Background: Self-rated health status (SRHS) is a reliable and valid measure for assessing the subjective and objective health of individuals. Previous studies have either focused predominantly on the elderly or investigated only a narrow range of factors potentially associated with SRHS. In examining student populations, these past studies were limited to single countries. The objectives of this study were to assess which candidate variables were independently associated with SRHS in university students, to compare these variables by country and by gender, and to investigate which of the variables was most important as a rating frame for SRHS.
In Germany, the proportion of foreign national residents receiving an invalidity pension is higher than that of Germans. Lower utilization and effectiveness of medical rehabilitation are presumed to be the main reasons. We aimed to examine whether differences in utilization and effectiveness of medical rehabilitation between Germans and foreign nationals are attributable to differences in socio-demography, socioeconomic background and health status. Utilization of rehabilitation was analyzed for household members aged 18 years or above enrolled in the German Socio-Economic Panel in 2002-2004 (n=19,521). Effectiveness of rehabilitation was defined by the occupational performance at the end of rehabilitation. It was examined by using an 80% random sample of all completed medical rehabilitations in the year 2006 funded by the German Statutory Pension Insurance Scheme (n=634,529). Our study shows that foreign nationals utilize medical rehabilitation less often than Germans (OR=0.68; 95%-CI=0.50;0.91). For those who do, medical rehabilitation is less effective (OR for low occupational performance=1.50; 95%-CI=1.46;1.55). Both findings are only partially attributable to socio-demographic, socio-economic and health characteristics: After adjusting for these factors, ORs for utilization and low occupational performance were 0.66 (95%-CI=0.49;0.90) and 1.20 (95%-CI=1.16;1.24), respectively. It can be concluded that differences in the utilization and effectiveness of medical rehabilitation between Germans and foreign nationals cannot be explained only by socio-economic differences or poorer health before rehabilitation. In addition, factors such as the ability of the rehabilitative care system to accommodate clients with differing expectations, and migrant-specific characteristics such as cultural differences, seem to play a role.3
BackgroundIn many European countries including Germany, migrants utilize preventive services less frequently than the majority population. This is also true for the utilization of dental checkups. Little is known about which demographic, social, behavioral, and health-related factors influence the decision of migrants to seek preventive dental health care and how these factors differ from those in non-migrants. The aim of the present study was to examine the role of these factors among migrants and non-migrants residing in Germany.MethodsData from cross-sectional national health surveys are used, providing information on preventive dental health behavior from n = 41,220 individuals, of which 15.0% are migrants. Andersen’s Behavioral Model of Health Services Use is the conceptual framework of the investigation. Multiple logistic regression models were applied to examine the role of different predisposing and enabling factors. Interaction terms were included in order to examine whether determinants differ between migrants and non-migrants. Average marginal effects (AMEs) are reported in addition to odds ratios (ORs) as measures of effect size which are robust against bias arising from unobserved heterogeneity.ResultsMigrants are at an about 36% lower chance of utilizing regular dental checkups than non-migrants [OR = 0.64 (95% confidence interval, 95% CI: 0.61, 0.68); AME = −0.081 (95% CI = −0.093, −0.069)]. Differences are partly explained by the influence of demographic, social, behavioral, and health-related factors [adjusted OR = 0.69 (95% CI: 0.64, 0.73); AME = −0.065 (95% CI = −0.076, −0.053)]. Younger age, being male, lower socioeconomic status, a non-statutory health insurance, not living in a relationship, living in the Western part of Germany and in an urban setting, and poor limited social support were associated with a lower chance of utilizing regular dental checkups. Interaction effects could be observed for age and for the type of health insurance.DiscussionThe study identifies different enabling and predisposing factors that are relevant for the utilization of dental checkups among the population in Germany, some of which differ between migrants and non-migrants. Differences are particularly pronounced for younger ages. This differs from findings on other preventive services where older migrants tend to be more disadvantaged. Additional explanatory factors such as barriers that migrants experience in the dental health care system need to be considered in order to implement patient-oriented services and to reduce disparities in access to dental prevention.
Background: COVID-19 caused by a new form of coronavirus (SARS-CoV-2) first appeared in China end of 2019 and quickly spread to all counties of the world. To slow down the spread of the virus and to limit the pressure on the health care systems, different regulations and recommendations have been implemented by authorities, comprising amongst others the closure of all entertainment venues and social distancing. These measures have received mixed reactions, particularly from young individuals, with many not following available advice. Drawing on the information in social media discussion forums, the present study explores the reasons why people ignore the orders and recommendations of the authorities and why the authorities are unable to produce a shared sense of inclusion concerning protective measures against the COVID-19 outbreak. Methods: Three open-access social media forums (Reddit, Twitter, and YouTube comments) were systematically searched with respect to COVID-19-related beliefs, attitudes, and behaviours of individuals. The data was retrieved in the first 3 weeks of March 2020. Qualitative document analysis and qualitative content analysis were used as the methodical approach. The data was reviewed by all authors and jointly interpreted to minimise inconsistencies. Results: The study reveals that reasons such as information pollution on social media, the persistence of uncertainty about the rapidly spreading virus, the impact of the social environment on the individual, and fear of unemployment associated with inequality in the distribution of income lead people to ignore the orders and recommendations of the authorities. The findings suggest that government representatives and politicians could not produce a shared sense of inclusion concerning protective measures against the COVID-19 outbreak, due to not building trust among the public and taking concrete economic steps to satisfy them. Conclusion: In uncertain crises, transparency in the presentation of information and government policies emerge as influential determinants in creating social susceptibility and solidarity. The differences between social classes constitute one of the important factors that affect the decision-making mechanisms of individuals in determining the necessary steps to be undertaken in times of crisis.
BackgroundMigrants in many European countries including Germany tend to utilize preventive measures less frequently than the majority population. Little is known about the dental health of migrants as well as about their oral health behaviour, particularly in the adult population. The aim of this study was to examine differences in the uptake of annual dental check-ups in adult migrants and non-migrants in Germany.MethodsWe used data from the cross-sectional survey ‘German Health Update 2010’ conducted by the Robert Koch Institute (n = 22,050). Data from 21,741 German-speaking respondents with information on the use of dental check-ups was available, of which 3404 (15.7%) were migrants. Multiple logistic regression models were applied to adjust for demographic and socioeconomic confounders, including the place of residence as well as type of health insurance.ResultsMigrants were generally younger, had a lower socioeconomic status and showed a lower utilization of dental check-ups. The unadjusted odds ratio (OR) for utilization was 0.67 (95%-CI = 0.61–0.73). After adjusting for demographic and socioeconomic confounders the chance only increased slightly (adjusted OR = 0.71; 95%-CI = 0.65–0.77).ConclusionsThe analysis shows that migration status is associated with a reduced chance of attending dental check-ups, independently of demographic and socioeconomic factors. The influence of other factors, such as type of health insurance and place of residence had also no influence on the association. Migrants are exposed to different barriers in the health care system, comprising the patient, provider and system level. Further studies need to examine the relevant barriers for the uptake of preventive dental services in order to devise appropriate migrant- sensitive measures of dental prevention.
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