AMH is a useful parameter that should be measured before performing an IVF/ICSI treatment. In younger patients, AMH levels do not predict pregnancy outcomes. In patients older than 36 years, AMH can be used as a prognostic factor. Even when a woman's AMH levels are too low to be detected, she still an acceptable chance of becoming pregnant.

BackgroundSince the late 1950’s, a steadily increasing immigrant population in Germany is resulting in a subpopulation of aging immigrants. The German health care system needs to adjust its services—linguistically, culturally, and medically–for this subpopulation of patients. Immigrants make up over 20% of the population in Germany, yet the majority receive inadequate medical care. As many of the labor immigrants of the 1960s and 1970s are in need of hospice and palliative care (HPC), little is known about this specialized care for immigrants. This epidemiological study presents utilization of HPC facilities in Berlin with a focus on different immigrant groups.MethodsA validated questionnaire was used to collect data from patients at 34 HPC institutions in Berlin over 20 months. All newly admitted patients were recruited. Anonymized data were coded and analyzed by using SPSS and compared with the population statistics of Berlin.Results4118 questionnaires were completed and included in the analysis. At 11.4% the proportion of immigrants accessing HPC was significantly (p<0,001) below their proportion in the general Berlin population. This difference was especially seen in the age groups of 51–60 (21.6% immigrants in Berlin population, 17.7% immigrants in HPC population) and 61–70 years (16,9% vs. 13,1%). The largest ethnic groups are Turks, Russians, and Poles, with a different weighting than in the general population: Turkish immigrants were 24% of all Berlin immigrants, but only 13.6% of the study immigrant population (OR: 0.23, 95%CI: 0.18–0.29, p<0.001). Russian and Polish immigrants account for 5.6% and 9.2% in the population, but 11.5% and 24.8% in the study population respectively (Russian: OR 0.88, 95%CI: 0.66–1.16; Polish: OR 1.17, 95%CI: 0.97–1.42). Palliative care wards (PC) were used most often (16.7% immigrants of all PC patients); outpatient hospice services were used least often by immigrants (11.4%). Median age at first admission to HPC was younger in immigrants than non-immigrants: 61–70 vs. 71–80, p = 0.03.ConclusionsImmigrants are underrepresented in Berlin´s HPC and immigrants on average make use of care at a younger age than non-immigrants. In this regard, Turkish immigrants in particular have the poorest utilization of HPC. These results should prompt research on Turkish immigrants, regarding access barriers, since they represent the largest immigrant group. This may be due to a lack of cultural sensitivity of the care-providers and a lack of knowledge about HPC among immigrants. In the comparison of the kinds of institutions, immigrants are less likely to access outpatient hospice services compared to PC. Apparently, PC appear to be a smaller hurdle for utilization. These results show a non-existent, but oft-cited “healthy immigrant effect” of the first generation of work immigrants, now entering old age. These findings correspond with studies suggesting increased health concerns in immigrants. Focused research is needed to promote efforts in providing adequate and fair access to HPC for all...

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BackgroundProspectively, patients with migratory backgrounds in need of Hospice and Palliative Care (HPC) will increase. Only few data about the health of this group in HPC context are available. The utilisation of Advanced Directives (AD) in this group is unknown, whereas the „Culturally Sensitive Advanced Directive” can improve consideration for and realisation of the presumed will.AimCollecting data about the utilisation of AD among migrants compared to non-migrants.MethodsMeasurement of the migrant status by an evaluated questionnaire and the presence of an AD of all admitted patients in 3 Palliative Care Wards for 6 month.Results428 patient data were analysed. 21% are migrants, 8% out of these patients were in possession of an AD, compared to 36% of the non-migrant patients. 60% of the migrants evaluate their German language competency as “very good” or “good”.DiscussionAD are under-utilised in the analysed group. According to the self-assessment, a lack of language skills might not be the reason. Sparse information about AD among this group could cause this disparity. Considering ethnic backgrounds as important factors in decision making at the end of life, comprehensive and precise AD might appropriate to improve the quality of HPC in migrants, especially if communication borders exist.ConclusionDespite the small cohort, the results suggest low utilisation of AD by migrants. Providing adequate information about AD for this group might be an important step in improving end-of-life care. Efforts should be taken by health insurances and care providers. Remark: at the time of presentation, patient data from 2 additional wards will be analysed.

Objective: In Tanzania, cancer is becoming a major public health concern. Risk factors such as poor dietary behavior, high body mass index, physical inactivity, alcohol and tobacco consumption increase the incidence. Limited cancer treatment facilities, prevention programs, and poor knowledge of cancer risk factors and symptoms in the population contribute to late-stage presentation and high mortality rates. The objective of this study is to examine the association of lifestyle factors including body mass index (BMI), physical activity, and dietary behaviors among participants who attended three cancer prevention events in rural and urban areas in Tanzania. Methods: A cross-sectional survey among PrevACamp- attendees in northern Tanzania between August 2019 and February 2020 were chosen. Participants were interviewed using a structured questionnaire on sociodemographic data, medical history, dietary habits, and physical activity, the body mass index was also determined.Results: 235 participants (114 urban/ 121 rural) were included in the survey. Urban residents had higher rates of obesity (p=0.0021) and less physical activity than participants from rural areas (4.63 days [SD=2.03] and 5.50 days [SD=2.00], respectively (p=0.006). Urban dwellers often skip their lunch and prefer to eat a snack. They use salt frequently, consume more processed meat, eat mainly starchy foods, drink more alcohol and sweetened sodas. Conclusion: Rural women more interested in cancer prevention than men. People in rural areas are more physically active and less overweight than those in urban areas. The cause is manifold, yet they hint at a lack of health care for women and a progressing urbanization according to Western patterns. There is an alarming high percentage of overweight among urban dwellers. Although people eat more healthy foods compared to rural populations, they tend to have a high body mass index. Physical inactivity and overweight will be a serious problem in Tanzania in the future, contributing to the risk of cancer.

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ObjectiveTo ascertain how the COVID-19 pandemic was perceived by oncology patients and community health workers (CHWs) and whether this contributed to disruptions in cancer care.DesignCross-sectional study using (1) structured telephone interviews with patients and (2) structured questionnaires completed by CHWs.SettingOutpatient and community care at Kilimanjaro Christian Medical Centre’s Cancer Care Centre (KCMCCCC), Northern Tanzania.Participants300 oncology patients (158 men and 142 women) who had attended KCMCCCC between January and April 2020 and 78 CHWs (16 men and 62 women) in the KCMC regional palliative care network who conducted home visits to patients with cancer during the period January to April 2020.Primary outcome measuresFor patients, missed appointments and fear of COVID-19 more than postponement of their treatment. For CHWs, no primary outcome (a broad range of questions on perception of the pandemic were asked).Results30% of patients said they missed appointments due to the pandemic, the most commonly cited reasons being financial problems (37%) and fear of acquiring COVID-19 infection during travel and/or in the hospital (37%). Only 12.7% of patients said they feared COVID-19 more than postponement of cancer treatment. 88% of CHWs noticed differences in delivering home care since the start of the pandemic, with 58% saying they had noticed more patients dying and 74% saying that more patients were relying on local healers. 31% of CHWs said they feared home visits because of COVID-19 and 46% perceived patients feared home visits due to COVID-19. However, 92% felt home visits should continue.ConclusionThese results indicated that while there was a significant degree of disruption and fear around the COVID-19 pandemic, the majority of patients and CHWs did not fear of COVID-19 more than disruption to cancer care. This highlights the importance to these groups of maintaining access to vital cancer services.