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Biomedical subjects

O Razum

Publications and source records attributed to O Razum.

At least 19 recordsLinked to original sources
PubMed2002

Transition in cancer patterns among Turks residing in Germany.

Cancer mortality among the 2.1 million Turks residing in Germany is assumed to change from a pattern typical for a developing country towards one of an industrialised country. To test this hypothesis, we compared age-standardised cancer mortality rates among Turkish residents and (West) Germans using death registration data. In addition, we assessed proportional cancer incidence ratios among Turkish cases (n=144) in a German population-based cancer registry. All-cancer mortality 1992-1997 (per 100000) was 34.8 (n=4192) among Turkish men (Germans: 72.3) and 21.5 (n=1862) among Turkish women (Germans: 52.4). Over time, gastric and lung cancer mortality increased among Turkish men, as did breast cancer mortality among Turkish women. The proportional cancer incidence (PCIR) for stomach cancer among men was 2.9 (95% Confidence Interval (CI): 1.7-4.8), and that for breast cancer among women was 0.7 (95% CI: 0.4-1.1). Turks had an increased proportional incidence ratio for non-Hodgkin's lymphoma. Our findings partly support a transition of cancer patterns among Turks in Germany.

Adolescent↗
PubMed2002

[The healthy migrant effect: role of selection and late entry bias].

BACKGROUND: First-generation immigrants frequently have a lower mortality than the host population, in spite of a low socio-economic status. This is usually explained by (self-) selection into migration. If this were the case, the immigrants' mortality risk would increase with time under observation. A persistently low mortality could be due to a late entry bias: if migrants are enrolled in a study years after immigration, sick or socio-economically unsuccessful individuals may already have returned to their countries of origin. Mortality risk would then be inversely associated with length of stay in the host country before enrollment. METHODS: We assessed the mortality risk of immigrants from Mediterranean countries to Germany in the German Socio-economic Panel, in relation to time under observation (1-15 years) and length of stay in Germany before enrollment (0-34 years), using the Cox regression. RESULTS: In 1984-98, 2624 immigrants aged 16-83 years accrued 21,858 person years; 59 died. The hazard ratio, adjusted for age, sex and marital status, for each additional year under observation was 0.93 (95 % CI: 0.87-0.99); and for each additional 10 years in Germany before enrollment 0.49 (95 % CI: 0.27-0.89) in the age group >/= 50 years. CONCLUSIONS: We found no evidence for a mortality increase with time under observation, suggesting that the healthy migrant effect is not primarily due to (self-)selection. The initial mortality advantage could be due to international differences in mortality patterns. A late entry bias does contribute to the persisting mortality advantage of older immigrants.

Adolescent↗
PubMed2002

Drug use and HIV risk in Trinidad and Tobago: qualitative study.

Crack use is an important risk factor for HIV infection because of its association with unsafe sexual practices. We investigated factors promoting the initiation of crack cocaine use; the sexual behaviour of crack users; and their rehabilitation care seeking behaviour in Trinidad and Tobago. We conducted 40 in-depth interviews with drug users. Respondents frequently reported a history of parental desertion, alcohol abuse, and physical abuse within the family. They perceived peer pressure and drug use in the family as important factors promoting first drug use. Exchanging sex for drugs was common, and practising oral sex was considered safe. Female drug users rarely seek rehabilitative care because of stigmatization and lack of care for their children. In Trinidad, attitudes towards drugs in society and families need to be changed. Campaigns promoting safer sex should emphasize the risk of oral sex. Rehabilitation facilities caring for female drug users should offer child care.

Adult↗
PubMed2001

How useful is a name-based algorithm in health research among Turkish migrants in Germany?

Migrants often face particular social, economic and health disadvantages relative to the population of the host country. In order to adapt health services to the needs of migrants, health researchers need to identify differences in risk factor and disease profiles, as well as inequalities concerning treatment and prevention. Registries of health-related events could be employed for these purposes. In Germany, however, routine data bases often hold no, or inaccurate, information on the national origin of the cases registered. We developed an algorithm based on a large data set of Turkish family and first names (n=15 000), with religion as additional criterion, to identify cases of Turkish origin in registries in a largely automatic search. We tested the performance of the algorithm in a population registry and in a cancer registry. The algorithm discriminates well against Greek and Arab names, with 1% false positive matches in our study. It achieves a specificity of > 99.9% in delimiting Turkish from German cases in the cancer registry. The sensitivity can be increased to 85%, provided the small proportion of case records with uncertain origin can be assessed manually. The name algorithm can be useful for registry-based health research among Turkish migrants in Germany. Possible applications are e.g. in cancer registries to compare survival among German and Turkish cancer patients, or in health insurance registries to compare the relative importance of work-related degenerative diseases. In specific circumstances, the algorithm may also be useful in aetiological research.

Algorithms↗
PubMed2001

Meningitis propagation in southern Tanzania: the role of a village video show.

An outbreak of meningitis with 85 secondary cases and an unusually high attack rate of 16% occurred in a rural village in southern Tanzania. We investigated risk factors for clinical illness in a community-based case-control study. Attending a commercial mobile video show carried an age- and sex-adjusted odds ratio of 8.0 (95% confidence interval: 3.8-16.8). The videos had been shown in a windowless and overcrowded storeroom and had been attended by the primary case, a visitor from neighbouring Mozambique who died from meningitis on the following day. We conclude that mobile video shows, which have become popular in many developing countries, constitute a potential health hazard in areas prone to meningitis epidemics.

Adolescent↗
PubMed2001

Critical reading of epidemiological papers. A guide.

Many clinicians, medical practitioners and decision makers have no formal training in epidemiology but need to understand and sometimes evaluate results in epidemiologic studies. This paper attempts to give guidance to non-epidemiologists on how to read and evaluate the quality of epidemiologic studies and their results critically. Different methodological issues for evaluating whether the results of a study are causal or by bias, chance or confounding are given. This includes criteria for the choice of an appropriate study design followed by problems of the definition of the study population and the sample selection. We will also point to potential sources of bias in the data collection procedure and list some principles for statistical analysis. Finally, we include comments on how the results should be presented and issues which are related to public health and ethical questions. Although it is not usually possible to perform a perfect study and the correct approach to study design and analysis is often highly dependent on specific features of the population and the surroundings, our paper should help to distinguish between weak and strong investigations and papers.

Bias↗
PubMed2000

Cardiovascular mortality patterns in Turkey: what is the evidence?

In Turkey, reliable cause-specific mortality data are not available. It is thus unknown whether ischaemic heart disease (as in western Europe and the US) or stroke (as in the Far East) is the prevailing cause of cardiovascular death. This information, however, is required for planning cardiovascular prevention programmes. We analyse available Turkish national cause-of-death data as well as patterns of cardiovascular mortality in a hospital in Ankara and among Turkish migrants in Germany. According to national statistics, the ischaemic heart disease-to-stroke ratio would be 0.3 among men aged 45-64 years, lower than that in Japan. Hospital and migrant data show this ratio to be 2-4. We demonstrate the implausibility of the national data by assessing the precision of cause-of-death assignment. We then discuss to what degree mortality experience among migrants is representative for their country of origin. Our findings suggest that the pattern of cardiovascular mortality in Turkey is closer to that in western Europe and the US than to that in the Far East. Finally, we discuss options for improving cardiovascular surveillance in Turkey.

Adult↗
PubMed2000

Combining a name algorithm with a capture-recapture method to retrieve cases of Turkish descent from a German population-based cancer registry.

An increasing proportion of the 2 million Turkish residents in Germany is reaching the age in which cancer becomes a common health problem. However, data on cancer incidence and survival among Turkish residents are lacking due to incomplete reporting of nationality in German cancer registries. In the population-based cancer registry of the Saarland, retrieval by reported nationality yielded only 38% (95% confidence interval (CI): 31-45%) of the estimated number of Turkish cases in the registry; furthermore, nationality information was found to be inaccurate, and completeness dependent on the vital status of cases. A newly developed algorithm based on family names retrieved 85% (95% CI: 79-90%) of Turkish cases. Combining the two sources in a capture-recapture approach yielded 91% (95% CI: 86-94%) of the estimated total number of Turkish cases. Hence, the name-based algorithm provides a new and attractive tool for valid registry-based cancer research among Turks in Germany.

Algorithms↗
PubMed2000

Effectiveness of a decentralized, community-related approach to reduce cardiovascular disease risk factor levels in Germany.

AIMS: Conventional community-oriented prevention programmes have been moderately successful in reducing cardiovascular disease risk factor levels in the population. Within the German Cardiovascular Prevention Study, a new decentralized and community-related form of preventive intervention was tested. METHODS AND RESULTS: Interested lay people and general practitioners co-operated in developing activities conducive towards a healthier lifestyle in two towns. Changes in risk factor levels were evaluated by repeated surveys of independent cross-sectional samples in two intervention communities (n=3460, baseline; 2561, final). National survey data (n=4788, baseline; 5311, final) were used to describe secular trends. Six years after the onset of intervention activities the following changes in risk factor prevalence for both sexes combined were observed in the intervention communities (95% CI in brackets): smoking -10.5% (-17.6 to -3.4); hypertension -29.0% (-38.1 to -19. 9); total cholesterol >/=250 mg. dl(-1)-8.1% (-15.4 to -0.9). In contrast to a national increase in the prevalence of obesity, this rate remained stable in the intervention communities. CONCLUSION: Initiating preventive activities developed by community members under the responsibility of local doctors is effective in lowering cardiovascular risk factors at community level. Unlike traditional intervention programmes this new approach does not require external funding and guidance.

Adult↗