The present study introduces the assessment of depression and depressive symptoms in the German National Cohort (NAKO), a population-based mega cohort. Distribution of core measures, and associatio...

The prevalence of psychological complaints is known to be very high in populations of asylum seekers. Despite this, data on the health care system’s ability to adequately meet these high-risk populations’ mental health needs are scarce. This article investigates how well the German outpatient health care system is able to detect and adequately treat them. To this end, we combined data from a cross-sectional survey with billing data from the local social welfare office from the year 2015. Using descriptive statistics, the data of the cross-sectional study are used to quantify the psychological health care needs of asylum seekers while the secondary data analysis indicates the actual access to and extent of psychological treatment. In the cross-sectional study, 54% of patients were screened positive for symptoms of depression, 41% for symptoms of anxiety disorder and 18% for symptoms of Posttraumatic Stress Disorder. In total, 59% were screened positive for at least one of these three disorders. However, when contrasting these screening-based prevalences with the prevalences based on data from the health care system, a mismatch becomes apparent: According to the social welfare office’s billing data, only 2.6% of asylum seekers received the diagnosis of depression, 1.4% were diagnosed with anxiety disorder and 2.9% with Posttraumatic Stress Disorder (PTSD). In combination, 4.9% were diagnosed with at least one of these three disorders. Overall, less than one tenth of asylum seekers with symptoms of depression, anxiety or PTSD received the corresponding diagnosis by the health care system. Among those who were diagnosed, about 45% received no treatment at all, while 38% were treated with drugs alone. Only 1% of all patients received psychotherapy. Psychological complaints are very common among asylum seekers, yet only a small proportion of this population receives the corresponding diagnoses and treatment. While various factors can contribute to these shortcomings, there is an urgent need to systematically address this deficit and introduce measures to improve mental health care for this high-risk population.

Vaccinations are a core element of infection control. Migrants have been reported to have low vaccination rates for many infectious diseases, including COVID-19. Still, determinants of migrants’ uptake of COVID-19 vaccinations are not sufficiently clear. The present study addresses this gap and examines the respective influence of three potential determinants: barriers to access, attitude towards vaccinations in general, and towards COVID-19 vaccines. The study uses a cross-sectional online survey among migrants in Germany. The questionnaire assessed the aforementioned determinants using standardized tools. Information on 204 individuals was available. The vaccination rate in the sample was 80%. Vaccinated as compared to unvaccinated respondents reported more often the absence of financial barriers (71% (95%CI: 64–73%) vs. 45% (95%CI: 28–63%)), short waiting times (51% (95%CI: 43–59%) vs. 22% (95%CI: 5–38%)), and the presence of a vaccination center close-by (91.5% (95%CI: 87–96%) vs. 69.7% (95%CI: 54–85%)). Concerning COVID-19 vaccine acceptance, the majority of respondents (68%) agreed that the vaccine is important. Unvaccinated respondents more often feared side effects, were convinced that the vaccine is not safe, and assumed that COVID-19 is not dangerous. Correspondingly, acceptance of vaccinations in general was higher among vaccinated respondents. In line with findings from previous studies, our survey found that all three determinants seem to influence migrants’ vaccination status while their overall vaccination rate was comparable to the general population. Hence, migration background per se does not sufficiently explain vaccine acceptance and further research is needed to identify subgroups of migrants that should be specifically addressed to increase their vaccination rate.

To reach the goals of the Global Hepatitis Elimination 2030 program, Indonesia is now preparing a new regulation for hepatitis B vaccinations for adult population. This study aimed to determine the factors influencing vaccine uptake for hepatitis B in the adult population, and identify barriers to, and facilitators of, hepatitis B vaccination programmes. An explanatory sequential mixed methods design was implemented in this study. We conducted a survey involving 893 participants in the general population followed by 14 in-depth interviews with health providers. The survey found that only 15% (95% confidence interval 13–18%) of participants received at least one dose of the hepatitis B vaccine. Factors associated with vaccine uptake were, living in Yogyakarta compared to living in Aceh, having secondary and higher education compared to primary education, working as a health worker compared to working in other sectors, and having health insurance that covered hepatitis B vaccination compared to not having such health insurance. Our qualitative study also identified several barriers to the adult hepatitis B vaccination programme in Indonesia such as the high cost of vaccination, lack of vaccine availability in certain areas, limited human resources to implement the hepatitis B vaccination programme, and the ineffective dissemination of hepatitis B vaccination. This study highlights that accessibility and affordability of vaccinations are important determinants of vaccination uptake that should be taken into account when planning vaccination campaigns.

Background: The growing immigration to Germany led to more patients whose medical needs are divergent from those of the domestic population. In the field of dental health care there is a debate about how well the German health system is able to meet the resulting challenges. Data on asylum-seekers’ dental health is scarce. This work is intended to reduce this data gap. Methods: We conducted this retrospective observational study in Halle (Saale), Germany. We included all persons who were registered with the social welfare office (SWO) in 2015 and received dental treatments. From the medical records, we derived information such as complaints, diagnoses, and treatments. Results: Out of 4107 asylum-seekers, the SWO received a bill for 568 people. On average, there were 1.44 treatment cases (95%-CI: 1.34–1.55) and 2.53 contacts with the dentist per patient (95%-CI: 2.33–2.74). Among those, the majority went to the dentist because of localized (43.2%, 95%-CI: 38.7–47.7) and non-localized pain (32.0%, 95%-CI: 27.8–36.2). The most widespread diagnosis was caries (n = 469, 98.7%, 95%-CI: 97.7–99.7). Conclusion: The utilization of dental care is lower among asylum-seekers than among regularly insured patients. We assume that the low prevalence rates in our data indicate existing access barriers to the German health care system.

Hintergrund Viele Menschen im deutschsprachigen Raum haben Probleme mit der deutschen Sprache. Im Gesundheitssystem ergeben sich hieraus Barrieren für den Zugang zu und die Nutzung von Angeboten. Ziel der vorliegenden Übersichtsarbeit ist es, den aktuellen Forschungsstand zur Relevanz von Sprachbarrieren in der medizinischen Versorgung darzustellen sowie eingesetzte Strategien zum Umgang mit sprachbedingten Kommunikationsproblemen zu erläutern. Methoden Die Übersichtsarbeit basiert auf einer Synthese englischsprachiger systematischer Reviews zum Thema ‚Dolmetschen im Gesundheitssystem‘, erweitert um alle seit 2015 veröffentlichten Originalarbeiten aus Deutschland. Ergebnisse Am häufigsten wird in Krankenhäusern bei Sprachproblemen auf das Dolmetschen durch Angehörige/Bekannte von Patient/-innen oder durch bilinguales Personal des Krankenhauses zurückgegriffen. Die Qualität dieser durch nicht ausgebildete Laien durchgeführten Sprachmittlung ist dabei häufig eingeschränkt, was sich negativ auf Versorgungsoutcomes auswirken kann. Der Einsatz professioneller Dolmetscher/-innen geht mit deutlich besseren Versorgungsergebnissen einher und stellt v. a. in Form des Telefon- oder Videodolmetschens einen flexibel und kostengünstig zu implementierenden Ansatz dar. Schlussfolgerung Sprachliche Verständigung ist eine wichtige Voraussetzung patientenorientierter Versorgung und muss aus ethischen, sozialen und rechtlichen Gründen durch das Gesundheitssystems sichergestellt werden. Hierbei sollten v. a. professionelle Dolmetschlösungen zum Einsatz kommen, für die auch die entsprechenden finanziellen und infrastrukturellen Ressourcen zur Verfügung gestellt werden müssen. Background Many people in German-speaking countries have a limited proficiency in the German language. In the health care system, this may result in barriers to accessing and utilization of health services. The aim of this review was to present the current state of research on the relevance of language barriers in medical care and to explain strategies used to address language-related communication problems. Methods The review is based on a synthesis of German- and English-language systematic reviews on the topic of ‘language interpretation in the health care sector’, including also all original papers from Germany published since 2015. Results The most common method used in hospitals for language problems was interpretation by relatives of patients or by bilingual staff of the hospital. The quality of this language mediation by untrained laypersons was often limited, which can affect health care outcomes. Using professional interpreters was associated with significantly better health care outcomes and, particularly in the form of interpretation via telephone, was a flexible and cost-effective approach. Conclusion Language-based communication is an important prerequisite for patient-centered care and must be ensured by the health care system for ethical, social and legal reasons. In this context, professional interpretation solutions should be used, for which the required financial resources and infrastructure must also be made available. Publication Date: 12 November 2020 (online) © 2020. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany