[Sociodemography of primiparae and multiparae in a population-based survey--the Survey of Neonates in Pomerania (SNiP)]. / Soziodemografie von Erstgebärenden und Mehrfachgebärenden in einer bevölkerungsrepräsentativen Erhebung--Ergebnisse des Survey of Neonates in Pomerania (SNiP).

BACKGROUND: The official birth statistics are regarded as a reliable data source on births and birth rate in the German population. However, they show methodological limitations with respect to the identification of first-time mothers and the number of children per mother. The mothers' social and economical background is not assessed. The goal of the present analysis was (a) to describe demographic and socio-economic variables of all births in a defined region over a fixed time-frame and (b) to make a comparison on the basis of parity and gravidity. METHOD: From 2004-2007 4,982 children were born in the region and data from n=4,788 children were assessed (96%); n=3,505 (73%) of these mothers consented to a more detailed assessment. RESULTS: The fertility rate in the SniP region is low. There are fewer children per 1,000 women and born per women in general. The average age of primiparae was 25 and 26 years. As can be expected there is a significant difference between primiparae and multiparae with respect to age. There is also a difference in occupational status. 17% of the primiparae have been multigravidae. CONCLUSIONS AND DISCUSSION: For the first time in Germany, the SNiP collected comprehensive population-based data on the age and socio-demographic variables of children and their mothers in a defined geographical region. A significant discrepancy for average age of primiparae between the study results and the official statistics is discussed in the light of methodological and regional issues. Our results require the continuation of comprehensive population-based data assessment. Furthermore, the SniP region could serve as a model region for future research. In international comparisons Germany's reproductive behaviour has proved to be unfavourable, which is accentuated in the region under examination.

[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.

Computerized arm training improves the motor control of the severely affected arm after stroke: a single-blinded randomized trial in two centers.

BACKGROUND AND PURPOSE: To compare a computerized arm trainer (AT), allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle, and electromyography-initiated electrical stimulation (ES) of the paretic wrist extensor in severely affected subacute stroke patients. METHOD: A total of 44 patients, 4 to 8 weeks after stroke causing severe arm paresis (Fugl-Meyer Motor Score [FM, 0 to 66] <18), were randomly assigned to either AT or ES. All patients practiced 20 minutes every workday for 6 weeks. AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session. The primary outcome measure was the blindly assessed FM (0 to 66), and the secondary measures were the upper limb muscle power (Medical Research Council [MRC] sum, 0 to 45) and muscle tone (Ashworth score sum, 0 to 25), assessed at the beginning and end of treatment and at 3-month follow-up. RESULTS: The AT group had a higher Barthel Index score at baseline, but the groups were otherwise homogenous. As expected, FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group. The initial Barthel Index score had no influence. In the robot AT group, FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group. MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group. Muscle tone remained unchanged, and no side effects occurred. CONCLUSIONS: The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients. This is probably attributable to the greater number of repetitions and the bilateral approach.

[Phase specific technical aids prescription in neurological rehabilitation]. / Phasenspezifische Hilfsmittelverordnungen in der neurologischen Rehabilitation.

OBJECTIVE: The purpose of this study was to gain a phase specific survey concerning amount, types and costs of technical aids (TA) in a German neurological rehabilitation centre. Further, a number of common rehabilitation outcome parameters were to be related to technical aids provision. DESIGN: A prospective study included all patients (N = 509) with stroke, traumatic brain injury (TBI), brain tumour and multiple sclerosis (MS) admitted within a two-year period to the Klinik Berlin. The TAs prescribed were registered separately for each phase concerning type, amount and costs. In all, 108 different technical aids were recorded, and the direct costs for these technical aids were calculated. Outcome parameters used were the Barthel Index (BI) at admission and discharge, length of stay, and discharge destination. RESULTS: The mean (median) length of stay in phase B (C) was 76 (56) days with a mean (median) increase of BI score of 25 (15) points. Patients in phase D staid 35 days (median) at the clinic, their BI had been 100 points (median) already on admission. 93,3 % of all patients returned home (phase B and C 78,2 %). On average, patients in phase B and C received 2 technical aids/person, in phase D the median was 0 technical aid/person. On discharge, patients in phase B had an average of 3 technical aids/person, phase C patients had 4,5 TA/person and phase D patients 1 technical aid/person (median). The mean cost of a technical aid was 670 DM in phase B, 405 DM in phase C, and 290 DM in phase D (median). CONCLUSION: Technical aids are important components in rehabilitation, especially for severely affected patients, who receive the most expensive technical aids such as wheelchairs and bath tub lifters. High competence in questions related to technical aids is absolutely indispensable for any unit dealing with these patients. On the other hand, less affected patients mostly receive walking aids and grab bars. Future studies should deal with utilization rates and satisfaction with technical aids at home, as well as with cost-effectiveness issues.

[Ambulatory rehabilitation exercises for stroke patients at home. Preliminary results of scope, methods and effectiveness]. / Ambulante Krankengymnastik von Schlaganfallpatienten zu Hause. Vorläufige Ergebnisse über Umfang, Inhalt und Effektivität.

AIM: This study was intended to examine extent, content, and effectiveness of outpatient physiotherapy in stroke patients. METHODS: Seventy-four first-time stroke survivors were included who had a mean Barthel index (BI) of 55.6 when discharged home. A questionnaire asked about the extent, content, and satisfaction with their outpatient physiotherapy over the previous 6 months and scored the items of the BI and the gross functions of the Rivermead Motor Assessment Score (RMS). RESULTS: Fifty of 54 patients had received ongoing physiotherapy, mean intensity was 90.2 min/week (SD 60.9) with a mean of 2.9 (range 1 to 5) sessions/week. Eighty-four per cent of the patients were content and rated the therapist as their most important social contact out of family. The BI and RMS remained stable. Therapy intensity did not correlate with their individual course. CONCLUSIONS: The moderately affected stroke patients received a great amount of therapy. They were content and had maintained their activity level. However, the individually varying therapy intensity did not correlate with any individual activity changes. Further studies are needed that take modern therapy concepts into account.