Do health literacy, physical health and past rehabilitation utilization explain educational differences in the subjective need for medical rehabilitation? Results of the lidA cohort study.

BACKGROUND: Medical rehabilitation can be helpful for maintaining workers' health and work ability. Its contribution to longer working lives is of high economic relevance in aging populations. In Germany, individuals must apply for rehabilitative measures themselves. Therefore, the subjective need for rehabilitation (SNR) is a prerequisite for rehabilitation access. A low education level is associated with poor health, lower health literacy and more frequent utilization of health services. In the present study, we investigated whether lower educational levels are also associated with a greater SNR and whether health literacy, past rehabilitation utilization and physical health play a mediating role in this path in older employees. METHODS: 3,130 socially insured older employees (born in 1959 or 1965) who participated in the German prospective lidA (leben in der Arbeit) cohort-study in 2011, 2014 and 2018 were included. A causal mediation analysis with an inverse odds weighting approach was performed with the SNR as the dependent variable; educational level as the independent variable; and health, health literacy and past rehabilitation utilization as the mediating variables. Sociodemographic variables were adjusted for. RESULTS: The SNR was significantly greater in subjects with a low education level, poor physical health, inadequate health literacy and those who had utilized rehabilitation in the past. For health literacy, past rehabilitation utilization and physical health, a significant partial mediating effect on the SNR was found for employees with low compared to those with high education levels. However, the combined mediating effect of all the mediators was lower than the sum of their individual effects. Among those with medium or high education levels, none of the variables constituted a significant mediator. CONCLUSIONS: The path between a low education level and a high SNR is mediated by inadequate health literacy, past rehabilitation utilization and poor physical health; these factors do not act independently of each other. Promoting health education may lower the SNR by improving physical health and health literacy. While improving physical health is beneficial for individuals, improved health literacy can be economically advantageous for the health system by reducing inappropriate expectations of rehabilitation benefits and subsequent applications for rehabilitation.

[Obstetric Care for Gestational Diabetes in Refugee and Immigrant Women in Comparison to Non-Immigrant Women in Berlin: an Analysis of Quantitative Data of the Pregnancy and Obstetric Care for Refugees (PROREF)-study]. / Geburtsmedizinische Versorgung bei Gestationsdiabetes von geflüchteten und immigrierten Frauen im Vergleich zu nicht-immigrierten Frauen in Berlin: Eine Analyse quantitativer Daten der Pregnancy and Obstetric Care for Refugees (PROREF)-Studie.

RESEARCH QUESTION: Are there differences in the frequency of gestational diabetes between women of self-defined refugee status (SDRS), immigrant women, and women born in Germany? Does the perinatal data of women with gestational diabetes (GDM) differ depending on the migration status? METHOD: For the Pregnancy and Obstetric Care for Refugees (ProRef) study between June 2020 and April 2022, data was collected with the Migrant Friendly Maternity Care Questionnaire (MFMCQ) among women on the postpartum ward in three perinatal centers in Berlin. The data concerning GDM was statistically analyzed. RESULTS: Women of SDRS were tested for GDM (3.2%, p=0.0025) significantly less often than immigrant women (1.4%) or women born in Germany (0.6%). The rate of GDM was higher among immigrant women (19.6%, p=0.001) than among women born in Germany (15.0%) and women of SDRS (14.1%). The rate of GDM varied depending on the country of origin. Vietnam (OR 3.41) and Turkey (OR 2.18) as countries of origin, corrected for age and body mass index, increased the chance of gestational diabetes. The perinatal outcome data among women with GDM did not differ depending on the migration status. CONCLUSION: As women of SDRS are tested for GDM less frequently, this potentially suggests a supply gap in the health care system. However, the perinatal outcome data does not differ for women of SDRS.

[Workload and Rehabilitation Needs of Older Workers with and without Migrant Background - Results of the lidA Cohort Study]. / Arbeitsbelastungen und Rehabilitationsbedarf bei älteren Erwerbstätigen mit und ohne Migrationshintergrund ­ Ergebnisse der lidA Kohortenstudie.

BACKGROUND: The need for rehabilitation measures will increase in the future due to increasing retirement age and demographic changes. In addition, the need for rehabilitation measures is determined, among other things, by the strenuousness of work. The aim of the present study was to investigate whether employees with a migrant background (EmM) are exposed to strenuous work more often and have a higher need for rehabilitation than employees without a migrant background (EoM). MATERIAL AND METHODS: The lidA study is a nationwide, prospective cohort study focusing on work, age, health and labour force participation. Study subjects (2443 female, 2281 male) were socially secured employees, born in 1959 or 1965. They were personally interviewed with computer assistance. Data from the first study wave (2011) were used. Multiple logistic regression analyses adjusted for socio-demographic factors (age, gender, education and household equivalent income) were carried out to estimate the influence of migrant background, nationality and high workloads on the need for rehabilitation. RESULTS: First generation EmMs were particularly affected by high workloads compared to EoM. The subjectively experienced workloads of EoM and EmM of the second generation were on a comparable level. In contrast, there were no differences between EmM with German and foreign citizenship. After adjustment for sociodemographic and workload-related factors, a higher need for rehabilitation was shown for the first-generation EmM (not significant) in comparison with the second-generation EoM and EmM, but not for EmM with foreign citizenship in comparison with EmM with German citizenship. DISCUSSION: First-generation EmMs are exposed to strenuous work significantly more often and have a higher need for rehabilitation. However, the migrant background itself is not a determinant for increased rehabilitation needs. The significantly higher need for rehabilitation can rather be explained by the strenuousness of work and socio-demographic characteristics that are more frequent in first-generation EmM. Differentiated considerations of the subgroups of EmM are important to identify special needs and to avoid undersupply (e. g. due to access barriers).

Correction: Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs?

[This corrects the article DOI: 10.1371/journal.pone.0263643.].

Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs?

Due to demographic change with an ageing workforce, the proportion of employees with poor health and a need for medical rehabilitation is increasing. The aim was to investigate if older employees with migrant background have a different need for and utilization of medical rehabilitation than employees without migrant background. To investigate this, self-reported data from older German employees born in 1959 or 1965 of the first and second study wave of the lidA cohort study were exploratory analyzed (n = 3897). Subgroups of employees with migrant background were separated as first-generation, which had either German or foreign nationality, and second-generation vs. the rest as non-migrants. All subgroups were examined for their need for and utilization of medical rehabilitation with descriptive and bivariate statistics (chi-square, F- and post-hoc tests). Furthermore, multiple logistic regressions and average marginal effects were calculated for each migrant group separately to assess the effect of need for utilization of rehabilitation. According to our operationalizations, the foreign and German first-generation migrants had the highest need for medical rehabilitation while the German first- and second-generation migrants had the highest utilization in the bivariate analysis. However, the multiple logistic model showed significant positive associations between their needs and utilization of rehabilitation for all subgroups. Further in-depth analysis of the need showed that something like under- and oversupply co-exist in migrant groups, while the foreign first-generation migrants with lower need were the only ones without rehabilitation usage. However, undersupply exists in all groups independent of migrant status. Concluding, all subgroups showed suitable use of rehabilitation according to their needs at first sight. Nevertheless, the utilization does not appear to have met all needs, and therefore, the need-oriented utilization of rehabilitation should be increased among all employees, e.g. by providing more information, removing barriers or identifying official need with uniform standards.

[Violence Against Staff in Delivery Rooms - Results of an Online-Survey and Structured Interviews in Obstetric Clinics in Berlin]. / Gewalt gegen Kreißsaalpersonal ­ Ergebnisse einer Online-Befragung und von Leitfadeninterviews an Berliner Geburtskliniken.

INTRODUCTION: Violence against medical staff is a known problem in emergency departments. Nevertheless, there is little empirical data about physical and verbal violence against staff members in delivery rooms in Germany. METHODS: This study comprises both quantitative and qualitative analyses. For the quantitative part, midwives and doctors working in delivery rooms in Berlin were asked to fill out a questionnaire about their experiences with violence within the last 6 months; this survey was completed between 15 November 2019 and 15 February 2020. For the qualitative part, structured interviews were conducted to investigate individual experiences of violence in more detail. RESULTS: Out of 173 participants in total, 148 (86%) reported to have experienced verbal violence and 82 (47%) reported to have experienced physical violence. Midwives and younger staff seem to be more often affected by violence. 70% of the participants did not feel sufficiently prepared for situations of violence. In a total of 36 interviews, the participants specifically named communicative problems, too high expectations of the pregnant women and their companion, as well as language barrier and cultural differences as reasons for furthering violence. CONCLUSION: Violence against staff is a relevant problem in delivery rooms in Berlin. Participants would welcome training to deal with violence and professional help for coming to terms with experiences of violence. Improved information about pregnancy and delivery, institutionalized translation, and more staff could possibly help to decrease frequency of violence.

The role of education and migration background in explaining differences in folic acid supplementation intake in pregnancy: results from a German birth cohort study.

OBJECTIVE: Official German recommendations advise women to start taking folic acid supplementation (FAS) before conception and continue during the first pregnancy trimester to lower the risk of birth defects. Women from lower socio-economic background and ethnic minorities tend to be less likely to take FAS in other European countries. As little is known about the determinants of FAS in Germany, we aimed to investigate the association between FAS and formal education and migration background, adjusting for demographic factors. DESIGN: We used data (2013-2016) on nutrition and socio-economic and migration background from the baseline questionnaire of the BaBi cohort study. We performed multivariate regressions and mediation analyses. SETTING: Bielefeld, Germany. PARTICIPANTS: Nine-hundred forty-seven women (pregnant or who had given birth in the past 2 months). RESULTS: 16.7% of the participants (158/947) did not use FAS. Migration-related variables (e.g. language, length of stay) were not associated with FAS in the adjusted models. FAS was lower in women with lower level of formal education and in unplanned pregnancies. Reasons given by women for not taking FAS were unplanned pregnancy and lack of knowledge of FAS. CONCLUSIONS: Health practitioners may be inclined to see migrant women as an inherently at-risk group for failed intake of FAS. However, it is primarily women who did not plan their pregnancy, and women of lower formal education level, who are at risk. Different public health strategies to counter low supplementation rates should be supported, those addressing the social determinants of health (i.e. education) and those more focused on family planning.

A method to define the relevant ego-centred spatial scale for the assessment of neighbourhood effects: the example of cardiovascular risk factors.

INTRODUCTION: The neighbourhood in which one lives affects health through complex pathways not yet fully understood. A way to move forward in assessing these pathways direction is to explore the spatial structure of health phenomena to generate hypotheses and examine whether the neighbourhood characteristics are able to explain this spatial structure. We compare the spatial structure of two cardiovascular disease risk factors in three European urban areas, thus assessing if a non-measured neighbourhood effect or spatial processes is present by either modelling the correlation structure at individual level or by estimating the intra-class correlation within administrative units. METHODS: Data from three independent studies (RECORD, DHS and BaBi), covering each a European urban area, are used. The characteristics of the spatial correlation structure of cardiovascular risk factors (BMI and systolic blood pressure) adjusted for age, sex, educational attainment and income are estimated by fitting an exponential model to the semi-variogram based on the geo-coordinates of places of residence. For comparison purposes, a random effect model is also fitted to estimate the intra-class correlation within administrative units. We then discuss the benefits of modelling the correlation structure to evaluate the presence of unmeasured spatial effects on health. RESULTS: BMI and blood pressure are consistently found to be spatially structured across the studies, the spatial correlation structures being stronger for BMI. Eight to 22% of the variability in BMI were spatially structured with radii ranging from 100 to 240 m (range). Only a small part of the correlation of residuals was explained by adjusting for the correlation within administrative units (from 0 to 4 percentage points). DISCUSSION: The individual spatial correlation approach provides much stronger evidence of spatial effects than the multilevel approach even for small administrative units. Spatial correlation structure offers new possibilities to assess the relevant spatial scale for health. Stronger correlation structure seen for BMI may be due to neighbourhood socioeconomic conditions and processes like social norms at work in the immediate neighbourhood.

An ego-centred approach for the evaluation of spatial effects on health in urban areas based on parametric semi-variogram models: concept and validation.

BACKGROUND: Neighbourhood is a complex structure but of high relevance for health. Its operationalisation remains however a challenge.The aim of this work is to present a new application of the use of semi-variograms as an approach for the evaluation of spatial effects on health. For this, we propose to estimate two parameters providing a measure of an average neighbourhood or spatial effect at city level without having to predefine any notion of physical neighbourhood. METHODS: We present the statistical method to estimate the parameters of this correlation neighbourhood by fitting an exponential model to the empirical semi-variogram at short distances. With a simulation study, we show for which sample size and sampling density the method performs well and illustrate how to use the method with data from a birth cohort using the outcome birthweight. RESULTS: For small sample sizes (500) the method provides reliable estimates if the density of observations is high. For larger sample sizes other parameters influencing the quality of estimates are the maximal distance at which the semi-variograms are estimated. CONCLUSIONS: Given the complexity of spatial scales relative to neighbourhood spatial processes, our approach offers the possibility to incorporate existing approaches to the operationalisation of neighbourhood in quantitative analyses while providing a measure of the part of health inequalities which could be possibly due to unmeasured spatial exposure as well as a measure of their spatial scale.

Placental weight in first generation migrant mothers in Germany. Do the length of stay, acculturation or migrant status play a role?

INTRODUCTION: Migration status affects perinatal outcomes. A small placenta is associated with placental dysfunction and poor outcomes. Placental weight and perinatal outcomes are influenced by migrant status, the length of stay and the level of acculturation in the host country. Our aim was to compare placental weight in first generation immigrants to native non-immigrants in a teaching hospital in Berlin. The influence of migrant status, the length of stay and the level of acculturation on placental weight was also ascertained. METHODS: At the Charité University Hospital in Berlin Germany between January 2011 and January 2012, 1373 non-migrant and 1243 first generation migrants were included. Data collection was by means of a standardized questionnaire. The level of acculturation was based on the Frankfurter Acculturation Questionnaire (Frankfurter Akkulturationsfragebogen-FRAKK). Demographic parameters such as age, maternal weight, country of origin, parity, anemia, diabetes, hypertension, smoking and neonatal outcomes including neonatal weight, placental weight were measured. RESULTS: We found no difference in mean placenta weight when comparing first generation women with a migration background to women of the native population (608 g vs 597 g, p-value 0.41). There was also no difference in placental weight when assessed by the length of stay and degree of acculturation in the host country. DISCUSSION: While first generation migrant women have increased perinatal complications, there is no influence of migrant status, length of stay and the degree of acculturation on placenta weight. Pregnancy outcomes maybe be more dependent on factors such as the access to adequate maternal care.

[Pregnant Women with Gestational Diabetes in Berlin - An Analysis of Perinatal Data Especially Regarding Immigration Background]. / Schwangere mit Gestationsdiabetes in Berlin ­ Perinataldatenanalyse mit besonderer Berücksichtigung des Migrationsstatus.

To date there has not been a systematic analysis of pregnant patients with an immigrant background and gestational diabetes in Germany, even though the number of these patients has been rising continuously since the 1980s. METHODS: The case number estimate for this prospective study targeted 160 patients with gestational diabetes with and without an immigrant background. A questionnaire on socio-economic status, immigrant background, acculturation, and food intake was developed. The birth parameters and pre- and postpartum parameters were regularly documented. RESULTS: In our study we included 198 patients with gestational diabetes, consisting of 110 patients with an immigrant background and 88 patients without an immigrant background. The number of labor inductions for the suspected diagnosis of fetal macrosomia was almost the same in both groups (immigrant background 3.6% vs. without immigrant background 4.6%, p=1.0; OR 1.73; 95% CI; 0.79-3.89, p=0.17). The study patients with an immigrant background were more likely to give birth spontaneously than via cesarean section or vaginal-operative birth. The perinatal outcome of children from our study patients with and without an immigrant background were similar. CONCLUSION: We show that regardless of their immigrant background gestational diabetes patients have similar and homogeneous patient-centered care at our clinic.

[Utilization of Medical Rehabilitation and Access Barriers for Persons with a Migrant Background - Results of the lidA Cohort Study]. / Inanspruchnahme medizinischer Rehabilitation und Zugangsbarrieren bei Personen mit Migrationshintergrund ­ Ergebnisse der lidA-Kohortenstudie.

INTRODUCTION: Rehabilitation services are considerably less used by persons with a migration background of working age in Germany than by persons without migration background. One reason could be access barriers. They can arise both from the structures of the health/rehabilitation system as well as from influences of the personal environment, e. g. financial burdens incurred through the use of rehabilitation or cultural expectations. In addition to the migration status, other factors such as country of origin, reasons for immigration, length of stay as well as the religious affiliation and social status could influence the utilization of medical rehabilitation. It was examined to what extent differences in utilisation are due to the migration background and to migration-independent personal barriers to access. METHODS: The lidA-study is a nationwide, representative prospective cohort study among employees with insurable employment born in 1959 and 1965 with a focus on work, age, health and employment. Data from the first (2011) and the second wave (2014) were combined for the analyses. In addition to bivariate analyses to describe the sample according to migration status, logistic regression analyses were carried out to estimate the odds ratios for the influence of migration background or nationality and other factors on the use of a medical rehabilitation measure. RESULTS: The chance of receiving medical rehabilitation is increased for migrants of the 1st generation (odds ratio (OR) 1.56, 95% confidence interval (CI): 1.09-2.25). If predominantly or exclusively no German is spoken at home, this could be associated with a comparatively much lower chance of utilisation (OR: 0.56, 95% CI: 0.28-1.15). Because only nationality is often available in routine data to determine the status of migration, another model only considers migrants and 2nd generation nationals and examines the influence of nationality on utilisation. A foreign nationality was not associated with a higher utilisation (OR: 1.07, 95% CI: 0.55-2.08). DISCUSSION: Results of previous studies on the use of medical rehabilitation for people with a migration background are inconsistent. This could be due to different examined population groups, different indications for rehabilitation, a temporal change in utilisation and the various study designs as well as data sources. We found a higher use of medical rehabilitation services by persons with a migrant background (1st generation) compared to non-migrant persons. One reason could be our more precise definition of the migration background compared to analyses of routine data. If predominantly or exclusively another language than German is spoken at home, the utilisation tends to be lower. The finding coincides with a lack of German language skills described as an access barrier in the literature.

Subjective employment perspective among older workers with and without migrant background in Germany-Results of the lidA cohort study.

OBJECTIVES: The aim of this study was to investigate the subjective employment perspective in higher working age for different employee groups with migrant background (EMB) and without (non-EMB), meaning willing, being able, and planning to work until the individual state pension age (iSPA). METHODS: A representative sample of socially insured employees born in 1959 or 1965 was surveyed in 2011, 2014, and 2018 with computer-assisted personal interviews. The current cross-sectional analysis is based on data from the third study wave (n = 3286) of the lidA cohort study. EMB were differentiated via generation (first generation, G1, vs second generation, G2) or nationality (German vs foreign). Applying bivariate statistics with the tests of independence and block-wise logistic regressions, group differences were investigated. Sex, age, educational level, net household income, health, and work factors were considered as covariates. RESULTS: When comparing subgroups of EMB, significant differences appeared in bivariate analyses for willing and planning to work. G1 were to a higher degree planning to work longer than G2 and those with foreign nationality were more willing and planning than those with German nationality. Multivariate analyses revealed significant differences of G1 and non-EMB for planning, being significant in the fully adjusted model, but not for willing. CONCLUSION: The findings underline the need for differentiation of migrant groups in social research and policy. When it comes to extended working lives, the first-generation migrant group, as well as foreigners may constitute risk groups and require increased attention from a work, health, and economic point of view.

Utilisation of medical rehabilitation services by persons of working age with a migrant background, in comparison to non-migrants: a scoping review.

In Germany, an ageing population is affected by societal and political changes due to demographic transition, e.g. by a prolonged working life for older employees. Demographic change also influences persons of higher working age with a migrant background. In 2018, 25% of all employees in Germany had a migrant background. Those affected by poor health at a higher working age can benefit from medical rehabilitation services, which aim to prevent early retirement and disabilities. So far, the utilisation of medical rehabilitation has been lower among persons of foreign nationality (often the only available proxy for migrant background), compared to that of Germans. The aim of this scoping review is to assess the utilisation of medical rehabilitation services by those with migrant background (PMB) and those without (non-PMB) and to identify the differences between these groups. We included 25 studies in our analysis, which were mainly secondary analyses of routine data and also a small number of primary studies. The results were inconsistent: studies published before 2018 showed a lower use of rehabilitation services for persons of foreign nationality compared to Germans. However, no differences were found between PMB and non-PMB in studies published in 2018 or later. PMB, as well as foreign nationals, showed poorer health before medical rehabilitation utilisation and had a higher chance of occupational disease and a lower education level. We identified a lower work-related performance, as well as barriers (e.g. information deficits) in the utilisation of rehabilitation services for groups of PMB. Our review is limited in that we cannot generalise our results to all PMB living in Germany. This is because of the heterogeneity, the limited number of studies and lack of representativeness in some studies. In many cases, studies only analyse the nationality, but they lack information about the second generation PMB. Future studies should survey the utilisation of medical rehabilitation services by migrant background rather than by nationality and focus on changes in the provision of rehabilitation measures following diversity-centred strategies.

Does social cohesion mediate neighbourhood effects on mental and physical health? Longitudinal analysis using German Socio-Economic Panel data.

BACKGROUND: Neighbourhood has risen as a relevant determinant of health. While there is substantial evidence that environmental factors affect health, far less evidence of the role of social mechanisms in the causal chain between neighbourhood characteristics and health is available. METHOD: To evaluate the role of social cohesion as a mediator between four different neighbourhood characteristics and health using data from German Socio-Economic-Panel (SOEP), a longitudinal mediation analysis was performed. Multilevel linear regression models adjusted for socio-economic variables involved three time points and two measures of physical and mental health (physical and mental component scores (PCS and MCS) of the SF12 Questionnaire. Participants were followed-up for 4 and 10 year starting in 2004. RESULTS: A total of 15,518 measures of MCS and PCS on 10,013 participants living in 4985 households were included. After adjusting for values of MCS and PCS at baseline and demographic/socio-economic variables, social cohesion was a significant positive predictor of both MCS and PCS (ß-coefficient MCS: 1.57 (0.27); PCS: 1.50 (0.24)). Interaction between social cohesion and follow-up were significant for PCS. The effect of environmental and built characteristics on health was consistently mediated by social cohesion with proportion varying between 10 and 23%. DISCUSSION: We show that social cohesion is part of the causal chain between environmental and built characteristics of a neighbourhood and health, with increasing mediation effect over time for physical health. Social mechanisms should be considered when studying the effect of neighbourhood characteristics on health inequalities making social cohesion as a legitimate target of public health interventions at neighbourhood level.

Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies.

OBJECTIVE: Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. METHODS: Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011-2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status. RESULTS: In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. CONCLUSIONS FOR PRACTICE: Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups.

Small-Area Factors and Their Impact on Low Birth Weight-Results of a Birth Cohort Study in Bielefeld, Germany.

Introduction: The location of residence is a factor possibly contributing to social inequalities and emerging evidence indicates that it already affects perinatal development. The underlying pathways remain unknown; theory-based and hypothesis-driven analyses are lacking. To address these challenges, we aim to establish to what extent small-area characteristics contribute to low birth weight (LBW), independently of individual characteristics. First, we select small-area characteristics based on a conceptual model and measure them. Then, we empirically analyse the impact of these characteristics on LBW. Material and methods: Individual data were provided by the birth cohort study "Health of infants and children in Bielefeld/Germany." The sample consists of 892 eligible women and their infants distributed over 80 statistical districts in Bielefeld. Small-area data were obtained from local noise maps, emission inventory, Google Street View and civil registries. A linear multilevel analysis with a two-level structure (individuals nested within statistical districts) was conducted. Results: The effects of the selected small-area characteristics on LBW are small to non-existent, no significant effects are detected. The differences in proportion of LBW based on marginal effects are small, ranging from zero to 1.1%. Newborns from less aesthetic and subjectively perceived unsafe neighbourhoods tend to have higher proportions of LBW. Discussion: We could not find evidence for negative effects of small-area factors on LBW, but our study confirms that obtaining adequate sample size, reliable measure of exposure and using available data for operationalisation of the small-area context represent the core challenges in this field of research.

Utilisation of rehabilitation services for non-migrant and migrant groups of higher working age in Germany - results of the lidA cohort study.

BACKGROUND: An ageing and a shrinking labour force implies that the prevention of a premature exit from work due to poor health will become more relevant in the future. Medical rehabilitation is a health service that aims at active participation in working life. The provision of this service will be relevant for an increasing part of the ageing labour force, namely, employees with a migrant background and their different subgroups. Thus, this study examines whether first- and second-generation employees with migrant background differ from non-migrants in their utilisation of rehabilitation services and whether within the subsample of migrant employees, those persons with foreign nationality differ from those with German nationality. METHODS: Socially insured employees born in 1959 or 1965 were surveyed nationwide in 2011 as part of the lidA cohort study (n=6303). Survey data of the first study wave were used to identify the dependent variable of the utilisation of rehabilitation (in- and outpatient), the independent variable of migrant status and the covariates of sociodemographic, work- and non-work-related factors. Applying bivariate statistics with tests of independence and block-wise logistic regressions, differences between the groups were investigated. Additionally, average marginal effects were computed to directly compare the adjusted models. RESULTS: The study showed that first-generation migrants had a significantly lower likelihood of utilising outpatient rehabilitation than non-migrants (fully adj. OR 0.42, 95% CI 0.22-0.82) and that average marginal effects indicated higher differences in the full model than in the null model. No significant differences were found between the first- or second-generation migrants and non-migrants when comparing the utilisation of inpatient rehabilitation or any rehabilitation or when analysing German and foreign employees with migrant background (n=1148). CONCLUSIONS: Significant differences in the utilisation of outpatient rehabilitation between first-generation migrants and non-migrants were found, which could not be explained by sociodemographic, work- and non-work-related factors. Thus, further factors might play a role. The second-generation migrants resemble the non-migrants rather than their parent generation (first-generation migrants). This detailed investigation shows the heterogeneity in the utilisation of health services such as medical rehabilitation, which is why service sensitive to diversity should be considered.

[Is There a Negative Night or Weekend Effect on the Child's Postnatal State Among Migrant Women?] / Gibt es einen negativen Nacht- oder Wochenendeffekt auf den kindlichen postnatalen Zustand bei Frauen mit Migrationshintergrund?

RESEARCH QUESTION: Is neonatal morbidity of women with a migration background (= a proxy variable for an increased risk of cultural/linguistic communication problems) increased in the sense of a "weekend effect"? METHODS: Data was collected at 3 Berlin maternity hospitals directly in the delivery room based on standardized interviews (questions on sociodemographics, care aspects, migration) and supplemented by maternal and clinical perinatal data. Surrogate markers for the child's morbidity were the Apgar score and umbilical cord pH value or transfer to a children's hospital. Descriptive and logistic regression analyses were carried out. RESULTS: The data sets of 2,014 1st-generation migrants, 771 2nd-generation migrants, and 2,564 women without a migrant background were included, including 39.7% so-called day-births (Monday - Friday, 7 a.m.-6 p.m.). In 2 models, the influence of birth time and various other parameters was examined for the 2 proxy parameters of childhood morbidity. The chances of unfavorable Apgar or umbilical pH levels were increased in births in the evening, at night, on weekends and public holidays (OR 1.84, 95% CI 1.23-2.76, p=0.003), in operative vaginal births (OR 3.36, 95% CI 2.07-5.46, p<0.001) or a secondary cesarean section (OR 1.94; 95% CI 1.28-2.96, p=0.002). The migration status of the woman giving birth was irrelevant. SUMMARY: Despite possible intercultural and linguistic communication problems, women with a migration background are treated as well as pregnant women without a migration background irrespective of the time of day or day of the week.