humanitarian crises, who have experienced cumulative trauma exposure during war and forced migration, it is not known whether cumulative trauma or particular events have the greatest impact on symptoms. Objective To examine which traumatic life events are associated with depression, anxiety, and somatization symptoms, compared with the cumulative amount, in a sample of female refugees. Design, Setting, and Participants For this cross-sectional study, data were collected in 2016 as a part of The Study on Female Refugees. The current analysis was conducted in 2022 to 2023. This multicenter study covered 5 provinces in Germany. Participants were recruited at reception centers for refugees. Women volunteered to participate and to be interviewed after information seminars at the different centers. Exposure Traumatic life events experienced by refugees from areas of the world experiencing war and humanitarian crises. Main Outcomes and Measures Demographic variables (age, country of origin, religion, education, relationship status, and children), traumatic and adverse life events, and self-reported depression, anxiety, and somatization symptoms were measured. Random forest regressions simultaneously examined the importance of these variables on symptom scores. Follow-up exploratory mediation models tested potential associative pathways between the identified variables of importance. Results For the final sample of 620 refugee women (mean [SD] age, 32.34 [10.35] years), family violence was most associated with depression (mean [SD] variable of importance [VIM], 2.93 [0.09]), anxiety (mean [SD] VIM, 4.15 [0.11]), and somatization (mean [SD] VIM, 3.99 [0.15]), even though it was less common than other traumatic experiences, including war, accidents, hunger, or lack of housing. Other factors, such as childhood sexual abuse, injury, near-death experiences, and lack of access to health care, were also important. Follow-up analyses showed partial mediation effects between these factors in their association with symptoms, supporting the unique importance of family violence in understanding mental health. Conclusions and Relevance The findings of this cross-sectional study of refugee women who experienced multiple severe traumas related to war in their home countries and danger encountered during their migration suggest that family violence was key to their current mental health problems. Culturally sensitive assessment and treatment need to place special emphasis on these family dynamics.
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Affiliation(s)
- James Kenneth Moran
- Department of Psychiatry and Psychotherapy, Multisensory Integration Lab, Charité Universitätsmedizin, St Hedwig Hospital, Berlin, Germany
| | - Jenny Jesuthasan
- Psychiatric University Clinic Charité, St Hedwig Hospital, Berlin, Germany
| | - Inga Schalinski
- Universität der Bundeswehr München, Department of Human Sciences, Institute of Psychology, Munich, Germany
| | - Christine Kurmeyer
- Office of the Equal Opportunities Officer, Charité–Universitätsmedizin, Berlin, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- AG 10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - Ingar Abels
- Office of the Equal Opportunities Officer, Charité–Universitätsmedizin, Berlin, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Annabelle Starck
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jana Gutermann
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ulrike Zier
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Now with Ministry of Science and Health of Rhineland-Palatinate, Mainz, Germany
| | - Anja Wollny
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Knejinja Richter
- CuraMed Tagesklinik Nürnberg, Nuremberg, Germany
- Technische Hochschule Nürnberg, Nuremberg, Germany
| | - Antje Krüger
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
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Warth J, Beckmann N, Puth MT, Tillmann J, Porz J, Zier U, Weckbecker K, Weltermann B, Münster E. Association between over-indebtedness and antidepressant use: A cross-sectional analysis. PLoS One 2020; 15:e0236393. [PMID: 32706806 PMCID: PMC7380887 DOI: 10.1371/journal.pone.0236393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 07/06/2020] [Indexed: 11/27/2022] Open
Abstract
Background Burden of disease caused by depression and its association with socioeconomic status is well documented. However, research on over-indebtedness is scarce although millions of European citizens in all socioeconomic positions are over-indebted. Prior studies suggested that over-indebtedness is associated with poor physical and mental health. Aims Investigate the association between over-indebtedness and antidepressant use in Germany. Method A cross-sectional survey among debt advice agencies’ clients was conducted in North Rhine-Westphalia, Germany, in 2017 (OID). Data were merged with the first wave of the German Health Interview and Examination Survey for Adults (DEGS1). Descriptive statistics and logistic regression analysis were used to examine antidepressant use in the previous 7 days (OID: n = 699; DEGS1: n = 7115). Results Prevalence of antidepressant use was higher in the over-indebted (12.3%) than the general population (5.0%). The over-indebted were significantly more likely to use antidepressants than the general population even after controlling for other socioeconomic, demographic and health factors (adjusted odds ratio 1.83; 95% confidence interval 1.35–2.48). Conclusions Stakeholders in health care, debt counselling, research and social policy should consider the link between over-indebtedness and mental illness to advance the understanding of health inequalities and to help those who have mental health and debt problems.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- * E-mail:
| | - Niklas Beckmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Department of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Faculty of Health/ Department of Medicine, Institute for General Medicine and Interprofessional Care, University Witten/Herdecke, Herdecke, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
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Warth J, Puth MT, Zier U, Beckmann N, Porz J, Tillmann J, Weckbecker K, Bosma H, Weltermann B, Münster E. Patient-physician communication about financial problems: A cross-sectional study among over-indebted individuals. PLoS One 2020; 15:e0232716. [PMID: 32369528 PMCID: PMC7199951 DOI: 10.1371/journal.pone.0232716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background About every tenth household across Europe is unable to meet payment obligations and living expenses on an ongoing basis and is thus considered over-indebted. Previous research suggests that over-indebtedness reflects a potential cause and consequence of psychosomatic health problems and limited access to care. However, it is unclear whether those affected discuss their financial problems with general practitioners. Therefore, this study examined patient-physician communication about financial problems in general practice among over-indebted individuals. Methods We conducted a cross-sectional survey among clients of 70 debt advice agencies in North Rhine-Westphalia, Germany, in 2017. We assessed the prevalence of patient-physician communication about financial problems and its association with patient characteristics using descriptive statistics and logistic regression analysis. Of 699 individuals who returned the questionnaire (response rate:50.2%), we included 598 respondents enrolled in statutory health insurance with complete outcome data in the analyses. Results Conversations about financial problems with general practitioners were reported by 22.6% (n = 135) of respondents. Individuals with a high educational level were less likely to report such conversations than those with medium educational level (aOR 0.11; 95%CI 0.01–0.83) after adjustment for other sociodemographic characteristics, health status and measures of financial distress. Those without a migrant background(aOR 2.09; 95%CI 1.32–3.32), the chronically ill(aOR 1.90; 95%CI 1.16–3.13) and individuals who reported high financial distress(aOR 2.15; 95%CI 1.22–3.78) and cutting on necessities to pay for medications(aOR 1.86; 95%CI 1.12–3.09) were more likely to discuss financial problems than their counterparts. Conclusions Few over-indebted individuals discussed financial problems with their general practitioner. Patients’ health status, coping strategies and perception of financial distress might contribute to variations in disclosure of financial problems. Thus, enhancing communication and screening by routine assessment of financial problems in clinical practice can help to identify vulnerable patients and promote access to health care and social services and well-being for all.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- * E-mail:
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Niklas Beckmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
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Warth J, Puth MT, Tillmann J, Porz J, Zier U, Weckbecker K, Münster E. Over-indebtedness and its association with pain and pain medication use. Prev Med Rep 2019; 16:100987. [PMID: 31534901 PMCID: PMC6744525 DOI: 10.1016/j.pmedr.2019.100987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022] Open
Abstract
In developed countries, millions of households are over-indebted, and the number continues to rise. Studies have found an increased risk of adverse health effects among individuals that cannot cover payment obligations with available assets persistently. However, little is known about the role of over-indebtedness in pain. This study examined the association between over-indebtedness and pain and pain medication use. A cross-sectional study conducted among over-indebted individuals in 70 debt advisory centres in Germany (OID-survey; n = 699) was linked to the nationally representative German Health Interview and Examination Survey for Adults (DEGS1; n = 7987). Descriptive statistics and logistic regression analyses were used to examine the association between over-indebtedness and pain and pain medication use among participants with valid data on both outcome variables (n = 7560). Pain was experienced by over-indebted individuals more frequently (71.3%) compared to the general population (59.6%) whereas the prevalence of pain medication use was similar in both samples (DEGS1 12.6% vs. OID-survey 13.1%). Over-indebtedness significantly increased the odds of pain (aOR 1.30; 95%-CI 1.07-1.59) after adjusting for socioeconomic, demographic and health factors. The over-indebted were significantly less likely to use pain medication compared to the general population after adjustment (aOR 0.76; 95%-CI 0.58-0.99). Taking over-indebtedness into account as risk factor for pain and restricted pain medication use in research and clinical practice will help to advance the understanding of pain disparities, develop suitable interventions for preventive action and promote accessible pain management among those at risk.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Warth J, Puth MT, Tillmann J, Beckmann N, Porz J, Zier U, Weckbecker K, Weltermann B, Münster E. Cost-related medication nonadherence among over-indebted individuals enrolled in statutory health insurance in Germany: a cross-sectional population study. BMC Health Serv Res 2019; 19:887. [PMID: 31771583 PMCID: PMC6880370 DOI: 10.1186/s12913-019-4710-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background Millions of citizens in high-income countries face over-indebtedness that implies being unable to cover payment obligations with available income and assets on an ongoing basis. Studies have shown an association between over-indebtedness and health outcomes, independent of standard socioeconomic status measures. Patterns of cost-related medication nonadherence (CRN) among over-indebted individuals are yet unclear. The aim of this study was to examine the frequency of nonadherence to prescribed medications due to cost, and to identify risk factors for CRN among over-indebted individuals in Germany. Methods In 2017, we conducted a cross-sectional survey among over-indebted individuals recruited in 70 debt advice agencies in North Rhine-Westphalia, Germany. Data on CRN in the last 12 months (i.e. not filling prescriptions, skipping or decreasing doses of prescribed medication due to financial problems) were collected by a survey using a self-administered written questionnaire that was returned by 699 individuals with a response rate of 50.2%. Prevalence of CRN was assessed using descriptive statistics. Multiple logistic regression analysis was performed to examine risk factors of CRN, including participants enrolled in statutory health insurance with complete data (n = 521). Results The prevalence of CRN was 33.6%. The chronically ill had significantly greater odds of cost-related medication nonadherence (aOR 1.96; 95% CI 1.27–3.03) than individuals without a chronic illness. CRN was more likely to occur in individuals who had discussed financial problems with their general practitioner (aOR 1.58; 95% CI 1.01–2.47). There was no association between CRN and other sociodemographic factors or socioeconomic status. Conclusions Medication nonadherence due to financial pressures is common among over-indebted citizens enrolled in statutory health insurance in Germany. Stakeholders in social policy, research and health care need to address over-indebtedness to develop strategies to safeguard access to relevant medications, especially among those with high morbidity. Trial registration Arzneimittelkonsum, insbesondere Selbstmedikation bei überschuldeten Bürgerinnen und Bürgern in Nordrhein-Westfalen (ArSemü), (engl. ‘Medication use, particularly self-medication among over-indebted citizens in North Rhine-Westphalia’), German Clinical Trials Register: DRKS00013100. Date of registration: 23.10.2017. Date of enrolment of the first participant: 18.07.2017, retrospectively registered.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Niklas Beckmann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Faculty of Medicine, Institute of General Practice, University of Düsseldorf, Düsseldorf University Hospital, Postfach 10 10 07, 40001, Düsseldorf, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Warth J, Beckmann N, Puth MT, Tillmann J, Porz J, Zier U, Weckbecker K, Weltermann B, Münster E. Antidepressant use in over-indebted individuals compared to the general population in Germany. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
About ten percent of European households across all socioeconomic groups are considered over-indebted due to ongoing difficulties meeting financial commitments and living expenses. Studies found an association between over-indebtedness and physical and mental health such as depression independent of standard socioeconomic status measures. However, antidepressant use in the over-indebted population has been understudied. In view of the substantial economic and social burden of mental illness in Europe, the aim of this study was to examine the association between over-indebtedness and antidepressant use in Germany to advance the understanding of socioeconomic inequalities in mental health.
Methods
We conducted a cross-sectional survey among clients of 70 debt advice agencies in North Rhine-Westphalia, Germany, in 2017 (OID), and merged data with the first wave of the German Health Interview and Examination Survey (DEGS1) representative of the general population. We used descriptive statistics and multiple logistic regression analysis to examine antidepressant use in the previous 7 days (OID: n = 699; DEGS1: n = 7115).
Results
Antidepressant use was more frequent in the over-indebted (12.3%) compared to the general population sample (5.0%). After adjustment for age, sex, education, employment, marital status and chronic disease, over-indebted respondents were more likely to use antidepressants than the general population sample (aOR 1.83; 95% CI 1.35-2.48).
Conclusions
Prevalence of antidepressant use was higher in the over-indebted compared to the general population. The association between over-indebtedness and antidepressant use cannot be fully explained by standard socioeconomic measures. Over-indebtedness reflects a relevant public health issue that needs to be addressed in health care, social policy and research. There is an urgent need to develop public health activities that specifically target those at risk of mental illness and over-indebtedness.
Key messages
Over-indebtedness is associated with antidepressant use. Public health interventions are needed to prevent adverse health effects of over-indebtedness and safeguard access to care according to need.
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Affiliation(s)
- J Warth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - N Beckmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - M-T Puth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - J Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - J Porz
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - U Zier
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - K Weckbecker
- Institute of General Practice, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - B Weltermann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - E Münster
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
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Warth J, Puth MT, Tillmann J, Porz J, Zier U, Weckbecker K, Münster E. Over-indebtedness and its association with sleep and sleep medication use. BMC Public Health 2019; 19:957. [PMID: 31315596 PMCID: PMC6637586 DOI: 10.1186/s12889-019-7231-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over-indebtedness is currently rising in high-income countries. Millions of citizens are confronted with the persistent situation when household income and assets are insufficient to cover payment obligations and living expenses. Previous research shows that over-indebtedness increases the risk of various adverse health effects. However, its association with sleep problems has not yet been examined. The objective of this study was to investigate the association between over-indebtedness and sleep problems and sleep medication use. METHODS A cross-sectional study on over-indebtedness (OID survey) was conducted in 70 debt advisory centres in Germany in 2017 that included 699 over-indebted respondents. The survey data were combined with the nationally representative German Health Interview and Examination Survey for Adults (DEGS1; n = 7987). We limited analyses to participants with complete data on all sleep variables (OID: n = 538, DEGS1: n = 7447). Descriptive analyses and logistic regression analyses were used to examine the association between over-indebtedness and difficulty initiating and maintaining sleep, and sleep medication use. RESULTS A higher prevalence of sleep problems and sleep medication use was observed among over-indebted individuals compared to the general population. After adjustment for socio-economic and health factors (age, sex, education, marital status, employment status, subjective health status and mental illness), over-indebtedness significantly increased the risk of difficulties with sleep onset (adjusted odds ratio (aOR) 1.79, 95%-confidence interval (CI) 1.45-2.21), sleep maintenance (aOR 1.45, 95%-CI 1.17-1.80) and sleep medication use (aOR 3.94, 95%-CI 2.96-5.24). CONCLUSIONS Evidence suggests a strong association between over-indebtedness and poor sleep and sleep medication use independent of conventional socioeconomic measures. Considering over-indebtedness in both research and health care practice will help to advance the understanding of sleep disparities, and facilitate interventions for those at risk. TRIAL REGISTRATION German Clinical Trials Register: DRKS00013100 (OID survey, ArSemü); Date of registration: 23.10.2017; Date of enrolment of the first participant: 18.07.2017, retrospectively registered.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
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Warth J, Puth MT, Tillmann J, Beckmann N, Porz J, Zier U, Weckbecker K, Münster E. Schlafprobleme und Schlafmittelgebrauch bei Überschuldung: Erkenntnisse einer Querschnittsstudie in NRW (ArSemü). Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J Warth
- Institut für Hausarztmedizin, Bonn, Deutschland
| | - MT Puth
- Institut für Hausarztmedizin, Bonn, Deutschland
- Institut für Medizinische Biometrie, Informatik und Epidemiologie, Bonn, Deutschland
| | - J Tillmann
- Institut für Hausarztmedizin, Bonn, Deutschland
| | - N Beckmann
- Institut für Hausarztmedizin, Bonn, Deutschland
| | - J Porz
- Institut für Hausarztmedizin, Bonn, Deutschland
| | - U Zier
- Institut für Hausarztmedizin, Bonn, Deutschland
| | | | - E Münster
- Institut für Hausarztmedizin, Bonn, Deutschland
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Münster E, Warth J, Tillmann J, Porz J, Zier U, Weckbecker K. Einzelbeitrag: Überschuldung und Arzneimittelgebrauch: Status-quo und Unterstützungsbedarfe. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E Münster
- Institut für Hausarztmedizin Universität Bonn, Bonn, Deutschland
| | - J Warth
- Institut für Hausarztmedizin Universität Bonn, Bonn, Deutschland
| | - J Tillmann
- Institut für Hausarztmedizin Universität Bonn, Bonn, Deutschland
| | - J Porz
- Institut für Hausarztmedizin Universität Bonn, Bonn, Deutschland
| | - U Zier
- Institut für Hausarztmedizin Universität Bonn, Bonn, Deutschland
| | - K Weckbecker
- Institut für Hausarztmedizin Universität Bonn, Bonn, Deutschland
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Wittenmeier E, Troeber C, Zier U, Schmidtmann I, Pirlich N, Becke K, Piepho T. Red blood cell transfusion in perioperative pediatric anesthesia: a survey of current practice in Germany. Transfusion 2018; 58:1597-1605. [DOI: 10.1111/trf.14581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Ulrike Zier
- Institute of Occupational, Social and Environmental HealthMainz Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and InformaticsMedical Centre of the Johannes Gutenberg‐UniversityMainz Germany
| | | | - Karin Becke
- Cnopf Childrens Hospital/Hospital HallerwieseNürnberg Germany
| | - Tim Piepho
- Krankenhaus der Barmherzigen Brüder Trier, Department of Anesthesiology and Intensive CareBrothers of Mercy HospitalTrier Germany
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Münster E, Letzel S, Passet-Wittig J, Schneider NF, Schuhrke B, Seufert R, Zier U. Who is the gate keeper for treatment in a fertility clinic in Germany? -baseline results of a prospective cohort study (PinK study). BMC Pregnancy Childbirth 2018; 18:62. [PMID: 29506468 PMCID: PMC5839010 DOI: 10.1186/s12884-018-1690-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 02/23/2018] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND It is estimated that 5-15% of all couples in industrialised nations are infertile. A perceived unfulfilled desire for a child or self-identification as infertile can lead to psychological strain and social isolation. About 53.000 women underwent assisted reproduction treatments in Germany in 2014. Little is known about the first medical consultation and patient needs prior to the first visit in a fertility clinic in Germany. The baseline survey of the prospective cohort study on couples undergoing fertility treatment in Germany (PinK Study) provides first results on this topic for Germany. METHODS The baseline survey was conducted between 2012 and 2013. Self-administered questionnaires were handed out to patients of six fertility clinics at the beginning of treatment by clinic staff. At a participation rate of 31.0%, we were able to analyse data on 323 women and 242 men. RESULTS 92.6% of the women had their initial medical consultation on their unfulfilled desire for a child with a gynaecologist. After the urologist (44.2%), the general practitioner (12.0%) was the second most approached initial contact person for men. 36.4% of all men had no medical consultation on the unfulfilled desire for a child before visiting a fertility clinic. 46.9% of the respondents expressed the wish that the conversation about infertility should be initiated by a physician. Prior to their first visit to a fertility clinic, 11.2% of the men and 24.8% of the women were informed by a physician that infertility treatment can cause emotional strain. CONCLUSION While almost all women consult a gynaecologist prior to the first visit in a fertility centre, one out of three men do not consult any physician at that stage. For the remaining group of men, urologists and general practitioners are the most important contact persons. Gender-specific health care needs are evident. In order to close the health care gap for men in Germany, more opportunities for discreet access to consultation should be offered. Due to its low threshold and family-oriented approach, general practice could make an important contribution to this effect.
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Affiliation(s)
- Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany. .,Institute of Occupational, Social and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany. .,Federal Institute for Population Research (BIB), Wiesbaden, Germany.
| | - Stephan Letzel
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany
| | | | | | - Bettina Schuhrke
- Protestant University of Applied Sciences of Darmstadt, Darmstadt, Germany
| | - Rudolf Seufert
- Clinic and Polyclinic for Obstetrics and Gynaecology, University Medical Center, University of Mainz, Mainz, Germany
| | - Ulrike Zier
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany
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13
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Jesuthasan J, Sönmez E, Abels I, Kurmeyer C, Gutermann J, Kimbel R, Krüger A, Niklewski G, Richter K, Stangier U, Wollny A, Zier U, Oertelt-Prigione S, Shouler-Ocak M. Near-death experiences, attacks by family members, and absence of health care in their home countries affect the quality of life of refugee women in Germany: a multi-region, cross-sectional, gender-sensitive study. BMC Med 2018; 16:15. [PMID: 29391012 PMCID: PMC5793395 DOI: 10.1186/s12916-017-1003-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/28/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The year 2016 has marked the highest number of displaced people worldwide on record. A large number of these refugees are women, yet little is known about their specific situation and the hurdles they have to face during their journey. Herein, we investigated whether sociodemographic characteristics and traumatic experiences in the home country and during the flight affected the quality of life of refugee women arriving in Germany in 2015-2016. METHODS Six hundred sixty-three women from six countries (Afghanistan, Syria, Iran, Iraq, Somalia, and Eritrea) living in shared reception facilities in five distinct German regions were interviewed by native speakers using a structured questionnaire. Sociodemographic data and information about reasons for fleeing, traumatic experiences, symptoms, quality of life, and expectations towards their future were elicited. All information was stored in a central database in Berlin. Descriptive analyses, correlations, and multivariate analyses were performed. RESULTS The most frequent reasons cited for fleeing were war, terror, and threat to one's life or the life of a family member. Eighty-seven percent of women resorted to smugglers to make the journey to Europe, and this significantly correlated to residence in a war zone (odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.4-4.6, p = 0.003) and homelessness prior to fleeing (OR = 2.1, 95% CI = 1-4.3, p = 0.04). Overall the described quality of life by the women was moderate (overall mean = 3.23, range of 1-5) and slightly worse than that of European populations (overall mean = 3.68, p < 0.0001). The main reasons correlating with lower quality of life were older age, having had a near-death experience, having been attacked by a family member, and absence of health care in case of illness. CONCLUSIONS Refugee women experience multiple traumatic experiences before and/or during their journey, some of which are gender-specific. These experiences affect the quality of life in their current country of residence and might impact their integration. We encourage the early investigation of these traumatic experiences to rapidly identify women at higher risk and to improve health care for somatic and mental illness.
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Affiliation(s)
- Jenny Jesuthasan
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Große Hamburger Straße 5 - 11, 10115, Berlin, Germany
| | - Ekin Sönmez
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Große Hamburger Straße 5 - 11, 10115, Berlin, Germany.,Department of Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ingar Abels
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Große Hamburger Straße 5 - 11, 10115, Berlin, Germany
| | - Christine Kurmeyer
- Office of the Equal Opportunities Officer, Charité-Universitätsmedizin, Berlin, Germany
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Renate Kimbel
- Insitute of Occupational, Social and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany
| | - Antje Krüger
- Insitute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Guenter Niklewski
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Kneginja Richter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany.,Faculty for Social Sciences, Technical University Nuremberg GSO, Nuremberg, Germany.,Faculty for Medical Sciences, UGD University Stip, Stip, Macedonia
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Anja Wollny
- Insitute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Ulrike Zier
- Insitute of Occupational, Social and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen (117), The Netherlands. .,Institute of Legal Medicine, Charité-Universitätsmedizin, Turmstr. 21, Haus N, 10559, Berlin, Germany.
| | - Meryam Shouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Große Hamburger Straße 5 - 11, 10115, Berlin, Germany.
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Kimbel R, Meyer B, Evrin F, Zier U. Umgang mit Sprachbarrieren im ärztlichen Alltag – Interaktives Seminar zur Überwindung sprachlicher Barrieren im Arzt-Patientenkontakt. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R Kimbel
- Institut für Arbeits-, Sozial- und Umweltmedizin der Universitätsmedizin Mainz, Mainz
| | - B Meyer
- Johannes Gutenberg-Universität Mainz, Fachbereich Translations-, Sprach- und Kulturwissenschaft, Germersheim
| | - F Evrin
- Johannes Gutenberg-Universität Mainz, Fachbereich Translations-, Sprach- und Kulturwissenschaft, Germersheim
| | - U Zier
- Institut für Arbeits-, Sozial- und Umweltmedizin der Universitätsmedizin Mainz, Mainz
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Zier U, Kimbel R. Subjektiver psychiatrischer/psychotherapeutischer Versorgungsbedarf und Inanspruchnahme bei geflüchteten Frauen in Mainz. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- U Zier
- Institut für Arbeits-, Sozial- und Umweltmedizin der Universitätsmedizin Mainz, Mainz
| | - R Kimbel
- Institut für Arbeits-, Sozial- und Umweltmedizin der Universitätsmedizin Mainz, Mainz
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Gomez R, Zier U, Passet-Wittig J, Seufert R, Münster E. Welche Rolle spielt der Gynäkologe als Ansprechpartner auf dem Weg in die Kinderwunschbehandlung? – Ergebnisse der Basiserhebung der prospektiven PinK-Studie (Paare in Kinderwunschbehandlung). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wiederkehr M, Letzel S, Zier U. Inanspruchnahme von Kinderfrüherkennungsuntersuchungen durch Kinder Asylsuchender in Mainz – Ergebnisse einer qualitativen Befragungsstudie. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zier U, Letzel S. Teilnahme an der Früherkennungsuntersuchung für Hautkrebs und Selbstuntersuchung der Haut – Ergebnisse einer Querschnittbefragung an Türken und Deutschen in Rheinland-Pfalz. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mirastschijski U, Sander J, Zier U, Rennekampff H, Weyand B, Vogt P. The cost of post-burn scarring. Ann Burns Fire Disasters 2015; 28:215-222. [PMID: 27279810 PMCID: PMC4883608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/20/2014] [Indexed: 06/06/2023]
Abstract
Deep burns lead to scarring and contractures for which there is little or no published data on treatment costs. The purpose of this study was to fill this gap by analysing treatment costs for burn sequelae. To do this, German-DRG for in-patient treatment was collected from the Burn Centre Lower Saxony. DRG-related T95.-coding served as a tool for burn-associated sequelae. Data on scar occurrence, plastic-reconstructive surgery and sick leave were collected by a questionnaire. The findings showed that 44.6% patients reported post-burn scarring and 31% needed surgical intervention. The expected risk for readmission was significantly higher (p=0.0002) with scars compared to without. Significantly higher costs for pressure garments were noted for scarred patients (p=0.04). No differences were found for ointments, silicone dressings or pain medication. Treatment costs for patients with scars were 5.6 times higher compared with no scar assessed by G-DRG. No differences were stated subsuming multiple readmissions for post-burn treatment per individual. Significantly higher costs (p=0.03) were noted for patients with burn sequelae other than scars with regard to individual readmissions. It has been revealed that treatment of scars causes higher costs than for other burn sequelae because of multiple surgical interventions. To reduce post-burn scarring and costs, specialized burn centres provide optimal and state-of-the-art treatment. As well as this, more emphasis should be laid on promoting research for the development of novel anti-scarring therapies.
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Affiliation(s)
- U. Mirastschijski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Bremen-Mitte, Germany
- CBIB, University of Bremen, Bremen, Germany
| | - J.T. Sander
- Department of Plastic, Hand and Reconstructive Surgery, Burn Centre Lower-Saxony, Hannover Medical School, Hannover, Germany
| | - U. Zier
- CBIB, University of Bremen, Bremen, Germany
| | - H.O. Rennekampff
- Department of Plastic, Hand and Burns Surgery, RWTH Aachen, Aachen, Germany
| | - B. Weyand
- Department of Plastic, Hand and Reconstructive Surgery, Burn Centre Lower-Saxony, Hannover Medical School, Hannover, Germany
| | - P.M. Vogt
- Department of Plastic, Hand and Reconstructive Surgery, Burn Centre Lower-Saxony, Hannover Medical School, Hannover, Germany
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Zier U, Letzel S. Wer nimmt teil an einer postalischen Befragung von Türken und Deutschen in Rheinland-Pfalz zur Inanspruchnahme von Gesundheitsleistungen? Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ahmadli G, Schnabel R, Jokuszies A, Vogt PM, Zier U, Mirastschijski U. [Impact of Martian and Lunar dust simulants on cellular inflammation in human skin wounds ex vivo]. HANDCHIR MIKROCHIR P 2014; 46:361-8. [PMID: 25412240 DOI: 10.1055/s-0034-1394419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND In 2006 NASA published its plans to build a manned lunar station in order to undertake missions to Mars in the future. Thus research projects have been conducted on the influence of Lunar and Martian dust on human health. The present study investigated the effect of Lunar and Martian dust simulants (LDS, MDS) in comparison with earth dust (ED) on viability, migration and inflammatory reaction during wound closure in an ex vivo human skin wound model. MATERIALS AND METHODS 6 mm full-thickness skin explants, with a central 3 mm epidermal wound were cultured with LDS, MDS or ED for 4 and 8 days and compared to wound closure without dust exposure. Tissue and conditioned medium were submitted to histological, immunohistochemical (Ki67, Caspase-3) and biochemical analyses (hydroxyproline assay, zymography, IL-6, TNF-α and TGF-β ELISA). RESULTS All dusts increased proinflammatory markers with significant increases in MDS-treated samples (IL-6: p<0.05; MMP-9: p<0.005) and reduced MMP-2 (p<0.05) compared to no dust controls over time. No significant differences were found regarding wound closure, proliferation, apoptosis and tissue degradation. CONCLUSION Highly oxidative Martian dust may cause increased cutaneous inflammation. As is currently advocated for wounds contaminated with earth dust, surgical wound debridement should be performed to ensure uncompromised wound healing.
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Affiliation(s)
- G Ahmadli
- Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Zentrum für Schwerbrandverletzte, Medizinische Hochschule Hannover, Hannover
| | - R Schnabel
- Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Zentrum für Schwerbrandverletzte, Medizinische Hochschule Hannover, Hannover
| | - A Jokuszies
- Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Zentrum für Schwerbrandverletzte, Medizinische Hochschule Hannover, Hannover
| | - P M Vogt
- Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Zentrum für Schwerbrandverletzte, Medizinische Hochschule Hannover, Hannover
| | - U Zier
- CBIB, University of Bremen, Bremen
| | - U Mirastschijski
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Klinikum Bremen-Mitte, Bremen
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Rieger S, Hochgatterer K, Wachter N, Zier U, Letzel S. Status quo der Begutachtung vibrationsbedingter Berufskrankheiten im Hand-Arm-Bereich in Österreich am Beispiel des Vibrationsbedingten Vasospastischen Syndroms (VVS). Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1386998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zier U, Münster E. Querschnittsstudie an Paaren in Kinderwunschbehandlung (PinK-Studie) – Sorgen um ausbleibende Schwangerschaft und der Weg in ein Kinderwunschzentrum. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1387073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Roßbach B, Kegel P, Zier U, Niemietz A, Letzel S. Protective efficacy of permethrin-treated trousers against tick infestation in forestry workers. Ann Agric Environ Med 2014; 21:712-717. [PMID: 25528907 DOI: 10.5604/12321966.1129920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION AND OBJECTIVE Prevention of tick borne diseases in forestry workers is essentially based on the use of appropriate clothing. The objective of this pragmatic, randomized, controlled trial was to assess the potential benefit of permethrin-treated working trousers for the prevention of tick infestation during forestry work. MATERIALS AND METHODS N=164 male forestry workers were equipped for a period of 16 weeks with permethrin-treated (intervention group-I) or untreated work trousers (control group-II). Subgroups, according to the use of trousers with (I-1, II-1) or without cut protection lining (I-2, II-2) were constituted. Tick infestation (quantity of ticks on the body surface) was assessed by questionnaire after 16 workdays. Control and intervention groups were compared by calculating the infestation rate (percentage of subjects with ticks) and the average number of ticks per workday. RESULTS The infestation rate in the intervention group was significantly lower than in the control group (36.6 vs. 63.4%, p=0.001; Fisher-test). Further analysis revealed a significant reduction of tick infestation by permethrin treatment only for subjects wearing trousers without the cut protection lining (I-2: 34.2 vs. II-2: 80.0%, p<0.001), while users of cut protection trousers did not benefit from such treated trousers (I-1: 38.6 vs. II-1: 47.6%, n.s.). Similar results were found for comparisons based on the average number of ticks per workday. CONCLUSIONS The use of permethrin-treated trousers does not completely prevent tick infestations. Improvement of tick protection has been shown only for some applications, but not in general. Additional prevention measures are therefore still indispensable.
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Affiliation(s)
- Bernd Roßbach
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Peter Kegel
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Ulrike Zier
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Adrian Niemietz
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Stephan Letzel
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Zier U, Roßbach B, Spahn D, Münster E. Sozial-erwünschtes Antwortverhalten von Grundschülern bei Angaben zur Tabakrauchexposition: Primär- und Sekundärprävention von Tabak- und Alkoholkonsum bei Kindern (PriSeTA-Studie). Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zier U, Nitsche D, Homann C, Münster E. [Financial problems involving contraceptives among women in poverty]. Gesundheitswesen 2012; 74:836-8. [PMID: 23254464 DOI: 10.1055/s-0032-1331183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- U Zier
- Institut für Arbeits-, Sozial- und Umweltmedizin der -Universitätsmedizin der Johannes Gutenberg-Universität Mainz.
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Zier U, Rüger H, Spahn D, Münster E. Erfahrungen mit Alkoholkonsum von Grundschülern in Hessen - Ergebnisse der PriSeTA-Studie (Primär- und Sekundärprävention von Tabak- und Alkoholkonsum bei Kindern: eine Querschnittsstudie). Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zier U, Spahn D, Nitsche D, Rüger H, Passet J, Schneider N, Schuhrke B, Seufert R, Münster E. Paare in Kinderwunschbehandlung (PinK) - Ergebnisse eines mündlichen und schriftlichen Pre-Tests für eine prospektive Kohortenstudie. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ochsmann EB, Zier U, Drexler H, Schmid K. Well prepared for work? Junior doctors' self-assessment after medical education. BMC Med Educ 2011; 11:99. [PMID: 22114989 PMCID: PMC3267657 DOI: 10.1186/1472-6920-11-99] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 11/24/2011] [Indexed: 05/04/2023]
Abstract
BACKGROUND Apart from objective exam results, the overall feeling of preparedness is important for a successful transition process from being a student to becoming a qualified doctor. This study examines the association between self-assessed deficits in medical skills and knowledge and the feeling of preparedness of junior doctors in order to determine which aspects of medical education need to be addressed in more detail in order to improve the quality of this transition phase and in order to increase patient safety. METHODS A cohort of 637 doctors with up to two years of clinical work experience was included in this analysis and was asked about the overall feeling of preparedness and self-assessed deficits with regard to clinical knowledge and skills. Three logistic regression models were used to identify medical skills which predict the feeling of preparedness. RESULTS All in all, about 60% of the participating doctors felt poorly prepared for post-graduate training. Self-assessed deficits in ECG interpretation (aOR: 4.39; 95% CI: 2.012-9.578), treatment and therapy planning (aOR: 3.42; 95% CI: 1.366-8.555), and intubation (aOR: 2.10; 95% CI: 1.092-4.049) were found to be independently associated with the overall feeling of preparedness in the final regression model. CONCLUSIONS Many junior doctors in Germany felt inadequately prepared for being a doctor. With regard to the contents of medical curricula, our results show that more emphasis on ECG-interpretation, treatment and therapy planning and intubation is required to improve the feeling of preparedness of medical graduates.
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Affiliation(s)
- Elke B Ochsmann
- Institute of Occupational and Social Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany
| | - Ulrike Zier
- Institute of Occupational, Environmental and Social Medicine, Mainz University Medicine, Obere Zahlbacher Strasse 67, D-55131 Mainz, Germany
| | - Hans Drexler
- Institute of Occupational, Environmental and Social Medicine, University of Erlangen-Nuremberg, Schillerstrasse 25/29, D-91054 Erlangen, Germany
| | - Klaus Schmid
- Institute of Occupational, Environmental and Social Medicine, University of Erlangen-Nuremberg, Schillerstrasse 25/29, D-91054 Erlangen, Germany
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Zier U, Kimbel R, Letzel S, Münster E. Multimediale Lehreinheiten in der Sozialmedizin am Beispiel des Themas Schwerbehinderung an der Universitätsmedizin der Johannes Gutenberg-Universität Mainz. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rüger H, Schneider NF, Zier U, Letzel S, Münster E. Koinzidenz kritischer Lebenslagen am Beispiel überschuldeter Väter und Mütter nach Trennung oder Scheidung und der Zusammenhang mit Gesundheit und Gesundheitsverhalten. Eine explorative Studie am Setting Schuldnerberatungsstellen. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Zier U, Rüger H, Münster E. Fehlinformation als Quelle ungleicher Gesundheitschancen - Am Beispiel der Auskünfte Gesetzlicher Krankenkassen bezüglich zahnärztlicher Vorsorgeuntersuchungen. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1274497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rueger H, Schneider NF, Zier U, Letzel S, Muenster E. Health risks of separated or divorced over-indebted fathers: separation from children and financial distress. Soc Work Health Care 2011; 50:242-256. [PMID: 21400364 DOI: 10.1080/00981389.2010.527793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The study examines over-indebted fathers after separation/divorce with respect to health-related lifestyles/state of health. A cross-sectional survey was conducted among over-indebted persons in Germany 2006/2007 (response rate 39.7%). Fathers in complete families (n = 73; M = 37 years) and single mothers (n = 72; M = 33.5 years) served as comparison groups to the separated fathers (n = 59; M = 37 years). Risks of depressive mood, unhealthy nutrition, and hypertension were higher compared to fathers in complete families. Tobacco use and low health awareness proved to be higher than among both comparison groups. The findings indicate problematic health-related behavior and health status among separated over-indebted fathers, and suggest recognizing them as a high risk group within social work.
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Affiliation(s)
- Heiko Rueger
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany.
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Muenster E, Zier U, Letzel S, Ochsmann E, Weirich HH, Toschke AM. Low social support and further risk factors for nicotine abuse in childhood and adolescence in Germany. Soc Work Health Care 2011; 50:230-241. [PMID: 21400363 DOI: 10.1080/00981389.2010.514551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The health hazards of tobacco consumption are well known; numerous prevention programs exist, but knowledge of risk factors for starting to smoke is scarce. This study addressed the question if school-related factors influence smoking behavior in 7-17-year-old pupils. A cross-sectional study including 2459 pupils of schools in Rhineland-Palatinate, Germany, was conducted. Roughly every twentieth child (n = 135, 4.5%) had smoked at least once. In the multivariate model the probability of smoking was associated with older age, being male, not being content, and having inadequate family support, as well as with feeling unfairly treated at school. These findings suggest the imposition of gender- and age-adequate prevention with a focus on social support from school and parents to decrease the number of juvenile smokers.
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Affiliation(s)
- Eva Muenster
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany.
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Zier U, Rüger H, Escobar Pinzón L, Letzel S, Münster E. Ungleiche Gesundheitschancen durch Fehlinformationen – Diskrepanz der Auskünfte Gesetzlicher Krankenversicherungen bezüglich der Zuzahlungsfreiheit zahnärztlicher Vorsorgeuntersuchungen im Vergleich zur rechtlichen Regelung. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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