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Brzoska P.,Bielefeld University | Voigtlander S.,Bielefeld University | Spallek J.,Bielefeld University | Spallek J.,Johannes Gutenberg University Mainz | And 2 more authors.
European Journal of Epidemiology | Year: 2010

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, socio-economic 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. © 2010 Springer Science+Business Media B.V.

Rohmel J.,Bremen Institute for Prevention Research and Social Medicine BIPS
Biometrical Journal | Year: 2011

For the all pairwise comparisons for equivalence of k (k≥2) treatments Lauzon and Caffo proposed simply to divide the type I error level α by k-1 to achieve a Bonferroni-based familywise error control when declaring pairs of two treatments equivalent. This rule is shown to be too liberal for k≥4. It works for k=3 yet for reasons not considered by Lauzon and Caffo. Based on the two one-sided testing procedures and using the closure test principle we develop valid alternatives based on Bonferroni's inequality. The set H of intersection hypotheses reveals a rich structure, leading to the possibility to present H as a directed acyclic graph (DAG). This in turn allows using some graph theoretical theorems and eases proving properties of the resulting multiple testing problems. © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Spallek J.,Bielefeld University | Spallek J.,Bremen Institute for Prevention Research and Social Medicine BIPS | Zeeb H.,Bremen Institute for Prevention Research and Social Medicine BIPS | Razum O.,Bielefeld University
Emerging Themes in Epidemiology | Year: 2011

Empirical findings show that morbidity and mortality risks of migrants can differ considerably from those of populations in the host countries. However, while several explanatory models have been developed, most migrant studies still do not consider explicitly the situation of migrants before migration. Here, we discuss an extended approach to understand migrant health comprising a life course epidemiology perspective. The incorporation of a life course perspective into a conceptual framework of migrant health enables the consideration of risk factors and disease outcomes over the different life phases of migrants, which is necessary to understand the health situation of migrants and their offspring. Comparison populations need to be carefully selected depending on the study questions under consideration within the life course framework. Migrant health research will benefit from an approach using a life course perspective. A critique of the theoretical foundations of migrant health research is essential for further developing both the theoretical framework of migrant health and related empirical studies. © 2011 Spallek et al; licensee BioMed Central Ltd.

Hense S.,Bremen Institute for Prevention Research and Social Medicine BIPS | Pohlabeln H.,Data Management | De Henauw S.,Ghent University | Eiben G.,Gothenburg University | And 6 more authors.
Sleep | Year: 2011

Study Objectives: To investigate differences and a possible effect modification by geographical region in the association between sleep duration and overweight. Design: Cross-sectional. Setting: Primary schools and preschools in 8 European countries. Participants: 7867 children aged 2 to 9 years. Interventions: Not applicable. Measurements: Nocturnal sleep duration was assessed as part of a parental 24-h recall. Height and weight were measured by standardized procedures across centers. Data on personal, social, environmental and behavioral factors were collected using a standardized parental questionnaire. Results: Sleep duration differed (P < 0.001) between European regions and normal vs. overweight children. A dose-dependent inverse association between sleep duration and overweight could be seen, with crude odds ratios ranging from 1.73 (99% CI 1.33; 2.25) for sleeping between 10 and 11 h to 3.81 (99% CI 2.85; 5.09) for sleeping less than 9 h (reference category > 11 h). This persisted after adjustment, but remained significant only for sleeping less than 9 h per night (north: OR = 1.70; 99% CI 1.13; 2.58 vs. south: OR = 2.84; 99% CI 1.57; 5.12) if stratified by region. No effect modification by region could be found, but adjustment for region accounted for changes in the effect estimate for sleeping less than 9 h (OR = 2.22; 99% CI 1.64; 3.02). The association was stronger in school children than in preschool children. Conclusion: Geographic region and related aspects - even if they do not seem to modify the association between sleep and overweight - should in any case be taken in consideration as a confounding factor on this association.

Behr S.,Bremen Institute for Prevention Research and Social Medicine BIPS | Andersohn F.,Charite - Medical University of Berlin | Garbe E.,Bremen Institute for Prevention Research and Social Medicine BIPS
Pharmacoepidemiology and Drug Safety | Year: 2010

Purpose: Intracerebral hemorrhage (ICH) is the most serious complication of oral anticoagulation. This study investigated the risk of ICH for phenprocoumon which is the most widely used oral anticoagulant in Germany. Methods: We conducted a nested case-control study in a cohort of 13.4 million insurants of 4 German statutory health insurances (SHIs) who were continuously enrolled for 6 months prior to cohort entry. Cases were patients hospitalized for ICH. Ten controls were matched to each case by SHI, birth year, and sex using incidence density sampling. Rate ratios (RR) of ICH for current phenprocoumon use as compared to non-use were estimated from odds ratios calculated by conditional logistic regression analyses considering multiple risk factors. Results: Analysis of the full cohort revealed a strong increase in incidence of ICH with increasing age. In the nested case-control study including 8138 cases of ICH and 81 373 matched controls, we observed an increased risk of ICH for current phenprocoumon exposure that varied with age. The phenprocoumon-associated risk of ICH was lower in older age groups with RRs from 4.20 (95% confidence interval (CI) 2.44-7.21) for phenprocoumon users less than 55 years of age to 2.43 (95%CI, 1.81-3.27) for those older than 85 years. Our study confirmed known risk factors of ICH. Discussion: Phenprocoumon exposure was associated with an increased risk of ICH. The interaction of risk for phenprocoumon with age was unexpected and needs further study. Copyright © 2010 John Wiley & Sons, Ltd.

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