Migrants and Refugees in Europe: Challenges, Experiences and Contributions.

Due to the current geopolitical situation more refugees from crisis countries were and will be treated in Europe. In 2015 the number of displaced people reached an unprecedented level, with more than one million crossing into Europe. The migration itself can impair both mental and physical health. Therefore, the provision of medical care for refugees and migrants is a novel and major challenge for the health care systems in Europe. In this article we describe our experiences and contribution in providing medical care for refugees who have newly arrived in Stuttgart, Baden-Wuerttemberg, Germany. Furthermore, we report our experiences from a tertiary referral University center in Regensburg, Bavaria, Germany. We focus on challenges in both the outpatient and the inpatient setting, with a special focus on intensive care patients. In addition, we provide an overview about the spectrum of diseases in this specific patient cohort.

Age-dependent normative values for differential luminance sensitivity in automated static perimetry using the Octopus 101.

PURPOSE: To determine age-dependent normative differential threshold values for the Octopus 101 instrument and to create a smooth mathematical model characterizing the age-dependency and asymmetry of the hill of vision. METHODS: Static automated perimetry within the central 30 degrees visual field (VF) was conducted with the Octopus 101 (background luminance 10 cd/m(2)) in 81 eyes of 81 ophthalmologically healthy subjects (11-12 per decade of age) aged 10-79 years. A 4-2-2 staircase strategy with three reversals was run. The test point grid consisted of 68 concentrically arranged points with test point condensation towards the VF centre, representing the approximately rotation-symmetrical 30 degrees hill of vision. Thresholds of differential luminance sensitivity (DLS) were estimated by the maximum likelihood method. A smooth mathematical model was fitted to the normative data. RESULTS: The model fit was satisfactory (r(2) = 0.74). Covariables were: age, eccentricity, angle and subject. Total random standard deviation (SD) was 1.75 dB. The residual SD exceeded 1.75 dB in the border region, was 1.5 dB within the centre and fell below 1.25 dB in a ring around the centre. Average thresholds of DLS varied with age quadratically. It is close to constant for the 10-40-year-old age group and declines ever more steeply thereafter. The effect of age on DLS in the VF increased with eccentricity. The greatest drop was located in the peripheral superior hemifield: at 25 degrees eccentricity the superior DLS was estimated to be 5.5 dB higher in 10-year-olds than in 75-year-olds. CONCLUSIONS: This new smooth model allows for the prediction of age-related normal threshold values for any stimulus location within the 30 degrees VF and thus for the calculation of global and local measures of defect such as mean defects or p-values for any type of stimulus.

The normal age-corrected and reaction time-corrected isopter derived by semi-automated kinetic perimetry.

PURPOSE: To determine the increase in isopter extent, resulting from the measurement of, and correction for, individual reaction time (RT; the latency between stimulus presentation and individual patient response), derived under the standardized conditions of semi-automated kinetic perimetry (SKP), and to model the age- and RT-corrected normative isopter values for SKP applicable to any Goldmann stimulus combination. DESIGN: Cross-sectional observational study. PARTICIPANTS: Eighty-three healthy participants aged 10 to 80 years (11-12 participants per decade of age). METHODS: One eye of each participant underwent SKP using the Octopus 101 perimeter (Haag-Streit, Koeniz, Switzerland). Four Goldmann stimulus combinations, III4e at 25 degrees/second, III4e at 5 degrees/second, I3e at 5 degrees/second, and I2e at 2 degrees/second, were presented centripetally (i.e., in a direction toward the center of the bowl) along the 8 cardinal meridia in random order. The local kinetic threshold (LKT) for each stimulus combination along each meridian was corrected for the angular distance traveled during the individual geometric mean RT and was modeled in terms of the covariables stimulus size, stimulus luminance, meridian, and age, and then presented in terms of a graphical reference plot. MAIN OUTCOME MEASURES: The variation of the LKT with RT, stimulus combination, meridian, and age. RESULTS: The median of the individual geometric mean RTs initially decreased and then increased with increase in age and was greater for stimulus combinations producing small isopters compared with those generating large isopters. Reaction time-corrected LKTs were fitted optimally by a multiple regression model (R2 = 0.86). For large (> or =size III) and intense (4e) stimuli, RT-corrected LKTs were independent of age and mainly were influenced by instrument- and facial anatomy-related characteristics. Reaction time-corrected LKTs, particularly for small (< or = size II) stimuli, exhibited a clear age dependence above the age of 40 years particularly for reduced luminance stimuli (< or = 2e), with an approximate reduction in angular extent of 2 degrees per decade for the I1e stimulus. CONCLUSIONS: The development of a graphical reference plot with mean isopters and accompanying reference intervals for age- and RT-corrected SKP, applicable to any individual patient, should facilitate the evaluation of clinical data and the implementation of a computerized alternative to manual Goldmann kinetic perimetry.