Juergen Breckenkamp

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries. DOI: http://dx.doi.org/10.7554/eLife.13410.001

Progress on quality management in the German health system – a long and winding road

The interest in quality management in health care has increased in the last decades as the financial crises in most health systems generated the need for solutions to contain costs while maintaining quality of care. In Germany the development of quality management procedures has been closely linked with health care reforms. Starting in the early nineties quality management issues gained momentum in reform legislation only 10 years later.This review summarizes recent developments in medical quality management as related to the federal reform legislation in Germany. It provides an overview on the infrastructure, actors and on the current discussion concerning quality management in medical care.Germany had to catch up on implementing quality management in the health system compared to other countries. Considerable progress has been made, however, it is recognized that the full integration of quality management will require long-term commitment in developing methods, instruments and communication procedures. The most ambitious project at present is the development of a comprehensive comparative quality management system for hospitals at national level, including public reporting. For the time being medical quality management in Germany is dealt with as a technical and professional issue while the aspects of patient orientation and transparency need further advancement.

Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study

Objective Research on health services for immigrants has mostly been concerned with access barriers but rarely with appropriateness and responsiveness of care. We assessed whether appropriateness and responsiveness of care depend on migration status, using provision of neuraxial anaesthesia (NA) during labour as indicator. In relation to their migration status, we analysed whether (1) women undergoing elective or secondary/urgent secondary caesarean sections (ESCS) appropriately receive NA (instead of general anaesthesia), (2) women delivering vaginally appropriately receive NA and (3) women objecting to NA, for example, for religious reasons, may deliver vaginally without receiving NA (provider responsiveness). Design Cross-sectional study. Setting Three obstetric hospitals in Berlin, Germany. Methods Questionnaire survey covering 6391 women with migration history (first and second generations) and non-immigrant women giving birth; data linkage with routine obstetric data. We assessed the effects of migrant status, German language proficiency, religion and education on the provision of NA (primary outcome) after adjusting for other maternal and obstetric parameters. Results The chance of receiving NA for elective/ESCS was independent of migrant status after controlling for confounding variables (adjusted OR (aOR) 0.93, 95% CI 0.65 to 1.33). In vaginal deliveries, first (but not second) generation women (aOR 0.79, 95% CI 0.65 to 0.95), women with low German language skills (aOR 0.77, 95% CI 0.58 to 0.99) and women with low educational attainment (aOR 0.62, 95% CI 0.47 to 0.82) had lower chances of receiving NA; there was no evidence of overprovision among women with strong affinity to Islam (aOR 0.77, 95% CI 0.63 to 0.94). Conclusions We found evidence for underprovision of care among first-generation immigrants, among women with low German language proficiency and particularly among all women with low educational attainment, irrespective of migration status. There was no evidence for overprovision of care to immigrant women, either inappropriately (general anaesthesia for ESCS) or because of low provider responsiveness (no opt-out for NA in vaginal delivery).

Werden Frauen mit und ohne Migrationshintergrund von den Gesundheitsdiensten gleich gut erreicht?@@@Are women with and without migration background reached equally well by health services?: Das Beispiel Schwangerenvorsorge in Berlin@@@The example of antenatal care in Berlin

ZusammenfassungHintergrundRund 20 % der Bevölkerung Deutschlands hat einen Migrationshintergrund („1. Generation“: selbst migriert; „2. Generation“: deren Nachkommen), der mit gesundheitlicher Benachteiligung einhergehen kann.FragestellungBestehen die in früheren Untersuchungen beobachteten Unterschiede bei der Inanspruchnahme der Schwangerschaftsvorsorge zwischen Frauen mit und ohne Migrationshintergrund weiterhin?MethodenDatenerhebung 2011/2012 an drei Berliner Geburtskliniken anhand standardisierter Interviews, Verknüpfung der Befragungsdaten mit Perinatal- und Mutterpassdaten. Adjustierung für Störgrößen im Regressionsmodell.ErgebnisseVon den 7100 Studienteilnehmerinnen (Response 89,6 %) hatten 57,9 % einen Migrationshintergrund. 92,1 % der Migrantinnen der ersten Generation versus 97,8 % der Nicht-Migrantinnen nahmen die erste Vorsorgeuntersuchung in der Schwangerschaftswoche 3–19 in Anspruch (Mittelwerte SSW der ersten Vorsorgeuntersuchung: Migrantinnen der 1. Generation mit Aufenthaltsdauer < 5 Jahre: 13,0; > 5  Jahre: 9,9; Nicht-Migrantinnen 9,7). Eine geringe Inanspruchnahme von ≤ 5 Vorsorgeuntersuchungen fand sich bei 644 Frauen (9,1 %). Unter den Nicht-Migrantinnen sind 7,1 % „Wenignutzerinnen“, unter den Migrantinnen der ersten Generation 11,8 % (bei Frauen ohne Deutschkenntnisse jedoch 33,0 %). Nichtmedizinische Angebote werden von Frauen mit Migrationshintergrund weniger genutzt.DiskussionIn Berlin hat heute ein Migrationshintergrund kaum noch Einfluss auf die Inanspruchnahme der Schwangerenvorsorge. Weder eigene Zuwanderung noch niedriger Akkulturationsgrad sind eigenständige Risikofaktoren für geringe Nutzung oder späte Teilnahme, tendenziell aber kurze Aufenthaltsdauer. Die kleine Gruppe der „Wenignutzerinnen“ sollte differenzierter betrachtet werden, hier bestehen häufiger sprachliche Barrieren.AbstractBackgroundAbout 20 % of the population in Germany has a migration background (1st generation: immigrated themselves; 2nd generation: offspring of immigrants), which can be associated with health differentials. We assessed whether differentials in uptake of antenatal care (ANC) observed in earlier studies still persist today.MethodsData collection in 3 obstetric hospitals in Berlin, Germany, over a 1-year period 2011/2012. We conducted standardised interviews before delivery and linked the data to routinely collected perinatal data and to data from participants’ antenatal cards. We checked for confounders using regression models.ResultsOf the 7100 study participants (response 89.6 %), 57.9 % had a migration background. First ANC attendance occurred in pregnancy weeks 3–19 in 92.1 % of 1st generation immigrants vs. 97.8 % of non-immigrants (mean week of first attendance: 1st generation immigrants with residence < 5 years: 13.0; 5 + years: 9.9; non-immigrants 9.7). A low ANC utilisation with ≤ 5 visits was found in 644 women (9.1 %). Among the non-immigrants there were 7.1 % low users, among 1st generation immigrants 11.8 % (among women with no German language skills 33.0 %, however). Uptake of non-medical support measures was lower among women with migration background.DiscussionIn our sample from Berlin, migration background had little effect on ANC uptake. Neither own migration nor low acculturation were independent risk factors for late onset or low utilisation of ANC. However, a small subgroup of women with a short duration of residence in Germany and with German language problems had a lower chance of timely onset and sufficient participation in ANC. This group needs special attention.

Treatment of elevated cholesterol in a representative cross-sectional sample of 4 892 Germans: is there a social gradient?

Background: effective control of cardiovascular risk factors remains low in most countries and also in Germany. We investigate whether socio-economic status has an impact on the level of medical treatment and control (normalized values) of total cholesterol. Methods: data on blood lipids from 4 892 participants in the last German Health Survey of 1998 are analysed, adjusting for key determinants in logistic regression analyses. Socio-economic status is not determined by educational achievement alone but also including occupation and household income. Results: the actual prevalence of total cholesterol of ≥240 mg/dl was 53.4%. Only 3.6% of prevalent cases are under effective treatment. Less favourable values of total cholesterol and HDL are displayed by males and in lower social groups, while the middle groups are in an intermediate position. Chances to be treated for hypercholesterolemia are significantly less favourable for females (odds ratio (OR) estimate: 0.70) and better for the age bands ≥50 (OR 2.37) and ≥60 (OR 3.57), if a general practitioner is visited (OR 1.77), and if living in Eastern Germany (OR 1.89). However, chances are not significantly different according to social status. Conclusions : statistically significant social group differences cannot be detected at the present low level of effective treatment. This may be different if higher levels of control are achieved.