Luise Prüfer-Krämer

Trends in sociodemographic and health-related indicators in Bangladesh, 1993-2007: will inequities persist?

OBJECTIVE To assess levels, trends and gaps between the poorest and the richest in selected health and human development indicators in Bangladesh. METHODS Data for selected indicators associated with sociodemographic characteristics among ever-married women, contraception use, child vaccination, antenatal care practices and health conditions were extracted from the Bangladesh Demographic and Health Surveys conducted in 1993-94, 1996-1997, 1999-2000, 2004 and 2007. Results for the whole sample and for the poorest and the richest wealth quintiles are presented. FINDINGS Positive trends were noted in urbanization, availability of electricity, age at first marriage, use of modern contraception, access to skilled antenatal care, child vaccination, knowledge of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome and overweight and obesity. In contrast, negative trends were seen in factors such as literacy, infant and child mortality, fertility rate, home delivery and malnutrition and underweight. However, changes in these indicators differed between the poorest and richest quintiles. For instance, only the richest quintile experienced rapid urbanization, whereas illiteracy declined more among the poorest. Noteworthy gaps were found in almost all factors. Rich-poor gaps in urbanization, age at marriage, fertility, condom use, home delivery and overweight increased; in contrast, gaps in education, water and sanitation, use of contraception (except condoms) and child vaccination declined. CONCLUSION Persistent inequities in Bangladesh endanger equitable and sustainable human development in the country. Pro-poor development strategies based on the principles of equity and quality should be implemented to narrow existing gaps and further promote holistic and equitable human development.

Differences in Health Determinants Between International and Domestic Students at a German University

The authors used a standardized questionnaire to survey 201 international and 193 German students at the University of Bielefeld, Germany, to determine differences in health practices between the 2 groups and to identity targets for health-promoting interventions. Multivariate logistic regression models revealed that long-term female international students (those whose duration of residency in Germany was more than 2 years) had lower levels of physical activity and alcohol consumption than their German counterparts and higher rates of smoking independently associated with international citizenship. Short-term international female students were less likely than German students to receive social support. Among men, long-term international student status was associated with daily smoking and inconsistent seat belt use, whereas short-term student status was associated with a lower rate of seat belt use, a higher level of perceived stress, and a healthier diet, compared with domestic students. Findings from the study could give rise to health-promotion activities for international students at German universities; additional studies at other European universities are necessary before making further recommendations.

Health status and disease burden of unaccompanied asylum-seeking adolescents in Bielefeld, Germany: cross-sectional pilot study

This exploratory pilot study aimed to investigate the physical and mental disease burden of unaccompanied asylum‐seeking adolescents arriving in Bielefeld, a medium‐size city in Germany.

Sexual behavior and the prevalence of Chlamydia trachomatis infection in asymptomatic students in Germany and Spain

This study aimed to assess patterns of sexual activity, preventive behaviors, contraceptive use, and the prevalence of chlamydia infection in student populations from two countries. 188 asymptomatic students of the University of Bielefeld, Germany and 590 students of the Navarra Public University, Spain were surveyed using a standardized self-administered questionnaire. Urine samples were analyzed by ligase chain reaction technique for chlamydia infection. Compared to German students, Spanish students were less likely to have more than one sex partner within the last 12 months (OR: 0.62; CI: 0.46–0.83), to have sexual intercourse more than one time per week (OR: 0.70; CI: 0.52–0.93) and to use oral contraceptives (OR: 0.16; CI: 0.10–0.26). They reported a higher use of condoms (OR: 2.93; CI: 2.01–4.27) and were more likely to always use condoms with a new sex partner (OR: 2.47; CI: 1.72–3.53). The prevalence of chlamydia infection was considerably higher in German students (4.8% in females; 2.2% in males) than in Spanish students, where no case was found. The higher frequency of sexual activity, a higher engagement in risk-taking sexual behavior and the lower use of barrier contraceptives may contribute to the higher prevalence of chlamydia infection in German students.

Climate Change and Infectious Diseases in Megacities of the Indian Subcontinent: A Literature Review

Global environmental change or climate change is a growing and challenging area of multidisciplinary research. It poses an emerging threat to global public health as well as to the wellbeing of many populations (Costello et al. 2009; Campbell-Lendrum and Corvalan 2007). It inhibits the progress of poverty reduction and the reaching of the Millennium Development Goals (Mitchell and Tanner 2006). Annually, over 150,000 deaths and 5 million disability-adjusted life years (DALYs) losses occur due to such change (Patz and Olson 2006). According to the recent report of the UCL Lancet Commission, the health effects of climate change will be even stronger in the next decades and will place the lives and wellbeing of billions of people at increased risk (Costello et al. 2009).

Experience with the new German hepatitis B vaccination strategy since 1995

In Germany general hepatitis B (HB) vaccination for newborns and adolescents was introduced in all federal states following the recommendation of the STIKO (Permanent Vaccination Commission) of 1995. In 1998 serological studies of the German National Health Survey showed that at least 9.8% in the age group of 18 to 19 years had been vaccinated against HBV infection. By 1996 the vaccine doses sold for children rose dramatically and started to reach a plateau of approximately five million per year in 1997. Data from the kassenärztliche Vereinigung of the Oberpfalz region in Bavaria also indicate that the new policy started to be implemented in 1996. At school entry, however, in 1997 only 10% of the children in seven West German states showed serological evidence of HB vaccination coverage. According to observations of virologists, paediatricians and public health experts the current acceptance of the HB vaccination recommendations is 80%–90% in children below the age of six years but only 30% to 40% in adolescents. To achieve high HB vaccination coverage rates in Germany more rapidly a modern surveillance system providing detailed data about vaccination coverage in the different age and population groups is needed. Based on those data additional targeted vaccination strategies for those that can only be contacted by the traditional health care system, such as teenagers and vulnerable groups, should be developed, involving the public health service, local communities and other agencies.

Gibt es einen Bedarf für eine betriebliche Gesundheitsförderung für Studierende

ZusammenfassungZu gesundheitlichen Ressourcen und Risiken und zum Bedarf an Angeboten zur Gesundheitsförderung von Studierenden liegen in Deutschland — anders als im angelsächsischen Raum — bislang nur wenige Studien vor. Wir untersuchten daher die Frage, inwieweit Studierende gesundheitsfördernde Angebote und Maßnahmen, die ihre Kompetenzen im Umgang mit der eigenen Gesundheit fördern, am Arbeitsplatz Universität wünschen und in Anspruch nehmen würden. In einer Querschnittsstudie im Wintersemester 1995/96 wurde bei 650 Studienanfängern neben der Erfassung spezifischer Gesundheitspotentiale und Gesundheitsrisiken auch der Bedarf an universitärer Gesundheitsförderung erhoben.Die Auswertung ergab, daß die Gruppe der Studierenden auf der einen Seite über gesundheitliche Potentiale, wie z.B. ein hohes Gesundheitsbewußtsein verfügten (60,0%), auf der anderen Seite jedoch spezifische Gesundheitsrisiken wie Rauchen (24,5%) und psychosozialer Streß (21,4%) identifiziert werden konnten. Es bestand ein hoher Bedarf nach Gruppen- und Beratungsangeboten zur Gesundheitsförderung, vor allem in den Bereichen Streßbewältigung, gesunde Ernährung und Schutz vor sexuell übertragbaren Erkrankungen. Frauen äußerten in einigen Bereichen ein größeres Interesse an solchen Angeboten als Männer. Gesundheitsrisiken wie psychosozialer Streß und eine Alkoholismusgefährdung waren die stärksten Prädiktoren für ein Interesse an einer Gesundheitsberatung.Es wurde gezeigt, daß bei den Studierenden der Universität Bielefeld ein großer Bedarf für eine universitäre Gesundheitsförderung besteht, der sich sowohl durch das objektive Vorhandensein von spezifischen Gesundheitsrisiken als auch durch eine große Nachfrage von Seiten der Studierenden herleitet.AbstractUnlike the Situation in the United States and Great Britain, health behaviors and the need for health promotion in university students have rarely been studied in Germany. Therefore, we wanted to know whether students were attracted by health promoting programs that empower them to healthy behaviors at the university setting. To assess the health resources as well as health hazards, and the need for health promotion in this population, a questionnaire survey was performed in 650 university freshmen in the winter semester 1995/96.Students were found to be highly health conscious (60,0%) and to have strong health Potentials; however, specific health hazards such as smoking (24,5%) and psychosocial stress (21,4%) were also identified. There was a strong demand for group programs and individual counceling aiming at stress management, healthy nutrition and prevention of sexually transmitted diseases. Women reported a higher interest in some of these programs than men. Psychosocial stress and a disposition for alcohol abuse were the strongest predictors for the interest in health councelling.From the prevalence of health hazards and the students’ interest in health promotion programs we condude that there is a strong needfor health promotion in the university setting.

[Serological and sociodemographic differences in HBV-patients with and without migration background].

BACKGROUND It is estimated that 0.5 to 1 % of the total German population is chronically infected with the hepatitis B virus (HBV). This means that approximately 500 000 chronically infected individuals live in Germany and that around 10 % of them need antiviral treatment. According to an epidemiological calculation, around 42 % of them are migrants. The aim of our study was to gather more information on socio-demographic features of HBV patients and the sero-epidemological status and treatment of these patients. METHODS Data collection was carried out in hepatological practices and outpatient clinics in Germany. We collected data from adult patients with chronic hepatitis B by studying their patient records and interviewing the patients and the responsible physicians. RESULTS Data of 160 patients from 20 different facilities could be collected. 57.5 % of them were male, mean age was 43.7 (range: 19 - 81 years). 61 (38.1 %) were Germans without a migration background, 82 (51.3 %) were first generation migrants and 17 (10.6 %) second generation migrants. We detected significant differences in the level of professional training and employment status between participants with and without migration background. Only 3 % of migrants had a university degree compared to 36.1 % of patients without migration background. In addition, more migrants were unemployed (38.9 % vs. 19.6 %). From all participants 72.4 % were HBeAg-negative. 111 (69.4 %) of all patients received a hepatitis B specific treatment at the time they were interviewed, most of them adefovir (41.5 %) or lamivudin (35.4 %) alone. DISCUSSION The estimated high HBV prevalence in migrants from countries with intermediate to high prevalence is reflected in the high number of patients with migration background in hepatological practices and outpatient clinics. To avoid further HBV infections in this population group and to reduce the HBV prevalence in Germany, the effect of further interventions, like a general HBV screening of all new incoming migrants from intermediate or high endemic areas, their vaccination and if necessary treatment, have to be tested.Background: It is estimated that 0.5 to 1% of the total German population is chronically infected with the hepatitis B virus (HBV) This means that approximately 500 000 chronically infected individuals live in Germany and that around 10% of them need antiviral treatment According to an epidemiological calculation, around 42% of them are migrants The aim of our study was to gather more information on socio-demographic features of HBV patients and the sero-epidemological status and treatment of these patients. Methods: Data collection was carried out in hepatological practices and outpatient clinics in Germany We collected data from adult patients with chronic hepatitis B by studying their patient records and interviewing the patients and the responsible physicians Results: Data of 160 patients from 20 different facilities could be collected. 57 5% of them were male, mean age was 43.7 (range. 19-81 years). 61 (38.1%) were Germans without a migration background, 82 (51.3%) were first generation migrants and 17 (10 6%) second generation migrants. We detected significant differences in the level of professional training and employment status between participants with and without migration background. Only 3% of migrants had a university degree compared to 36.1% of patients without migration background. In addition, more migrants were unemployed (38.9% vs 196%) From all participants 72 4% were HBeAg-negative. 111 (69 4%) of all patients received a hepatitis B specific treatment at the time they were interviewed, most of them adefovir (41 5%) or lamivudin (35.4%) alone. Discussion: The estimated high HBV prevalence in migrants from countries with intermediate to high prevalence is reflected in the high number of patients with migration background in hepatological practices and outpatient clinics. To avoid further HBV infections in this population group and to reduce the HBV prevalence in Germany, the effect of further interventions, like a general HBV screening of all new incoming migrants from intermediate or high endemic areas, their vaccination and if necessary treatment, have to be tested

Klimawandel und Infektionskrankheiten

Klimaveranderungen, die einen Einfluss auf die biologische Umwelt und das Verhalten und die Empfanglichkeit des Menschen haben, wirken sich auf die Verbreitung von Infektionskrankheiten aus. Erkrankungen, die im Rahmen des Klimawandels in den Tropen und Subtropen eine besondere Rolle spielen, sind vor allem gastrointestinale Infektionen, Malaria, Denguefieber und Chikungunyafieber. In gemasigten Zonen sind dies z. B. Borreliosen, Fruhsommermeningoenzephalitis, Campylobacter- und Hantavirusinfektionen. Selbst in polarnahen Gebieten ist in warmen Sommern durch erhohte Wassertemperatur und die Abnahme des Permafrostes mit einer Zunahme von bestimmten Infektionen zu rechnen. Public Health-Masnahmen mit Beteiligung verschiedener Akteure und betroffener Gruppen konnen die Adaptation auf der Mikro- und Makroebene sicherstellen.

Infektionskrankheiten bei Frauen und Männern

Wenn man die Verbreitung von Infektionskrankheiten unter historischen Gesichtspunkten betrachtet, so ist zu erkennen, dass grose Epidemien oftmals vorzugsweise bestimmte Personen- oder Bevolkerungsgruppen betrafen. Beispiele von Epidemien, die vor allem Manner betrafen, sind Typhus- und Ruckfallfieberepidemien bei deutschen Truppen im Ersten und Zweiten Weltkrieg. Im Folgenden wird eine geschlechtervergleichende Betrachtung von Infektionskrankheiten durchgefuhrt, welche auf der Analyse von Sekundardaten beruht. Diese explorative Datenanalyse dient dem Zweck, Hypothesen uber die moglichen Ursachen fur die Geschlechterunterschiede bei Infektionskrankheiten zu generieren.