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Background Studies have shown differences regarding prevalence and incidence of chronic diseases among first (own migration experience) compared to second (born in host country) generation migrants. The aim of this study was therefore to investigate the incidence of cardiovascular diseases (CVD) among persons of Turkish descent with and without migration experience living in Berlin, Germany. Methods In 2012-2013, Berliners with a Turkish migration background were recruited, examined, and contacted again 5 years later via postal mail. Incidence of diagnosed CVD (myocardial infarction, stroke, coronary heart disease, heart failure, cardiac arrhythmia, intermittent claudicatio or transient ischaemic attack) was assessed via self-report. Incidence of any CVD is presented as number and percentages. Associations between the incidence of any CVD and having an own migration experience were investigated with uni- and multivariable regression analyses. Results are presented as odds ratios with a 95%-confidence interval (OR, 95%-CI). Results Data of 234 persons of Turkish descent (62.8% women) with a mean age±standard deviation of 44±12.4 years were included in the analyses. Out of these, 79.9% were first generation migrants. First compared to second generation participants differed regarding CVD incidence (any CVD 16.6% vs. 4.3%, respectively; p = 0.03), socio-demographic, and lifestyle factors. After adjusting for these factors, multivariable analysis showed that only BMI (OR 1.12 per BMI point, 95%CI [1.02;1.24], and having a diagnosis of dyslipidemia (OR 4.0, 95%CI [1.45;12.05]), were independently associated with CVD incidence. Conclusions In a cohort study with Berliners of Turkish descent, CVD incidence was associated with increasing BMI and dyslipidemia, but not with own migration experience. Future migration-related public health research needs to focus on the prevention of harmful health behaviours to avoid the progression of overweight/obesity and dyslipidemia. Key messages CVD incidence is higher in persons with migration experience compared to those without. Migration experience is not associated with CVD incidence after adjusting for confounders (e.g. age, BMI).

Mortality in developing countries has multiple causes. Some of these causes are linked to climatic conditions that differ over the year. Data on season-specific mortality are sparse.We analysed longitudinal data from a population of approximately 35,000 individuals in Burkina Faso. During the observation period 1993-2001, a total number of 4,098 deaths were recorded. The effect of season on mortality was investigated separately by age group as (i) date of death and (ii) date of birth. For (i), age-specific death rates by month of death were calculated. The relative effect of each month was assessed using the floating relative risk method and modelled continuously. For (ii), age-specific death rates by month of birth were calculated and the mean date of birth among deaths and survivors was compared.Overall mortality was found to be consistently higher during the dry season (November to May). The pattern was seen in all age groups except in infants where a peak was seen around the end of the rainy season. In infants we found a strong association between high mortality and being born during the time period September to February. No effect was seen for the other age groups.The observed excess mortality in young children at or around the end of the rainy season can be explained by the effects of infectious diseases and, in particular, malaria during this time period. In contrast, the excess mortality seen in older children and adults during the early dry season remains largely unexplained although specific infectious diseases such as meningitis and pneumonia are possible main causes. The association between high infant mortality and being born at around the end of the rainy season is probably explained by most of the malaria deaths in areas of high transmission intensity occurring in the second half of infancy.

To analyse the effects of zinc supplementation on growth parameters in a representative sample of young children in rural Burkina Faso. Design Randomized, double-blind, placebo-controlled efficacy trial. Setting Eighteen villages in rural northwestern Burkina Faso. Subjects In all, 709 children aged 6-31 months were enrolled; 685 completed the trial. Intervention Supplementation with zinc (12.5 mg zinc sulphate) or placebo daily for 6 days a week for 6 months. Outcomes Weight, length/height, mid-arm circumference, and serum zinc.In a representative subsample of study children, 72% were zinc-deficient at baseline. After supplementation, serum zinc increased in zinc-supplemented but not in control children of the subsample. No significant differences between groups were observed during follow-up regarding length/height, weight, mid-arm circumference, and z scores for height-for-age, weight-for-age, and weight-for-height.We conclude that zinc supplementation does not have an effect of public health importance on growth in West African populations of young children with a high prevalence of malnutrition. Multinutrient interventions are likely to be more effective.

Based on a demographic surveillance population from 39 villages in rural Burkina Faso, we describe mortality patterns in adults (15‐59 years) and older people (� 60 years), and discuss seasonal trends in mortality. During the study period 1993‐1998, 589 deaths in adults and 593 deaths in older people were recorded from an average adult and older people population of 13 550. The crude all-cause mortality rate per 1000 for adults was 7.3 (95 per cent confidence interval (CI) 6.7‐7.8) and for older people 55.8 (95 per cent CI 51.3‐60.3). The probability of dying before age 60 after reaching age 15 was 34 per cent for males and 32 per cent for females. Malaria and diarrhoea, recorded through verbal autopsy, accounted for 21 per cent of total deaths in adults and 22 per cent in older people. A seasonal trend in mortality for older people with a peak in February was identified. The study shows that malaria is an important cause of death in adulthood.

Background: In 2011, almost 20.0% of the population of Germany had a migration background. Studies on their health tend to have low participation rates. The aim of our study was to compare different sampling strategies and to test different approaches to recruit migrants for an epidemiological study. Methods: Four recruitment centres of the German National Cohort recruited persons of Turkish origin and ethnic German immigrants from former Soviet Union countries. A register-based (random samples from residents’ registration offices) and a community-orientated strategy were applied. Participants underwent a medical examination and self-completed a questionnaire. Results: Used approaches: The community-orientated strategies comprised the acquisition of key persons from migrant networks to support the recruitment, invitation talks and distribution of study materials in migrant settings, etc. The identifying variables in the registry data were name, nationality or country of birth. All but one centres used bilingual study material and study staff. Participation: When comparing the two strategies, the register-based participation rates ranged from 10.1 to 21.0% ( n = 668 participants) and the community-oriented recruitment resulted in 722 participants. Conclusion: Register-based recruitment should use a combination of name, nationality and country of birth in order not to be limited to identifying persons with a foreign nationality. However, according to the study staff, the community-oriented approach involving key persons of the same cultural background leads to a better acceptance by the participants. Also, it covers a more heterogeneous group. Yet, it is time-consuming and needs considerably more staff. Further research should establish the effectiveness of a combination of both strategies.

BACKGROUND Nitrate is known to be a precursor in the endogenous formation of N-nitroso compounds which are thought to be associated with the development of brain tumours. METHODS We conducted a population-based case-control study on the aetiology of primary brain tumours in adults in which the nitrate concentration in drinking water was investigated as a quantitative variable. For this purpose, an additional drinking water survey was performed. RESULTS Analysis of 173 incident cases and 418 controls did not show any relationship between exposure to nitrate in drinking water and risk of developing primary brain tumours. We found mean nitrate concentrations of 15.98 mg/l (SD 15.61) in the drinking water history of the cases and of 16.16 mg/l (SD 15.72) for controls. In addition, we compared the quantitative history of nitrate contamination of the study participants to a semi-quantitative assessment by a stick method. Although we found good agreement between these methods we would recommend the use of detailed water surveys for retrospective studies on contaminants in drinking water. CONCLUSION The results suggest the absence of an association between nitrate levels in drinking water and the risk of brain tumours. However in order to draw definite conclusions quantitative prospective studies are needed.

In a hospital-based case-control study 194 lung cancer cases, 194 hospital controls, and 194 population controls were interviewed for their smoking, occupational, and residential history by trained interviewers, using a standardized questionnaire. In order to include many different environmental exposures, case ascertainment took place in seven different hospitals with catchment areas ranging from rural to highly industrialized. Lung cancer risk strongly increases with cumulative cigarette dose, reaching an odds ratio (OR) of 16.19 (95% confidence limits (CL): 5.10, 51.33) for male smokers of more than 40 pack-years and an OR of 19.99 (95% CL: 4.98, 80.24) for female smokers of more than 20 pack-years. For the quantification of occupational exposure to known carcinogens of the lung a novel approach was developed which accumulates exposure information obtained by supplemental questionnaires through an automatic procedure. The OR for the highest exposure group in males was 2.7 (95% CL: 1.23, 5.78). Significantly increased risks were observed in the metal industry, particularly in smelter and foundry workers (OR 4.8, 95% CL: 1.15, 20.16) and in turners (OR 2.2, 95% CL: 1.05, 4.75). In the construction industry the risks were particularly high in road construction workers (OR 3.7, 95% CL: 1.06, 13.20) and in unskilled construction workers (OR 2.7, 95% CL: 1.24, 5.76). The risks in these occupational groups increased with duration and with latency. Quantification of air pollution was done on a county basis by time period. An index based on emission data for sulphur dioxide was compared to a semiquantitative index, which included additional information on ambient air pollution. After adjustment for smoking and occupational exposures an OR of 1.01 (95% CL: 0.53, 1.91) for an emission index and of 1.16 (95% CL: 0.64, 2.13) for a semiquantitative index was obtained.

In recent years a lot of efforts have been invested in providing estimations for the malaria burden in Africa and the rest of the world. The results available so far on the number of deaths due to malaria have helped to highlight the graveness of malaria and budgetary support towards malaria research and interventions is continuously increasing. However the precision of these estimates still needs improvement since there are a number of known limitations involved in the estimation procedures. Among these are a very incomplete coverage of the population at risk and the difficulty to diagnose a malaria death post mortem. Recently Rowe et al. estimated the burden of malaria mortality among African children for the year 2000. Their comprehensive framework rounds off other recently completed approaches from various study groups that are working on the estimations of the global malaria burden. The authors applied estimation methods used by Snow relying on aggregation of published and unpublished data population or survey estimates and model based estimates which take geographical and climatic determinants into account. They further improved on these methodologies by adding a yearly prediction model to estimate the figures for the year 2000. The result is a summary figure that takes account of different estimation assumptions from the single reports that contribute to this value. Such assumptions range from methods on how to allocate deaths with unknown causes standardization procedures to model based assumptions. Differences in such assumptions create variations in results-a thought shared by Smith who acknowledges that mortality rates from similar sites in Africa vary enormously. (excerpt)