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Background: In addition to the primary health care of refugees, their integration into the regular outpatient care system should be ensured. Initial data suggest that a gap of vaccination among (school) children of refugee families might have emerged in the period between the first general inspection on arrival (the first central health measure) and the transition to the local health care system., Objectives: The aim of this study was to obtain the opinion of practicing paediatricians regarding the vaccination status of refugee children to examine whether a variance in the measles, mumps, rubella (varicella) vaccination schedule might have emerged between the periods of initial admission and school enrolment examination. Evaluations of both inhibiting and promoting conditions should generate fields of action regarding the systematic integration into the regular health care system., Method: Qualitative interviews with experts as well as a quantitative questionnaire survey to measure the opinion of registered paediatricians in Münster were analyzed., Results: The assessments showed that there was no clear vaccination gap among (school) children of refugee families. One challenge was the systematic integration into the local outpatient care system. Critical issues were inadequate vaccination education, language barriers, and frequent changes in location. The vaccination engagement and vaccination behaviour of refugees were assessed as most positive. International standards, in particular the sphere standards, attracted insufficient attention in practical implementation within the refugee relief programs., Conclusions: Based on the results, it is possible to identify fields of action for the prevention of vaccination gaps among refugees as well as for their systematic integration into the regular outpatient care system. The sphere standards as international standards should be incorporated more consciously., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonfliktbesteht., (Thieme. All rights reserved.)

Background: Ketone bodies are a highly relevant topic in nutrition and medicine. The influence of medium-chain triglycerides (MCT) on ketogenesis is well known and has been successfully used in ketogenic diets for many years. Nevertheless, the effects of MCTs and coconut oil on the production of ketone bodies have only partially been investigated. Furthermore, the increased mobilisation of free fatty acids and release of catabolic hormones by caffeine suggest an influence of caffeine on ketogenesis., Methods: In a controlled, double-blind intervention study, seven young healthy subjects received 10 mL of tricaprylin (C8), tricaprin (C10), C8/C10 (50% C8, 50% C10), or coconut oil with or without 150 mg of caffeine, in 250 mL of decaffeinated coffee, over ten interventions. At baseline and after every 40 minutes, for 4 h, ß HB and glucose in capillary blood as well as caffeine in saliva were measured. Furthermore, questionnaires were used to survey sensory properties, side effects, and awareness of hunger and satiety., Results: The interventions with caffeine caused an increase in ß HB levels-in particular, the interventions with C8 highly impacted ketogenesis. The effect decreased with increased chain lengths. All interventions showed a continuous increase in hunger and diminishing satiety. Mild side effects (total = 12) occurred during the interventions., Conclusions: The present study demonstrated an influence of caffeine and MCT on ketogenesis. The addition of caffeine showed an additive effect on the ketogenic potential of MCT and coconut oil. C8 showed the highest ketogenicity., Competing Interests: The authors declare that they have no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Anna Baumeister et al.)

Purpose: Homeless persons have a high risk for tuberculosis. The prevalence of latent tuberculosis infection and the risk for a progression to active tuberculosis is higher in the homeless than in the general population. The objective was to assess the prevalence and risk factors of tuberculosis/latent tuberculosis infection in a homeless population in Germany., Methods: Homeless individuals (n = 150) were enrolled in a cross-sectional study at three shelters in Münster, Germany (October 2017-July 2018). All participants were screened using an ELISPOT interferon-γ release assay (IGRA). Those participants tested positive/borderline by IGRA provided three sputa for microbiological analysis (line probe assay, microscopy, culture) and underwent a chest X-ray to screen for active pulmonary TB. Risk factors for tuberculosis/latent tuberculosis infection were analysed using a standardized questionnaire., Results: Of the 142 evaluable IGRA, 21 (15%) were positive and two (1%) were borderline. No participant with a positive/borderline IGRA had an active tuberculosis as assessed by chest X-ray and microbiology. A negative IGRA was associated with a citizenship of a low-incidence country for tuberculosis (according to WHO, p = 0.01), low-incidence country of birth (p<0.001) or main residence in a low-incidence country in the past five years (p = 0.002)., Conclusions: The prevalence of latent tuberculosis infection (diagnosed by a positive/borderline IGRA) was 16%; no active tuberculosis was detected. The highest risk for latent tuberculosis infection was found in patients from high-incidence countries. This population at risk should be either treated for latent tuberculosis infection or need to be monitored to early detect a progression into active disease., Competing Interests: The authors have declared that no competing interests exist.

Background: In recent refugee migration into Germany the responsibilities and reactions of health authorities are still lacking general co-ordination., Problem: Can the ethical and technical standards of international humanitarian assistance serve as an appropriate and even a compulsory guideline for relief agencies, public health and regulatory authorities in Germany?, Methods: Documents from the field of medical ethics, medical law, international humanitarian law and disaster medicine will be examined and checked for practicability by consulting experiences during the 1990s Balkan wars refugee movement and international missions of relief agencies., Results: Ethical and technical standards of international humanitarian assistance have been developed, improved and evaluated for 20 years, and are valuable tools for emergency management., Conclusions: Victims of disaster or conflict have a right to live in dignity and therefore have a right to receive health care according to international standards. International ethical and technical standards for refugees should be considered in the Federal Republic of Germany like in any other country.

Heavy snowfalls caused electrical power cuts in the rural Muenster area in November and December of 2005. Because of the necessity of complex relief coordination, the incident command was soon transferred to the administrative districts. In a survey, 591 of the affected households were asked in written form on their attitude towards disaster preparedness and private stockpiling of foodstuffs in the districts of Steinfurt und Borken in June, 2006. Even their personal experience of a failure of critical infrastructures had not changed the confidence of the affected population in public disaster management and their unconcerned attitude towards private stockpiling of foodstuffs had not been affected either.

The 53rd scientific congress of the Federal association of physicians and dentists in the public health services addressed the interdependence of migration and health under the motto "health unlimited" in May, 2003. Manifold interactions between migration and health contribute to the public health services' everyday experiences. Immigrants often encounter manifold obstacles to their access to health services in Germany. These barriers are often of communicative or administrative nature. The system of public health administration and services has, by its very nature, opportunities and assignment a special obligation to support the immigrant population. The public health services will increasingly become guarantors of equal health opportunities in times of cumulative migration and social inequalities. In cooperation with the German Federal Commissioner for Migration, Refugees and Integration the German Federal Working Group on Migration and Public Health acts as facilitator and advocate for health of immigrants to Germany since 1994. A very close co-operation with the public health services and an interdisciplinary, intercultural, population-oriented and health-promoting approach are core elements of the working group that is lobbying the health of a multinational population within the borders of Germany.

In a complex humanitarian emergency, a catastrophic breakdown of political, economic, and social systems, often accompanied by violence, contributes to a long-lasting dependency of the affected communities on external service. Relief systems, such as the Emergency Response Units of the International Federation of Red Cross and Red Crescent Societies, have served as a sound foundation for fieldwork in humanitarian emergencies. The experience in emergencies gained in Rwanda in 1994 and Kosovo in 1999 clearly points to the need for individual adjustments of therapeutic standards to preexisting morbidity and health care levels within the affected population. In complex emergencies, public health activities have been shown to promote peace, prevent violence, and reconcile enemies. A truly democratic and multi-professional approach in all public health training for domestic or foreign service serves as good pattern for fieldwork. Beyond the technical and scientific skills required in the profession, political, ethical, and communicative competencies are critical in humanitarian assistance. Because of the manifold imperatives of further public health education for emergency assistance, a humanitarian assistance competence training center should be established. Competence training centers focus on the core competencies required to meet future needs, are client-oriented, connect regional and international networks, rely on their own system of quality control, and maintain a cooperative management of knowledge. Public health focusing on complex humanitarian emergencies will have to act in prevention not only of diseases and impairments but also of political tension and hatred.

The circumstances of life and the health status of children and adolescents in Germany have undergone fundamental changes. Public institutions, such as schools or kindergartens more often are not only support but a substitute for family structures. Individual medical care being guaranteed, seeking for prevention and treatment and health status differ widely according to sociological patterns. Health care and social compensation programmes on a multiprofessional basis will thus be accessible only in a very general sense to all youth at the public institution of a school. Besides all the general public health programmes in schools, medical expertise on an individual level is becoming more and more important because of the increasing number of classes integrating diseased and disabled children in regular school. The public school health services will not only act as individual medical experts themselves but more as coordinators of all medical and health promoting efforts on an administrative, school, inpatient and outpatient level. Medical professionals working in public school health services will therefore have to be trained in the following spheres: normal range of developmental milestones, knowledge of health systems and regional structures of health care, epidemiological basics, communicative and social training, clinical expertise in the fields of general paediatrics, child psychiatry and occupational health. Being fully trained in clinical paediatrics and public health will surely be an asset, but will not cover all the requirements for successfully working in school health care. For this reason the programmes of higher education in public health have to be adjusted to the recent demands in this special field of work. School health services will have to engage in occupational health and will have to be present mostly in the school buildings proper. School health services will have to report and publish epidemiological data for use by school, community and medical professionals. In case of continued compulsory medical examination of schoolbeginners wide use should be made of qualified assistant personnel, so that physicians can focus on true medical problems in school and moreover will be enabled to deliver medical expertise and treatment within the community to people and population groups in need.

New German legislative ordinances prescribe hygiene control in nursing homes and homes for the aged, e. g. the Law for Protection against Infectious Diseases and in North-Rhine Westphalia the Public Health Law. However, there are as yet no clearly defined standards of hygiene because the special features of nursing homes must be considered when applying the "Guidelines for Hospital Hygiene and Prevention of Infections" issued by the Robert Koch Institute. Hence, specific recommendations are given for hygiene of the hands, disinfection, hygienic treatment care, protective and professional clothing, washing of textiles, central kitchen, disposal of waste, house cleaning and handling of drugs and medicines.

About 9 % of the German population is of immigrant descent. Correlations between migration and health have recently been focused on by health and social sciences in Germany. Migration due to different motivations itself strongly affects the health status of individuals and subpopulations. Therapeutic institutions on an individual level and public health services in Germany will need further development towards professional intercultural health care. An international workshop on the topic of migration and health in March 2000 illustrated the importance of the public health services and their opportunities in co-ordination of the health related multicultural variety. Migration generally was regarded being an asset to health in the community. Improvement of verbal communication skills and of the medical expert opinion practice towards culturally sensitive health care were pointed out being major objectives for the public health services as were prevention and health care programs for children and for psychosocially endangered persons within the immigrant population.

The unique opportunities of databased community health promotion in cooperation with local community health authorities are pointed out. Especially within the local refugee population many organisational and psychological obstacles to otherwise widely distributed health services are obvious. Population-focused community health practice involves home health care with interdisciplinary collaboration, and promotes clients's responsibility and self-care. Health promotion depends on communal health reporting focused on specific needs of subpopulations. Health and population data concerning the refugees in Muenster show a considerably higher proportion of children than among the general population of the town, thus indicating special needs for the paediatric care of this group. Communal data concerning health-relevant indicators such as vaccination rates or routine paediatric checkup coverage illustrate the necessity for improving low levels of health care for the communal refugee population. The concept of transcultural community health nursing with vice versa information about health traditions and practices improves health services and care for the refugee population and the health-related communal culture in general.