The Relevance of Maternal Socioeconomic Characteristics for Low Birth Weight - a Case-Control Study.

Introduction: The number of children born underweight (low birth weight, LBW) is increasing despite extensive prevention and screening programmes. The cost is high for the health system, and affected children are burdened with health predictors that can affect them negatively throughout their lives. This study investigates to what extent socioeconomic factors, in addition to known medical causes and the health behaviour of pregnant women, influence LBW. Materials and Methods: In this case-control study 131 mothers of singletons with a birth weight ≤ 2500 g (cases) and 323 mothers of normal birth weight babies (controls) were interviewed with respect to socioeconomic status, health behaviour and stress in the workplace. Medical data were collected by specialist staff using a questionnaire. Results: Independent of medical diagnosis and health behaviour, women with lower level education (OR [95 % CI] = 2.24 [1.12; 4.51]) and those who were not working (OR [95 % CI] = 1.82 [1.10; 3.00]) were more likely to have an LBW baby. No effect was shown for immigrant background (OR [95 % CI] = 1.14 [0.59; 2.21]) or stress in the workplace (OR [95 % CI] = 1.17 [0.90; 1.51]). Discussion and Conclusion: These results show that the association between social and health inequalities starts from before birth. In order to reduce the rising number of babies born underweight, socioeconomic determinants in the care and supervision of pregnant women should systematically receive more attention to enable appropriate early preventive strategies to be implemented.

["So I would have been sitting at home and moping...": How do older single people in need of support experience companionship by volunteers after discharge from hospital?]. / "Ich hätte also zu Hause gesessen und Trübsal geblasen...": Wie erleben alleinstehende und hilfebedürftige ältere Menschen eine poststationäre Begleitung durch Ehrenamtliche?

BACKGROUND: Despite the well-known link between social support and health as well as quality of life only a few scientifically meaningful studies have been carried out to actively promote social support. In the +P Project (post-hospital lay support for patients) elderly people in need of support after a stay in hospital are accompanied in their daily life by volunteers. The qualitative research part in the study evaluates conditions which led to the adoption of the support by the volunteers and how the elderly people experienced this companionship. METHODS: The analysis followed the grounded theory method. In a theoretical sampling nine accompanied people were identified and participated in narrative interviews regarding their experience of the voluntary support. RESULTS: In addition to personality traits of the elderly and perceived seriousness of the project the interpersonal relationship was important for the adoption of the companionship. Key factors were the perceived similarity between the older people and their supporters as well as confidence in the volunteers and their skills. The support contributed to facilitating and enriching the daily life of the elderly and even friendships with the volunteers developed. CONCLUSIONS: The results indicate that volunteers can help to compensate a lack of social support for the elderly. The results confirm theoretical models of coping with age and disease-related losses and models of social relations in old age. At the same time this study underpins political recommendations to strengthen community engagement to promote social networks for older people.

[Health behaviour and changes in health behaviour - are education and social status relevant?]. / Gesundheitsverhalten und Änderungen im Gesundheitsverhalten - welche Relevanz haben Bildung und Schicht?

BACKGROUND: Individual health behaviour counts as an important factor for health status. A healthier lifestyle substantially contributes to better health. People burdened with lower health and with lower socio-economic status could benefit notably. So far it is not known exhaustively to what extent education and social status contribute to changes in health behaviour and which motifs play a decisive role. METHODS: Based on cross-sectional data from the seventh wave of the "Gesundheitsmonitor", Bertelsmann Foundation, (n=1 436), the influence of social status and education on health behaviour and changes in behaviour was analysed. RESULTS: Specific health behaviour correlates with level of education and socio-economic status. In contrast, regarding health behaviour changes in the last 12 months prior to survey, no social class- or education-specific effect was found. Age, health status as well as fears and wishes in relation to health seem to be important causalities for changes of health-related behaviour. CONCLUSION: Interventions to foster healthy lifestyles should include class differences in specific health-related behaviour and personal reasons for behavioural changes.

[Predictors for low birth weight--an epidemiological case-control study with women in childbed in the federal state Saarland, Germany]. / Prädiktoren für niedriges Geburtsgewicht - Eine epidemiologische Fall-Kontroll-Studie an saarländischen Wöchnerinnen.

BACKGROUND AND AIMS: Low birth weight is associated with elevated health-care costs and adverse conditions for the newborn's start to life. A variety of health problems and an impaired potential for the infant's development are known long-term effects. Only few studies have examined the role of psychosocial and socioeconomic determinants for the incidence of low birth weight, especially in Germany. The aim of our study was to test the impact of maternal socioeconomic and psychosocial characteristics as well as health behaviour on the infant's birth weight. METHODS: In an exploratory case-control study we tested whether the before mentioned potential determinants of low birth weight were observed more often among cases (birth weight <2,500 g) than among controls. Standardised interviews were conducted with maternal cases and controls. RESULTS: The results show that mothers in the control group more often were married or cohabiting (100% vs. 77%; p<0.05) and that they had a higher occupational status (83% non-manual vs. 54%; p<0.05). Level of education was not significantly related to birth weight. Mothers in the case group more often reported exhaustion (p<0.05) and marital problems [M=1.8 (1.1) vs. M=1.3 (0.5); p<0.05). They were characterised by a higher burden of work-strain in terms of weather conditions, heat or infiltration [M=1.7 (1.0) vs. M=1.1 (0.4); p<0.05). The available living space was slightly smaller in the case group [M=96.5 m(2) (31.5 m(2)) vs. M=118.5 m(2) (46.8 m(2)); p<0.1). DISCUSSION AND CONCLUSIONS: Our results confirm international studies showing differences regarding the social context of women who give birth to a child with normal or low birth weight. Apart from vertical status characteristics, marital conditions and resulting psychosocial stressors seem to have an impact.

[Social inequality and perceived quality of doctor-patient relationship among the chronically ill]. / Soziale Ungleichheit in der wahrgenommenen Qualität der Arzt-Patienten-Beziehung bei chronisch Kranken.

BACKGROUND: Several recent German studies indicate an association between social inequality and quality of health care, i.e., patients with a low socioeconomic position receive lower quality care than patients with a high position. In this study, we investigate whether two indicators of social inequality (education and income) are associated with the perceived quality of the doctor-patient relationship among chronically ill men and women. METHOD: Data basis is the TNS Health Care Access Panel (N=27 049). For the analyses chronically ill respondents were selected from the sample (N=12 343). In a multiple logistic regression analysis, odds ratios were calculated separately for men and women and for three age groups (18-30, 31-60, 61 years and older). We used three indicators for measuring the quality in the doctor-patient relationship: trust in physician, information received from the physician and participation in the decision-making process. RESULTS: Results show that income and education are consistently though weakly associated with the perceived quality of the doctor-patient relationship. Among chronically ill men and women with comparatively low income and educational level odds for rating the perceived quality of health care as suboptimal are slightly higher. This is especially true for the group of old chronically ill persons (61 years and older). DISCUSSION: Social inequality is associated with perceived quality of health care among chronically ill older men and women in Germany. These inequalities in health care can be explained by patient factors (e.g., information seeking, participation seeking) and physician related factors (e.g., providing information).

[Documentation of outpatient treatment of Paget's disease in Westphalia-Lippe. Descriptive analysis of statutory health insurance data for the year 2005]. / Dokumentation der ambulanten Morbus-Paget-Behandlung am Beispiel der Region Westfalen-Lippe: Deskriptive Analyse der Abrechnungsdaten gesetzlich Krankenversicherter für das Jahr 2005.

GOAL: Inpatient health care data are often used as a source of information for health reporting in Germany, despite the fact that a lot of diseases are predominantly treated in the outpatient sector. This study provides a first overview of the outpatient care situation in relation to Paget's disease. METHOD: Outpatient care data from the Association of Statutory Health Insurance Physicians constituted the database for a descriptive analysis, capturing the state of medical care for the rare rheumatic illness Paget's disease (Osteodystrophia deformans) in the region of East Westphalia-Lippe in 2005. RESULTS: While the health report of North Rhine-Westphalia documents a total of 56 cases of M. Paget discharged from hospital for the year 2003, 166 patients suffering from Paget's disease consulted an practice-based physician in 2005 in the district of Detmold alone. The latter figure corresponds to 8.0 treated patients per 100.000 inhabitants. The treatment rates of men and women are comparable. The probability of treatment increases with advancing age. On average, patients with Paget's disease are 65.6 years old (SD=15.4 years). Almost 90% of the diagnoses of Paget's disease are classified as M88.9 according to ICD 10; more exact localisations are provided only for relatively few cases. Nearly a quarter of the cases (24.1%) are treated by general practitioners and internists. Anaesthetists treated 17.5% of the patients and orthopaedists 16.9%. In addition, ophthalmologists treat a considerable proportion of cases (12.0%). CONCLUSION: Consistent with the rareness of Paget's disease, the treatment data are as low as expected. However, the results show that routinely collected health care data allow insights into morbidity structures within the outpatient sector. It follows that for statutory health insurants (approximately 90% of the population) there should be an extension of health reporting to diseases that are mainly treated in outpatient settings.

[Women and men after acute myocardial infarction: are there gender differences in participation rates in cardiac rehabilitation?]. / Frauen und Männer nach Herzinfarkt: Gibt es in Deutschland geschlechtsspezifische Unterschiede in der Inanspruchnahme rehabilitativer Leistungen?

In Germany and other countries a possibly lower programme attendance in cardiac rehabilitation of women compared to men has been critically discussed for many years. Up to now however there are only limited data related to gender-specific utilization rates and programme attendance. In a longitudinal study with three points of measurement, 496 men and 172 women after an acute myocardial infarction and their physicians were asked to complete questionnaires referring to different aspects of the medical and psychosocial situation as well as to provision of acute cardiac care and rehabilitation services. The results show that currently in Germany no gender differences exist in the use and provision of cardiac rehabilitation. Whether this apparently "fair" distribution in relation to gender can be seen as an adequate supply however is questionable in the context of different needs - especially with respect to the different psychosocial conditions of women and men.

[Marketing orientation in rehabilitation--exemplified by image analysis of a rehabilitation clinic for addictions]. / Marketing-Orientierung im Bereich Rehabilitation--Beispiel einer Image-Analyse einer Rehabilitationsklinik für Suchterkrankungen.

This article presents the findings of an image analysis carried out for a rehabilitation clinic for addictive diseases. The cross-sectional study was designed as an anonymous survey sent to relevant (regional) referral agencies (n = 90), e.g. counselling services for addictive diseases. The study covers the clinic's actual and ideal image, discriminating frequency of referrals, diagnostic categories, region, and type of institution. Results concerning the real profile indicate that on average the dimensions cooperation, communication with regard to personal contact, and reputation of the clinic were more critically judged than the issues information, communication with regard to discharge reports, standards of quality, and consideration of patients' needs. Cooperation, communication with regard to personal contact, and quality standards turned out to be the most important criteria from the referring agencies' perspective (ideal profile). A statistical comparison between those with high and low assignment rates suggested that customers rated the clinic more favourably than non-customers. Thus, it seems that the clinic's image has considerable influence on referral decisions. Particularly interesting is the additional finding that the referring institutions perceive pension insurers' directives to be of secondary relevance.