Naturalistic changes in the readiness of postpartum women to quit smoking.

BACKGROUND: This study involves a long-term examination of the natural behavioral changes in postpartum women undergoing smoking cessation. The analysis was based on the readiness to quit smoking as assessed using the Transtheoretical Model of intentional behavioral change. This is a secondary data analysis of a randomized controlled trial. METHODS: Between May 2002 and March 2003, all women in the maternity wards of six hospitals in the German state of Mecklenburg-West Pomerania were screened for smoking before or during pregnancy. Of the women who answered in the affirmative, 871 (77%) participated in the study.We utilized a questionnaire to classify 345 women into stages of progress regarding their motivation to change their smoking behavior 4­6 weeks postpartum (T0). Participants were followed-up after 6 (T1), 12 (T2), and 18 months(T3). In addition to the descriptive analysis, latent transition analysis was applied as a statistical method to test models of patterns of change and to evaluate transitions in the stages of change over time. RESULTS: During the time interval between consecutive follow-up surveys, 59.1% (T0/T1), 72.3% (T1/T2), and 67.9% (T2/T3) of women remained at the same stage of motivation to change. Most relapses into earlier stages occurred 6 months postpartum (T1) (31.5% of the stage transition). The patterns of change across the first three time points were best described by a model that includes stability, one-stage progressions,and one-to-four-stage regressions. CONCLUSIONS: Readiness to quit smoking in study participants did not substantially change over the span of 18 months postpartum.

[Interventions for smoking cessation in pregnancy and postpartum. Modalities, efficacy, introduction to motivational interviewing and social-cognitive models for behaviour changes]. / Interventionen gegen das tabakrauchen in der schwangerschaft und post partum. Modalitäten, wirksamkeit, einführung in die Motivierende Gesprächsführung und sozial-kognitive Modelle zur Verhaltensänderung.

BACKGROUND: Interventions for smoking cessation in pregnancy are effective. But the effects are small. Cognitive-behavioural approaches and social support are more efficacious. Interventions for relapse prevention postpone relapse for six months. METHODS: Motivational interviewing serves as a practical basis for interventions. Social-cognitive models serve as basis to plan interventions. RESULTS: Our own results may be summarised as follows: 1) smoking in pregnancy and postpartum has a high priority with paediatricians and midwives; 2) also after delivery women express an interest in being counselled; 3) interventions increase the proportions of newly abstinent women and postpone relapse. CONCLUSIONS: The effects of such interventions are small and diminish between six and twelve months postpartum. With respect to population impact, it may be assumed that implementation in routine care will show sustained effects at the population level.

[Prevalence of smoking in women before and during pregnancy: population-based data]. / Prävalenz des Rauchens vor und während der Schwangerschaft--populationsbasierte Daten.

BACKGROUND AND OBJECTIVE: Population-based data on smoking behavior in Germany of women before or during pregnancy have been lacking. Smoking rates of these women have now been recorded over a period of 3 years against the background of growing tobacco control activities in Germany. METHODS: The study was conducted between 4/2003 and 3/2006 in the context of a prospective population-based survey about perinatal morbidity and mortality (Survey of Neonates in Pomerania - SNiP). This survey registers all newborns and their mothers in one defined region. Of the women eligible for the study 2 297 (68.1%) participated after delivery by giving data about their smoking behavior before and during pregnancy. RESULTS: 61.2% of the women had smoked at some time, 46.6% had smoked before, 24.2% into the 4. month and 20.5% into the last 4 weeks of pregnancy. Smoking rates remained unchanged over the 3 years that were studied. The rates of smokers who had quit by the time of delivery varied according to the length of school education: (<10 years: 30%; 10 y: 59%; >10 y: 84%) and age (<24 years: 45%; 25-30 y: 65%; >30 y: 77%). CONCLUSION: This study for the first time provides population-based data about the prevalence of smoking before and during pregnancy among women in Germany. The data show extremely high numbers of smokers, especially younger women and women of only 10 years or less of school education. Despite growing tobacco control activities no changes in smoking rates were observed over three years. These findings underline the need to develop effective interventions to prevent smoking of women before and during pregnancy.

Postpartum smoking cessation and relapse prevention intervention: a structural equation modeling application to behavioral and non-behavioral outcomes of a randomized controlled trial.

The aim of the study was to test the effectiveness of a postpartum smoking cessation and relapse prevention intervention. Structural equation modeling techniques were applied to evaluate the impact of the intervention on smoking behavior and on non-behavioral variables derived from the Transtheoretical Model (TTM). Women were randomized to an intervention (I) and control group (C). Smoking status, TTM-variables, and control variables were assessed four weeks, six and 12 months postpartum. Membership in the intervention group significantly predicted non-smoking and higher self-efficacy six months, but not one year postpartum, after controlling for demographic, smoking, and postpartum risk variables.

[Referral behaviour of general practitioners to professionals in outpatient care and in addiction treatment sites in Mecklenburg-West Pommerania]. / Die Uberweisung von Patienten mit Abhängigkeitserkrankungen in die ambulante und stationäre professionelle Suchtkrankenhilfe - Ergebnisse einer repräsentativen Befragung unter Hausärzten in Mecklenburg-Vorpommern.

AIM: This study gives an overview about the collaboration of general practitioners (GP) with professionals in outpatient care and in addiction treatment sites. The goal of the study is to examine whether characteristics of the GP and distances to various specialised professionals have an effect on the referral of patients to GPs, primarily in the pilot study of nine "Medical practices for addiction". METHOD: A random sample of 330 general practices was drawn from the records of the association of the Compulsory Health Insurance. The participation rate was 75.8%. RESULTS: There was a high level of networking between general practitioners (GP) and professionals in outpatient care and in addiction treatment sites. The greater the distance to a "Medical practice for addiction", the lower was the chance of referral. There was no influence of distance concerning referral and other specialised outpatient professionals. CONCLUSIONS: Only part of the general population benefits from the pilot study. Aspects such as accessibility and well proven habits of the GPs concerning referral, should be considered to a greater extent for future collaboration among addiction care systems.

[Why woman postpartum resume smoking]. / Warum Frauen nach der Geburt ihres Kindes wieder mit dem Rauchen anfangen.

BACKGROUND: Following a successful period of nicotine abstinence during pregnancy approximately 50% of all women relapse to smoking during the 6 months after delivery. About 34% of all children are exposed to environmental tobacco smoke due to maternal smoking. The objectives of this study are: (a) which women postpartum intend to start smoking again, (b) how does the intention to resume smoking influence the smoking status after 6 months and (c) what are the individual reasons to start smoking again. METHOD: Four weeks after giving birth (T0) sociodemographic variables, smoking behaviour before pregnancy and the intention to resume smoking were assessed in a sample of 301 women who stopped smoking before or during pregnancy. Six months after giving birth (T1) 285 women answered questions regarding their smoking behaviour and reasons for relapse. RESULTS: After giving birth 13% of the women intended to start smoking again. There was no statistical difference between women intending to start and women not intending to start smoking again with regard to sociodemography and smoking behaviour (p > 0.05). Six months later of these significantly more women smoked compared to the women without intention to resume smoking (68% vs. 27%, chi2 = 23.6; df = 1, p < 0.05, OR = 5.5). Individual reasons to resume smoking were reported by 50 % of the women, stress being the most frequent reason. DISCUSSION: At least one of ten women who were abstinent during the course of their pregnancy intends to start smoking again. They do not differ from women not intending to resume smoking. The intention to resume smoking has a predictive value for an early relapse, but also every fourth woman without intention resumes smoking. Just half of the women report a personal reason for relapsing. The results underline the need for proactive interventions for relapse prevention.

[Exposure to tobacco smoke (passive smoking) in the home and inpatient treatment of children under the age of 5 years in Germany]. / Tabakrauchexposition in der Wohnung und stationäre Behandlungen von Kindern unter 5 Jahren in Deutschland.

BACKGROUND AND OBJECTIVE: Exposure to environmental tobacco smoke (ETS) poses an impact on the health of the newborns and infants. In Germany research about the tobacco-attributable morbidity and mortality has been conducted to a very small extent. This analysis examines all data from 16 federal states in regard to number and duration of hospitalization of children exposed to ETS up to 5 years of age. MATERIAL AND METHODS: Integration of two different data sets: (a) national data (number of households with children younger than 5 years exposed to a current smoker) with (b) hospital statistics (number and duration of hospitalisations by diagnoses) for all 16 federal states. Relative risks for tobacco-attributable diseases were taken from current research. RESULTS: In Germany the rate for tobacco-attributable hospitalisations of children between 0 and < 5 years range from 1.6 % to 3.8 % between states. Between 22.0 % and 27.1 % of all hospitalisations with the diagnosis of otitis media or respiratory diseases are attributable to passive smoking. CONCLUSION: Tobacco-attributable hospitalisations pose a serious but preventable problem for the health care system.

[Interventions to prevent health risks due to tobacco smoke in pregnant women, postpartum women and their infants]. / Interventionen zur Prävention gesundheitlicher Risiken durch Tabakrauch für Schwangere, Frauen post partum und deren Kinder.

The aim of this study was to develop recommendations for interventions aiming at reducing health risks due to tobacco smoking in pregnant women, women postpartum and their infants. Meta-Analyses and selected studies are summed up. Epidemiological findings and health risks due to smoking are summed up. Subsequently findings from intervention studies are cross-referenced and integrated as recommendations. Interventions may be divided into three categories: 1. interventions to obtain abstinence in pregnancy, 2. interventions for relapse prevention after abstinence has been attained in pregnancy, 3. interventions aimed at reducing exposure to environmental tobacco smoke in homes with children. Empirical evidence is cross-referenced to the following points: 1. Self-help materials, 2. brief counselling, 3. more time-consuming counselling, 4. interventions to reduce exposure to environmental tobacco smoke and 5. interventions by midwives. Results from meta-analyses as well as results from selected studies suggest the following recommendations: 1. use of a trusting relationship in counselling, 2. repeated counselling, 3. complementary use of self-help materials; self-help material alone is not effective enough, 4. use of state-of-the-art counselling approaches and, 5. theoretical foundation and appropriate individualized counselling.

[The readiness of women, after they have given birth to children, to participate in individualized counselling for smoking cessation ]. / Bereitschaft von Frauen, nach der Geburt ihres Kindes an einer individuellen Beratung zum Rauchen teilzunehmen.

OBJECTIVES: Smoking after pregnancy implies health risks for both the woman and the newborn. Smoking cessation interventions postpartum can prevent relapse in women who quit during pregnancy, protect the infant from environmental tobacco smoke (ETS), and motivate smokers to quit. The readiness of women postpartum to participate in smoking cessation counselling is described. METHODS: In 6 maternity wards n = 2790 women were screened for smoking, n = 1128 smoked before pregnancy. Of these n = 869 gave informed consent. Information on sociodemographic status and smoking behaviour is available for n = 642 participating women and for n = 217 non-participating women. RESULTS: No differences between women participating and non-participating were found in age (p >.05) and having a partner (p >.05). Participants were slightly higher educated (p <.001) and were mainly in maintenance (44 %) or in precontemplation stage of change (38 %). The proportions were 44 % and 22 % in the group of the non-participating women. CONCLUSIONS: The readiness of women postpartum to participate in smoking cessation counselling was high. By reaching abstinent women and women not motivated to quit, a target group was addressed that barely benefits from currently existing preventive activities. Maternity wards are an effective location for addressing smoking behaviour of mothers.

The Mycoplasma fermentans prophage phiMFV1: genome organization, mobility and variable expression of an encoded surface protein.

The approximately 16 kb genome of the Mycoplasma fermentans phiMFV1 prophage is described, and its mobility, replication and effect on the mycoplasma surface phenotype are demonstrated. In various M. fermentans strains, phiMFV1 was either absent or integrated at diverse (and sometimes multiple) chromosomal sites, each marked by a conserved TTTTTA target sequence that is duplicated upon integration. Precise excision, replication of an extrachromosomal form and loss of phiMFV1 from the mycoplasmal genome were documented in a series of clonal derivatives of M. fermentans propagated in culture. Of 18 open reading frames (ORFs) encoded by phiMFV1, most can be ascribed functions related to phage biology, whereas one encodes a unique coiled-coil membrane surface protein, Mem, that was confirmed to be expressed in propagating populations of M. fermentans. With the exception of Mem and other minor ORFs, the striking similarity between the deduced proteomes of phiMFV1 and the recently described phiMAV1 of arthritogenic strains of Mycoplasma arthritidis, along with the prominent gene synteny between these elements, provides the taxonomic basis for a new family of prophage. Their coding features are consistent with long-term residence in mycoplasma genomes and the divergence of species within a phylogenetic clade of mycoplasmas. The unique Mem protein expressed from phiMFV1 and the unique hypothetical surface lipoproteins encoded by phiMAV1 and phiMFV1 also suggest that prophage-associated genes may provide specific, selectable phenotypic traits during co-evolution of mycoplasma species with their respective mammalian hosts. Retention of these labile prophage elements in organisms with such drastically reduced genome sizes implies a significant role in adaptation and survival.

[Characteristics of patients with alcohol- or drug problems in medical practices "addiction" in Mecklenburg-Vorpommern]. / Charakteristika von Patienten mit Alkohol- oder Drogenproblemen in den Schwerpunktpraxen "Sucht" in Mecklenburg-Vorpommern.

BACKGROUND: The pilot scheme "Medical practices with emphasis on addiction" examines one approach in the outpatient treatment of patients with addiction. Nine medical practices in Mecklenburg-West Pomerania participate in this project, and the goal is to lower the threshold for the utilisation of help and to provide a long-term relationship between the patient and the physician. GOAL: Results of the first survey of patients and physicians are presented as part of the scientific evaluation of the entire project. METHOD: Data of 876 patients was assessed. There is data about the severity of alcohol dependence (SESA), about negative consequences of drinking and about utilisation of help for n = 627 patients. These were compared with a sample of n = 153 subjects with a diagnosis of alcohol dependence from a population-based survey. Medical doctors provided information on the duration and quality of patient contact, current drug consumption and content of treatment for n = 472 patients. RESULTS: Of all patients, 51 % were treated for more than 3 years in the respective practice. Among the patients, 45 % were current drug users, further help was recommended for 77 %. In comparison with the reference group, patients with a diagnosis of alcohol dependence in those practices were more severely dependent, reported more problems concerning health, work, or finances and utilised addiction-specific help more often. DISCUSSION: The medical practices under examination undertake the task to provide long-term support for patients with addiction diagnoses and encourage patients to utilize more help from further sources. Their patients with alcohol diagnoses differ substantially from persons in the general population with regard to severity of dependence and related problems. This justifies an intensive medical and psychosocial support by specialised practitioners.

Phase variation among major surface antigens of Mycoplasma penetrans.

The pathogenicity and prevalence of Mycoplasma penetrans, a Mycoplasma species recently isolated from humans, are still debated. A major P35 antigen, which is used as target epitope in serological assays, was shown to be a phase-variable lipid-associated membrane protein (LAMP). In this study, we performed a comparative analysis of the LAMP patterns from five M. penetrans clinical isolates and from the type strain. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis profiles and immunoblots with sera serially collected from an M. penetrans-infected patient indicated that these strains expressed different LAMP repertoires. Furthermore, the intraclonal variation in the expression of LAMPs (P34A, P34B, P35, and P38) was monitored by immunoblot analysis with three specific monoclonal antibodies (MAbs) developed in this study and MAb 7 to P35. The phase variation of these LAMPs occurs in an independent manner, with frequencies of variation ranging from 10(-2) to 10(-4) per cell per generation. Consistent with their amphipathic nature, the P34B and P38 antigens were found exposed at the cell surface. The DNA sequence encoding the P38 antigen was defined and found to be related to those of the P35 gene and other putative LAMP-encoding genes, suggesting that these variable antigens are encoded by a family of related genes. Finally, the serum samples from an M. penetrans-infected patient contained antibodies that reacted with a P36 antigen expressed in different M. penetrans strains but not in the isolate recovered from this patient. This result suggested that in vivo phase variation of P36 occurred, which would support a role for these LAMP variations in avoiding the host's immune vigilance.

Accuracy of volume measurements in mechanically ventilated newborns: a comparative study of commercial devices.

OBJECTIVE: Ventilatory measurements in ventilated newborns are increasingly used to monitor and to optimize mechanical ventilation. The aim of this study was to compare the accuracy of volume measurements by different instruments using standardized laboratory conditions. METHODS: The accuracy of displayed volume values of different commercial devices (Bicore CP-100, Ventrak 1500, Ventrak 1550, Babylog 8000, PEDS IV and SensorMedics 2600) was investigated using adjustable calibration syringes (volume range 2-60 ml, breathing rates 30/min-60/min) and humidified (>95%), heated (35 degrees C) breathing gas with adjustable FIO2 (0.21-1.0). The pneumotach and also the tubes were placed within an incubator (37 degrees C). RESULTS: The relative volume error of all devices was in conformity with clinically allowed tolerances (Bicore CP-100 6.4+/-0.5% (mean +/- SD), Ventrak 1500 3.6+/-4.2%, Ventrak 1550 6.5+/-2.7%, Babylog 8000 -5.5+/-1.5%, PEDS IV -4.0+/-1.4%, SensorMedics 2600 3.5+/-1.75%) for the measuring range studied (10 ml < V < 60 ml, rate 30-60/min, FIO2 = 0.21). Unacceptable errors were obtained for volumes lower than 10 ml with Bicore CP-100 (-28.5+/-26%) and PEDS IV (-10.3+/-3.4%). Changes in FIO2 had an important influence on volume measurements and only the SensorMedics 2600 and the PEDS IV corrected properly for FIO2 changes. CONCLUSION: Most of the currently available neonatal spirometry devices allow sufficiently accurate volume measurements in the range of 10-60 ml and at frequencies between 30-60/min provided that an increased FIO2 is taken into account.

[Detection of intracellular multiplication of Legionella pneumophila in protozoa by antigen quantification using ELISA]. / Nachweis der intrazellulären Vermehrung von Legionella pneumophila in Protozoen durch Antigenquantifizierung mittels ELISA.

Legionellae and Acanthamoeba castellanii were co-cultivated (37 degrees C, 2 days) to study the intracellular multiplication of Legionella pneumophila strains (n = 37) derived from different sources. The quantification of intracellular growth was observed by both traditional counting of colony forming units and antigen detection by ELISA using polyclonal and monoclonal antibodies. There was a good correlation between the two methods. Depending on detection antibodies chosen, the correlation coefficient ranged from 0.86 to 0.91. Clinical and water isolates associated with legionellosis exhibited significant higher multiplication rates than water isolates without association with legionelloses. Utilization of antigen estimation by ELISA proved to have the following advantages: (1) Availability of results within a few hours after lysis of cells, and (2) simple handling of co-cultivation owing to omission of killing non-ingested bacteria and elutriate the antibiotic. Therefore, the procedure described is recommended for virulence screening, particularly for large number of colonies of Legionella-positive water samples or genetically manipulated legionellae.