[Differential Provision of Care for Patients with Mental Disorders by Different Care Providers. An Analysis of Reimbursement Claims in Mecklenburg-West Pomerania in 2010]. / Differentielle Versorgung von Patienten mit psychischen Störungen. Analyse von Abrechnungsdaten der Kassenärztlichen Vereinigung Mecklenburg-Vorpommern aus dem Jahr 2010.

Aim of this study was to use reimbursement claims to analyse in how far the heterogeneous spectrum of mental disorders is reflected by the provision of care by different providers. Of the 728 542 reimbursement claims from the last quarter in 2010, most claims were billed for depressive (22.0%), somatoform (16.8%) and anxiety disorders (7.6%). Most claims were billed by general (50.7%), neurological/psychiatric (16.0%) or practices for internal medicine (10.6%). Claims from most providers reflected the expected spectrum of disorders per specialisation. General practices covered nearly the whole spectrum of disorders. Neurological/psychiatric practices billed more claims for depressive (26.6%) and, anxiety disorders (10.0%) or dementia (4.9%), practices for internal medicine billed more claims for somatoform (18.6%) or tobacco related disorders (13.5%). In the outpatient provision of care, a broad spectrum of disorders is cared for by a broad spectrum of providers. Outpatient practices, independently from their specialisation provide care for all kinds of disorders. At the same time, a focus of disorders along the spectrum of specialisation is observable.

[The home environment of families with children as address for a public health action for reduction of tobacco smoke]. / Die häusliche Umgebung von Familien mit Kleinkindern als Adresse für ein Public Health Angebot zur Reduktion von Tabakrauch.

AIM: There is limited research about the acceptance of population-based prevention activities, offered systematically and directly at home. Screening data about smoking behaviour in families with children younger than 3 years were used. We examined associations between family variables (education, employment, number of children in the household), the "proportion of persons on social welfare" (PPSW) in the population aged 15-65 years and the following dependent variables: participation rate in a systematic screening, proportion of smokers within the sample of screened families and participation rate in counselling. METHODS: For postal and personal contacts reporting data of children aged < 3 years, resident in Stralsund (due date 01.06.2008, N=1 298) were used. A total number of 827 families participated in the screening. The counselling was offered if at least 1 adult had smoked at least 1 cigarette per day in the last 4 weeks. Associations between family variables, PPSW and dependent variables were analysed using multilevel statistics. RESULTS: The higher the PPSP the lower is the probability for participation in the screening (odds ratio=0.982; 95% confidence interval=0.970-0.996). There was at least one adult smoker in 425 (51.4%) of these 827 families participating in the screening. The counselling was offered in 425 families, whereby 65.9% (280) participated. There was no association between family variables, PPSW and participation in the counselling. CONCLUSION: Differences in participation in the screening procedure are low: a high proportion of families in districts with a high PPSW took part. Even in districts with a PPSW rate of more than 30%, 71.3% of the families were successfully contacted. There is the recommendation to offer prevention measures in social< deprived city areas in a more proactive way considering the association between the prevalence of smoking in families and the proportion of PPSW.

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.

[Smoking behavior in adolescents: a comparison of population-representative, regional or selectively assessed data and implications for prevention]. / Das Rauchverhalten von Jugendlichen im Vergleich von bevölkerungsrepräsentativ, regional oder selektiv erhobenen Daten und Implikationen für die Prävention.

INTRODUCTION: The prevalence of adolescent smoking underlines the necessity of preventive measures, which goals are based on representative data. It is not known whether schools participate in prevention interventions, where smoking constitutes a relatively big or minor problem. OBJECTIVE: This study examines a population of adolescents on (a) different smoking variables and (b) compares them with representative, population based data. METHODS: Survey of n = 324 adolescents of grade 7-10 in 3 schools in Greifswald and surroundings that were ready to participate in a prevention curriculum. RESULTS: In total, 80% of the students under examination indicated to have at least tried smoking in their lifetime. Daily smokers were 31%, 18% were occasional smokers, 39% have indicated that they hat tried to quit without success. These figures vary across age, grade and sex. Smoking prevalence is comparable between schools ready to participate in prevention and regionally assessed data, but much higher than population based data would have estimated. CONCLUSION: The goal of preventive measures can not be solely grounded on representative, population-based data, but needs (a) to be regionally defined and (b) to consider the population actually participating in such prevention interventions. The readiness to participate is not higher in schools where smoking constitutes a comparable minor problem. Preventive measures are applied in schools where the problem is perceived.

[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.

Post-partum intention to resume smoking.

Little is known about the motivational background of smoking after a period of nicotine abstinence during pregnancy. The study examines the intention to resume smoking (IRS) in the post-partum period and its predictive value for smoking within 12 months post-partum. In a sample of 301 women recruited from obstetric wards who reported having stopped smoking during pregnancy, data on IRS, sociodemographic variables, recent smoking behaviour and smoking in the social network were collected. Smoking status was assessed 6 and 12 months after pregnancy. Among all formerly smoking women, 39 (13%) intended to resume smoking and 262 (87%) intended to maintain abstinence. Women with IRS returned to smoking more often than women without IRS [77 versus 45%, odds ratio (OR) = 4.1, 95% confidence interval (CI): 1.89-9.05]. In a logistic regression model, IRS (OR = 3.7, 95% CI: 1.51-9.01) and number of months currently abstinent (OR = 0.9, 95% CI: 0.76-0.96) attained statistical significance. IRS proved to be the main predictor for relapse; yet, women with no IRS are at risk to restart smoking again, too. IRS offers a cue for tailoring interventions.

[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.

Computer-assisted feedback-driven quality management for psychotherapy: the Stuttgart-Heidelberg model.

The authors present the Stuttgart-Heidelberg Model for quality management of psychotherapy. The system is characterized as an active internal approach with external support from researchers. Problem-solving activities are initiated and maintained by computer-assisted feedback on possible treatment shortcomings. The system provides support for the 3 key tasks of quality management: (a) monitoring of relevant quality criteria in the clinical routine, (b) standardized assessment that allows comparison with established standards at various levels of service provision, and (c) transfer of information on achieved quality to those whom it concerns. The central function of the system is an alarm function, signaling a possible deficit of the provided psychotherapy on the basis of the standard evaluation of treatment outcome for individual patients. In this article, the main system components are described and data on its feasibility and validity are presented.