Effects of medical causes, role concepts and treatment stages on quality of life in involuntary childless men.

Goal of this study was to investigate differences in quality of life in men contingent upon various fertility treatment stages, infertility causes and adoption of roles. A quantitative study with n = 115 men in three German fertility centres was devised. Participants completed a standardised, fertility-specific questionnaire devised for men (TLMK), sociodemographic and role items. Men having experienced severe medical conditions, for example cancer, reported significant higher quality of life compared to men with other infertility reasons [F(1,56) = 12.77, P = 0.001]. Furthermore, allocating participants into distinctive groups by means of kind and duration of treatment revealed significant group differences [F(2,111) = 4.94, P = 0.009], with quality of life decreasing with the use of more invasive fertility methods. A higher satisfaction with life was also stated by men adopting many tasks in the treatment process. The high quality of life displayed by men having experienced severe medical conditions contains valuable and far-reaching information about possible resilience factors that need to be researched more in detail. The finding of decreasing quality of life in men with the use of more invasive methods in treatment applies for increased psychosocial services in fertility clinics.

Patients Presenting to the Emergency Unit with Gynaecological Lower Abdominal Pain, with and without Pathological Clinical Findings - Service Utilisation, Pain History, Implications.

Introduction: Few studies have evaluated the utilisation of emergency gynaecological services, although lower abdominal pain (LAP) is one of the most common symptoms prompting emergency presentation. Although such pain may be caused by potentially life-threatening gynaecological diseases, very often no clinical cause is found. The aim of this study was to describe the characteristics of emergency presentations in order to enable quicker identification of real emergencies in routine clinical practice. Materials and Methods: Standardised, so-called first aid cards of 1066 consecutive patients with LAP presenting acutely to one emergency unit were analysed in this retrospective, cross-sectional study. Results: Over one third of cases did not constitute actual medical emergencies on objective criteria, with investigations yielding "no pathological findings". Parameters were identified that more often lead to hospital admission, e.g. palpation of a mass/resistance or at least one pathological ultrasound finding. In addition, it was found that symptoms of longer duration (average 8 days), and not only acute LAP, were also often experienced by patients as emergencies. Conclusion: A diagnosis of "no pathological findings", which was common in our study, suggests a subjective experience of an emergency from the patient's point of view, although the possibility of unrecognised pathology has to be borne in mind. Apart from functional disorders, the origins of symptoms may include psychosomatic causes and psychosocial problems, which cannot be further defined in the emergency care setting. Also, the phenomenon of increased utilisation of emergency services parallel to the assumed opening hours of routine outpatient care facilities must be seen in a critical light.

Sexuality, Self-Esteem and Partnership Quality in Infertile Women and Men.

Introduction: Infertile couples often report quality-of-life impairments, especially in terms of sexuality, self-esteem and partnership quality. So far, there have been no systematic studies of the sex lives and behaviour of infertile women and men before and after the emergence of their mutual desire for a child. Materials and Methods: From February 2010 to August 2010 all couples starting treatment either at Heidelberg University's Women's Hospital or at the Fertility Center Berlin were asked to fill out the Self-Esteem and Relationship Questionnaire (SEAR). A total of n = 158 women and n = 153 men participated in the study. Results: Decreasing tendencies were observable for both partners in the domains Sexual Relationship Satisfaction and Confidence and in the subscales Self-Esteem and Overall Relationship Satisfaction. There were especially clear indications of a loss of spontaneous sexuality during the experience of infertility. We were also able to establish that infertility has a negative impact on women's self-esteem. Discussion: The results of this study indicate that SEAR can be used as a feasible instrument for identifying infertile women and men whose infertility has a negative effect on their relationship quality and/or sex lives.

[In vitro fertilization and intracytoplasmic sperm injection: current medical aspects]. / In-vitro-Fertilisation und intrazytoplasmatische Spermieninjektion : Aktuelle medizinische Aspekte.

Since the delivery of the first baby conceived via in vitro fertilization (IVF) in 1978, IVF has become a standard procedure in sterility treatment. In Germany, 78,000 IVF/intracytoplasmic sperm injection (ICSI) cycles are performed annually with a delivery rate per embryo transfer of about 20 %. The cumulative delivery rate after three trials is more than 50 %. The main medical problems are the high rates of multiple pregnancies of more than 20 %, which carry an increased risk for mothers (preeclampsia) and children (preterm delivery, lung immaturity, brain problems). Also singleton babies after IVF are more often too small (small for gestational age, SGA) and delivered preterm. As a result, proper counselling is necessary. New laboratory methods have increased the success rate. Cryopreservation techniques such as vitrification are standard for freezing oocytes, pronuclear-stage oocytes and embryos if they are not needed during the current treatment cycle. Continuous observation of embryos by time-lapse imaging helps to identify the best embryos for transfer. The current legislation in the German embryo protection act (Embryonenschutzgesetz) is the main problem. It is unclear how many fertilized oocytes can be cultured to achieve a transfer of one to three embryos. The prohibition of oocyte donation and surrogacy are not comprehensible from a medical, psychological, and ethical point of view. Reimbursement of publicly insured patients is restricted in comparison with other European countries. Married couples receive half of the payment for three IVF/ICSI cycles; non-married couples receive no payment at all.

Yoga for Patients with Early Breast Cancer and its Impact on Quality of Life - a Randomized Controlled Trial.

The aim of this prospective, randomized, controlled trial was to investigate the impact of yoga on newly diagnosed patients with early breast cancer in the immediate postoperative phase. 93 women newly diagnosed with early breast cancer were randomized into an intervention group (IG) and a control group (waiting group, WG). The IG started yoga immediately after the operation. The WG started yoga 5 weeks after surgery. Both groups attended yoga classes twice weekly for 5 weeks. Quality of life (QoL) was evaluated using the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires before the intervention, immediately after the operation and after 3 months. After 3 months the patients were asked whether yoga improved their physical activity and whether they wished to continue with yoga. The overall QoL (p = 0.002) and the functional status (p = 0.005) increased significantly in the IG, while physical symptoms decreased over time in both groups. 86 % of patients in the IG and only 59 % of patients in the WG (p = 0.04) confirmed a positive change in their physical activity through yoga. More women in the IG intended to continue with yoga (p = 0.03). Early initiation of yoga as a supportive treatment in cancer had a positive impact on QoL. Teaching yoga allowed patients to practice yoga by themselves, enhanced the patients' QoL and was found to improve physical activity.

[The physician's role in various clinical contexts. Physician counseling on in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD)]. / Die Arztrolle in unterschiedlichen klinischen Kontexten. Ärztliche Beratung bei In-vitro-Fertilisation (IVF) und Präimplantationsdiagnostik (PID).

The role of the physician in the context of in vitro fertilization and preimplantation genetic diagnosis has certain distinct characteristics. Involuntary childlessness by definition of the WHO is a disease with good treatment options. As it is not considered a medical emergency, the focus lies more on intensive information giving, education, and counseling. Because the diagnosis and treatment can be a medical and psychological strain for the couple, counseling should address both medical and psychological aspects. The physician needs to have detailed medical knowledge as well as good communication skills to be able to meet the specific needs of the couple. Moreover, the physician should point out the realistic success rates of treatment and should refer to alternatives, such as remaining childless, adoption, and sperm or egg donation. The concurrent inclusion of biological, psychological, social, and ethical aspects in terms of psychosomatic basic care (Psychosomatische Grundversorgung) seems to be useful. There is potential for conflicts, for example, due to the economic interests of the physician. On the other hand, the treatment can be a financial burden for the couple. Of importance are the physician's and the patient's moral concepts, especially concerning some aspects of therapy (sperm and egg donation, surrogacy). The expected welfare of the intended child should also be respected (e.g., higher risk of preterm birth in multiple pregnancies). Further possible conflicts in reproductive medicine arise because of the crossing of moral boundaries (oocyte donation for postmenopausal women, surrogacy, cloning of human beings). The framework of counseling is based on the guidelines of the German Medical Association (Bundesärztekammer) for assisted reproduction (2006). Preimplantation genetic diagnosis has special requirements from a medical and psychosocial point of view.

The State of Reproductive Medicine in Germany.

In the 1960s and 70s, Germany played a leading role in the field of gynaecological endocrinology, which was reflected by the scientific activity of German universities during this period. More recently, however, a dramatic change occurred, resulting in a decreasing number of publications in this field. This has undoubtedly contributed to the marginal scientific position of Germany in gynaecological endocrinology today. This change is reflected by the decreasing number of university centres carrying out active scientific research in the fields of gynaecological endocrinology, reproductive medicine and andrology. Universities now lack mid- and upper-level faculty staff, as interesting and senior positions in the field of reproductive medicine, andrology and reproductive medicine no longer exist. Moreover, in 1991 the German embryo protection law came into force, which severely curtailed scientific research and blocked scientific efforts in this area. German scientists and, of course, childless couples were cut off from scientific advances, e.g. the possibility of single embryo transfer. Germany's scientific position in the fields of gynaecological endocrinology, reproductive medicine and andrology needs to be strengthened. The creation of appropriate structures in German universities is therefore necessary. These would include important cooperations with private medical practices, which currently account for about 75 % of patient care. The lines of communication between the groups representing reproductive medicine in Germany need to be greatly improved. Moreover, we suggest that an important step would be the development of a general human embryology and fertilisation act which would allow German couples to benefit from the global advances in the field of reproductive technology. Germany must stop its policy of scientific obstruction and permit scientific progress in this field in German universities.

Cryoconservation of Oocytes in a Patient with Breast Cancer and Intrauterine Early Pregnancy.

Case Report: A 38-year-old patient newly diagnosed with invasive ductal breast cancer wished to cryoconserve her unfertilised oocytes. Stimulation was started on the 26th day of her menstrual cycle with daily administration of 300 IE hMG s. c. and a GnRH antagonist (cetrorelix 0.25 mg s. c.). The patient additionally received an aromatase inhibitor during the first 5 days of stimulation (letrozole 5 mg p. o.). Induction of ovulation occurred on the 11th day of stimulation with hCG (10 000 IE s. c.) and a GnRH agonist (triptorelin 0.2 mg s. c.). Seventeen oocytes were retrieved during follicle puncture and 11 were cryopreserved. Despite the administration of cetrotide (a GnRH antagonist) no luteolysis occurred during stimulation. A pregnancy test was therefore done on the 11th day of stimulation and the result was positive (ß-HCG 3493 mIU/ml). Sonography showed an intrauterine pregnancy. The patient was in gestational week 5 + 0. The aspirated oocytes mostly showed a normal morphology (metaphase II) despite high progesterone levels during stimulation. The patient decided to terminate the pregnancy before starting adjuvant chemotherapy. Conclusion: We describe the case of a patient who underwent stimulation for cryopreservation of oocytes during a spontaneous pregnancy conceived in the same cycle just before starting stimulation. Stimulation was done over a short period using a combination of a GnRH antagonist and an aromatase inhibitor to ensure the lowest possible estradiol levels. The quality of the oocytes does not appear to have been negatively affected by the high progesterone levels of early pregnancy.

[Correlation between sonographic findings and level of knowledge/self-report of symptoms in women with uterine leiomyomata]. / Korrelation von sonografischem Untersuchungsbefund mit Informiertheit und Symptom-Selbsteinschätzung bei Frauen mit Uterus myomatosus.

PURPOSE: Is there any correlation between the pre-therapeutic level of knowledge concerning the number/size of leiomyomata or self-reported symptoms and confirmation by sonography? How does the assumption of the number/size of leiomyomata influence the self-perception of symptoms? MATERIALS AND METHODS: In an anonymous questionnaire 498 patients were asked about the number, size and symptoms induced by leiomyomata using a visual chart from 0 - 10. The data were correlated with findings from transvaginal and abdominal ultrasound. RESULTS: The self-reported number of leiomyomata corresponded with the sonographic findings in 80 % of patients with 1 leiomyoma and in 54 % of patients with 2 or 3 leiomyomata, while the self-reported size only corresponded with the sonographic findings in 20 % to 70 % of patients. There was no correlation between the number of leiomymata confirmed by sonography and self-reported symptoms. There are significant correlations between the sonography-defined size and self-reported level of dysmenorrhea (p = 0.003) and self-reported pressure in the abdomen (p = 0.02), as well as submucosal leiomyomata and hypermenorrhea (p = 0.01). Patients who assumed multiple or large leiomyomata ≥ 10 cm reported strong pressure on the bladder or pressure in the abdomen significantly more frequently than patients who assumed 1 leiomyoma (p = 0.03) or a leiomyoma less than 10 cm (p = 0.018). CONCLUSION: There is a discrepancy between the relatively good knowledge about the number of leiomyomata and the lack of knowledge about their size. Subjective incorrect presumptions concerning the number or size of leiomymata can result in different disorders. Therefore, they should not be the exclusive indication for further operative interventions.

Intraperitoneal immune cell status in infertile women with and without endometriosis.

Endometriosis is a widespread chronic disease characterized by endometrial tissue located outside the uterine cavity. Clinical signs are chronic pelvic pain and infertility. Emerging evidence indicates that the immune system is profoundly involved in the onset and/or progression of endometriosis. However, mechanistic pathways have not yet been conclusively specified. In this study, women undergoing diagnostic laparoscopy due to infertility were recruited, and classified as early-stage endometriosis (n=30), advanced-stage endometriosis (n=8) or no endometriosis (n=31). The frequency and phenotype of leukocytes were evaluated in peritoneal fluid. While the frequency of lymphocytes was not significantly different, neutrophils were increased in endometriosis. Flow cytometry analysis revealed an increased frequency of CD4(+) and CD8(+) cells in peritoneal fluid of endometriosis patients. In addition, the frequency of CD4(+)CD25(+)CD103(+) cells and lineage(-)HLA-DR(+)CD11c(+)CD123(+) dendritic cells was decreased in peritoneal fluid in endometriosis, whereas CD57(+) NK cells and CD8(+)CD28(-) T suppressor cells remained largely unaltered. We conclude that therapeutic approaches in endometriosis might focus on peritoneal leukocytes as a target or surveillance marker; however, immune alterations in peritoneal fluid are subtle and their analysis will require highly standardized and harmonized protocols.

Female genital mutilation: an injury, physical and mental harm.

This article gives an overview over the huge topic of 'female genital mutilation' (FGM). FGM means non-therapeutic, partial or complete removal or injury of each of the external female genitals. It concerns about 130 million women around the world. FGM is performed in about 30 countries, most of which are located in Africa. Four types of FGM are distinguished: type I stands for the removal of the clitoral foreskin, type II means the removal of the clitoris with partial or total excision of the labia minora. Type III is the extreme type of FGM. Not only the clitoris but also the labia minora and majora were removed. The orificium vaginae is sewn up, leaving only a small opening for urine or menstruation blood. Other types like pricking, piercing of clitoris or vulva, scraping of the vagina, etc. were defined as type IV of FGM. The mentioned reasons for FGM are: encouragement of the patriarchal family system, method for birth control, guarantee of moral behaviour and faithfulness to the husband, protection of women from suspicions and disgrace, initiation ritual, symbol of feminity and beauty, hygienic, health and economic advantages. Acute physical consequences of FGM include bleeding, wound infections, sepsis, shock, micturition problems and fractures. Chronic physical problems like anemia, infections of the urinary tract, incontinence, infertility, pain, menstruation problems and dyspareunia are frequent. Women also have a higher risk for HIV infections. During pregnancy and delivery, examinations and vaginal application of medicine are more difficult. Women have a higher risk for a prolonged delivery, wound infections, a postpartum blood loss of more than 500 mL, perineal tears, a resuscitation of the infant and an inpatient perinatal death. Mental consequences after FGM include the feelings of incompleteness, fear, inferiority and suppression. Women report chronic irritability and nightmares. They have a higher risk for psychiatric and psychosomatic diseases. FGM carried out by doctors, nurses or midwives is also called medicalisation of FGM and is definitely unacceptable. Regarding human rights, FGM refuses women the right of freedom from bodily harm. Specific laws that ban FGM exist in many countries in Europe, Africa, USA, Canada, New Zealand and Australia.

Quality of care of VLBW neonates: relationship between unit volume and outcome is different between metropolitan and rural regions.

BACKGROUND: Recent studies from predominantly rural areas in Germany show that neonatal outcome of very low birth weight (VLBW) neonates is (on average) inferior with lower NICU (neonatal intensive care unit) volume. However, there are no data available which show that study results of one specific region can be transferred to other areas with possibly different medical infrastructure and needs. AIM: It was investigated whether a systematic difference of treatment quality between smaller (1000-2000 births/year; < or =20 neonatal beds) vs. larger neonatal centres in Berlin (>3000 births/year; >20 neonatal beds) exists. Furthermore, the results are compared to data from a rural region in order to discuss transferability between regions. METHODS: Retrospectively, completely, and for the first time, the data of all centres which treat VLBW neonates (< or =1500 g birth weight) in the city-state of Berlin, Germany, from the years 2003/2004 were reviewed. RESULTS: Our study showed no difference in the treatment quality of smaller vs. larger neonatal units in Berlin. This result differs from those of a study in Baden-Württemberg, a predominantly rural state, with different medical infrastructure than Berlin. CONCLUSION: The present study suggests that regional investigations on the infrastructure vs. treatment outcome are not transferable between areas. Patient volume/unit appears inadequate for predicting the future treatment quality of neonatal departments. Direct quality indicators are stable for the assessed departments and should be preferably used to organize medical infrastructure.

Attitudes of German infertile couples towards multiple births and elective embryo transfer.

BACKGROUND: In Germany, embryo screening programmes combined with elective embryo transfer are illegal, but there is controversial debate about their legalization. Studies about the attitudes of infertile couples towards multiples, elective embryo transfer and multifetal reduction may help to illuminate how this law shapes patient choices. METHODS: A survey of 265 German infertile couples was conducted. Different logistic regression analyses were performed to assess independent factors associated with the parity for multiple births, approval for elective embryo transfer and multifetal reduction. RESULTS: Despite prior information about the risk of multiple births, 81% of respondents saw no risk in twin pregnancies and a sizable minority saw no risk even in triplet pregnancies. Eighty-nine percent of the respondents rated a twin pregnancy as desirable, whereas 35% rated a triplet birth as desirable. When presented with a choice of having multiple births versus having no biological children, 99% of the respondents endorsed twins, 84% triplets and 58% quadruplets. Seventy-four percent of the respondents approve of legalizing embryo screening programmes to select a good-quality embryo combined with elective embryo transfer. Ninety-two percent of the respondents rejected fetal reduction of twins. CONCLUSIONS: German infertile couples might conceivably be more willing to accept elective embryo transfer if screening for viable embryos was permitted.

Attitudes of German infertile couples towards preimplantation genetic diagnosis for different uses: a comparison to international studies.

BACKGROUND: In Germany, preimplantation genetic diagnosis (PGD) is currently not legal, but there is still a controversial debate about legalization. Studies about the attitudes of infertile couples towards PGD are rare. METHODS: A survey was conducted with 265 German infertile couples about knowledge, attitudes and prospective use of PGD. The influence of independent variables associated with approval of PGD is analysed by binary logistic regression. RESULTS: Sixty percent of respondents have heard about PGD. Eighty-seven percent support a general legalization of PGD in Germany for severe, early-onset genetic diseases. Seventy-four percent consider PGD morally acceptable. Sixty percent supported legalizing PGD for HLA-matching. But only a minority approved PGD to test for non-health-related traits. Respondents with a higher education level were the least supportive to all uses of PGD. CONCLUSIONS: Our results suggest that German infertile couples are as liberal towards PGD for health-related uses as in other western countries. They would legalize and use PGD to raise the rates to get pregnant and to avoid severe diseases of the offspring. Taking the opinions of German infertile couples into consideration could help redefine and reframe the public debate towards legalization of PGD and the moral status of the embryo in Germany.

Intrapartum transfer from a birth centre to a hospital - reasons, procedures, and consequences.

BACKGROUND: Investigation of the reasons for the transfer of women from a birth centre to a hospital in the course of childbirth as well as modalities and effects. PATIENTS AND METHOD: In the prospective investigation from September 1, 1999 to August 31, 2001, information was collected for all women in Berlin and Bavaria transferred intrapartum from a birth centre to a hospital concerning the reason for the transfer, stage of delivery at the start of transfer, details of the transport, accompaniment, state of mother and medical diagnosis on arrival at the hospital, further progress of delivery, and the condition of the baby postnatum. Comparison groups were formed by all birth centre deliveries in Berlin and Bavaria 1999/2000 (n = 3060) and hospital deliveries in Berlin and Bavaria 1998/1999 (selected data, n = 89 696 births). RESULTS: Three hundred and sixty transfer cases could be evaluated, and a majority of these were nulliparous. The most frequent reasons for transfer were prior premature rupture of membranes and failure to progress in labor. Fifty-seven percentages of the women who were transferred subsequently delivered spontaneously, with an episiotomy rate of approximately 30%. 1-min Apgar value < or = 7 were frequently in nulliparous and multiparous patients in the transfer group than in the comparison groups, as were 5-min Apgar values < or = 7 and pH < 7.10 in arterial cord blood in particular for nulliparous in the transfer group. Hospitalisation of neonates born to the transfer group and in particular the nulliparous was significantly more common. CONCLUSIONS: Women delivering in a birth centre represent in general a low-risk group as a result of careful preselection by the centres. However, some neonatal data and the high rate of operative deliveries (cesarean section, forceps, and vaginal extraction) indicate that the intrapartum-transferred women, in particular when nulliparous, represent than a special high-risk group.

[Birthplace free-standing birth center -- perinatal data in comparison with clinic deliveries in Bavaria and Berlin]. / Geburtsort Geburtshaus -- Perinataldaten im Vergleich zu Klinikentbindungen in Bayern und Berlin.

QUESTION: The purpose of this investigation is to find any differences between important maternal and infantile perinatal data from a clinic and a birth center group. Is the perinatal and/or maternal mortality in the birth center group higher? What influence do different socioeconomic factors have on the clinic group? PATIENTS AND METHODS: We have carried out a retrospective comparison of the obstetric parameters from all birth center deliveries in the states Berlin and Bavaria for the years 1999 and 2000 (n = 3,060) and the perinatal data investigations of selected clinical groups of both states (n = 55,875). RESULTS: Objective parameters in both groups regarding week of potation at delivery, parity, age of pregnant women, infantile measures, primi- and multiparae and Apgar scales were comparable. There are significant differences in the delivery mode (spontaneous deliveries: birth centers > clinics; operative deliveries: birth centers < clinics), in blood loss over 1,000 ml (birth centers > clinics), in the episiotomy and perineal tear rate (birth centers < clinics), in the infantile transfer rate to a neonatology unit (birth centers < clinics) and in the frequency of necessary neonatological measures in the neonate (birth centers > clinics). The perinatal and maternal mortality in the groups were similar. Within the clinical group the socioeconomic status and a background of immigration had no significant influence on the perinatal data. CONCLUSION: The retrospective data show that the more "invasive" clinical obstetrics leads to a similar postnatal condition of the neonates in comparison to the birth house group. Further comparative studies over several years are necessary to make statements about the occurrence of rare risks and maternal mortality in the free-standing birth center groups.

[Chronic pelvic pain in women]. / Zum chronischen Unterbauchschmerz der Frau.

In this review we discuss the pathophysiological mechanisms and diagnostic criteria of chronic pelvic pain in women. The psychosomatic correlations and important somatic reasons of this complicated disease picture is discussed. For a large number of the patients the diagnostic criteria of somatoform pain disorder are fitting. The therapeutic approaches, which to a large extend are based on experience, are described. Psychosomatic knowledge is very helpful in the management of chronic pelvic pain in women and contributes to a satisfying doctor-patient-relationship.

Couples becoming parents: something special after IVF?

The majority of catamnestic studies on successful IVF treatment deal with the development of the children and the parent-child-relationship. Far fewer studies pay attention to the changes within the relationship of couples that become parents. This particular study focused on the transition from partnership to parenthood with assessments at different measuring points (T1: the last trimester of pregnancy; T2: 3 months after birth; and T3: 12 months after birth) and compared 47 IVF couples with 45 couples that conceived naturally. The couples were observed with psychodynamic couple interviews and standardized as well as non-standardized questionnaires. The most striking result of our study was the inconspicuousness of IVF couples and their parent-child-relationship. Partnerships featured a high degree of satisfaction among the couples; the progress of pregnancy was described as very satisfying and free of complaints. Surprisingly these descriptions were given despite more frequent and longer hospital stays by the IVF women during their pregnancy. However, IVF couples acted less openly in the interviews and expressed their own feelings less often, especially the more negative ones. In the partnerships we found that IVF women displayed more avoiding tendencies in their relationships 1 year after the birth of their child/children.

[What Turkish-speaking women expect in a German hospital and how satisfied they are with health care during their stay in a gynaecological hospital in Berlin - a comparative approach]. / Erwartungen und Zufriedenheit deutscher und türkischsprachiger Patientinnen im Krankenhaus - eine vergleichende Befragung in einer Berliner Frauenklinik.

Although cultural diversity in German metropolises is rapidly increasing, immigrant patients are rarely included in clinical studies. Specific needs of these patients are hardly known. In a comparative study, 320 German and 262 Turkish immigrant women, respectively, were interviewed via bilingual questionnaires to assess their expectations from and their satisfaction with provided health care services. While no significant differences could be found between basic expectations concerning anticipated health care standards between the two study groups, women of Turkish origin were markedly less satisfied with provided health care services. High expectations of immigrant patients towards information during their stay, communication with doctors and nurses and psychosocial services were only insufficiently met. The results indicate that specific health-relevant factors, such as social and educational status, knowledge of German language and health knowledge together with structural deficiencies of a health care service that is not prepared to correspond properly to patients of different social and cultural backgrounds, have a negative impact on patient satisfaction for migrant women.