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Objective: The objective was to conduct a systematic review and meta-analysis of studies that examined the effects of structured exercise on depressive symptoms in stroke patients., Methods: We searched for published randomized controlled trials that evaluated the effect of structured exercise programs (e.g. functional, resistance, or aerobic training) on depressive symptoms. The mean effect size, a 95% confidence interval (CI) and I-squared (I 2 ) for heterogeneity were estimated. Sensitivity analyses were conducted., Results: Thirteen studies (n = 1022) were included in the meta-analysis. Exercise resulted in less depressive symptoms immediately after the exercise program ended, standardized mean difference = -0.13 [95% CI = -0.26, -0.01], I 2 = 6%, p = 0.03, but these effects were not retained with longer term follow-up. Exercise appeared to have a positive effect on depressive symptoms across both the subacute (≤6 months post stroke) and chronic stage of recovery (>6 months). There was a significant effect of exercise on depressive symptoms when higher intensity studies were pooled, but not for lower intensity exercise protocols. Antidepressant medication use was not documented in the majority of studies and thus, its potential confounding interaction with exercise could not be assessed., Conclusions: Exercise may be a potential treatment to prevent or reduce depressive symptoms in individuals with subacute and chronic stroke., Competing Interests: Declaration of conflicting interests The Author(s) declare(s) that there is no conflict of interest, (© The Author(s) 2014.)

A group from Germany, Canada, and the United Kingdom undertook country-specific scoping reviews and stakeholder consultations before joining to holistically compare migration and maternity in all three countries. We examined four interlinking dimensions to understand how international migrant/minority maternal health might be improved upon using transnational research: (a) wider sociopolitical context, (b) health policy arena, (c) constellation, outcomes, and experiences of maternity services, and (d) existing research contexts. There was clear evidence that the constellation and delivery of services may undermine good experiences and outcomes. Interventions to improve access and quality of care remain small scale, short term, and lacking in rigorous evaluation.

Objective: To examine the association between region of origin and severe illness bringing a mother close to death (near-miss)., Design: Retrospective cohort study., Setting: Maternity units in Lower Saxony, Germany., Population: 441 199 mothers of singleton newborns in 2001-2007., Methods: Using chi-squared tests, bivariate and multivariable logistic regression we examined the association between maternal region of origin and near-miss outcomes with prospectively collected perinatal data up to seven days postpartum., Main Outcome Measures: Hysterectomy, hemorrhage, eclampsia and sepsis rates., Results: Eclampsia was not associated with region of origin. Compared to women from Germany, women from the Middle East (OR 2.24; 95%CI 1.60-3.12) and Africa/Latin America/other countries (OR 2.17; 95%CI 1.15-4.07) had higher risks of sepsis. Women from Asia (OR 3.37; 95%CI 1.66-6.83) and from Africa/Latin America/other countries had higher risks of hysterectomy (OR 2.65; 95%CI 1.36-5.17). Compared to German women, the risk of hemorrhage was higher among women from Asia (OR 1.55; 95%CI 1.19-2.01) and lower among women from the Middle East (OR 0.66, 95%CI 0.55-0.78). Adjusting for maternal age, parity, occupation, partner status, smoking, obesity, prenatal care, chronic conditions and infertility showed no association between country of origin and risk of sepsis., Conclusion: Region of origin was a strong predictor for near-miss among women from the Middle East, Asia and Africa/Latin America/other countries. Confounders mostly did not explain the higher risks for maternal near-miss in these groups of origin. Clinical studies and audits are required to examine the underlying causes for these risks., (© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: Public health researchers are increasingly encouraged to establish international collaborations and to undertake cross-national comparative studies. To-date relatively few such studies have addressed migration, ethnicity and health, but their number is growing. While it is clear that divergent approaches to such comparative research are emerging, public health researchers have not so far given considered attention to the opportunities and challenges presented by such work. This paper contributes to this debate by drawing on the experience of a recent study focused on maternal health in Canada, Germany and the UK., Discussion: The paper highlights various ways in which cross-national comparative research can potentially enhance the rigour and utility of research into migration, ethnicity and health, including by: forcing researchers to engage in both ideological and methodological critical reflexivity; raising awareness of the socially and historically embedded nature of concepts, methods and generated 'knowledge'; increasing appreciation of the need to situate analyses of health within the wider socio-political setting; helping researchers (and research users) to see familiar issues from new perspectives and find innovative solutions; encouraging researchers to move beyond fixed 'groups' and 'categories' to look at processes of identification, inclusion and exclusion; promoting a multi-level analysis of local, national and global influences on migrant/minority health; and enabling conceptual and methodological development through the exchange of ideas and experience between diverse research teams. At the same time, the paper alerts researchers to potential downsides, including: significant challenges to developing conceptual frameworks that are meaningful across contexts; a tendency to reify concepts and essentialise migrant/minority 'groups' in an effort to harmonize across countries; a danger that analyses are superficial, being restricted to independent country descriptions rather than generating integrated insights; difficulties of balancing the need for meaningful findings at country level and more holistic products; and increased logistical complexity and costs., Summary: In view of these pros and cons, the paper encourages researchers to reflect more on the rationale for, feasibility and likely contribution of proposed cross-national comparative research that engages with migration, ethnicity and health and suggests some principles that could support such reflection.

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., (© Georg Thieme Verlag KG Stuttgart · New York.)

Femtosecond vacuum ultraviolet (VUV) radiation provided by the free-electron laser FLASH was used for digital in-line holographic microscopy and applied to image particles, diatoms and critical point dried fibroblast cells. To realize the classical in-line Gabor geometry, a 1 microm pinhole was used as spatial filter to generate a divergent light cone with excellent pointing stability. At a fundamental wavelength of 8 nm test objects such as particles and diatoms were imaged at a spatial resolution of 620 nm. In order to demonstrate the applicability to biologically relevant systems, critical point dried rat embryonic fibroblast cells were for the first time imaged with free-electron laser radiation.

Coherent diffractive imaging for the reconstruction of a two-dimensional (2D) finite crystal structure with a single pulse train of free-electron laser radiation at 7.97 nm wavelength is demonstrated. This measurement shows an advance on traditional coherent imaging techniques by applying it to a periodic structure. It is also significant that this approach paves the way for the imaging of the class of specimens which readily form 2D, but not three-dimensional crystals. We show that the structure is reconstructed to the detected resolution, given an adequate signal-to-noise ratio.

Objective: To explore the role of utilization of prenatal care on the risk for stillbirth among women with migration background in Germany by comparing stillbirth rates of women from different origins characterized by adequate and inadequate utilization of prenatal care to German women with adequate utilization of care., Design: Retrospective cohort study., Setting: Lower Saxony, Germany., Population: Singletons born in 1990, 1995 and 1999 (n = 182,444)., Methods: We analyzed perinatal data collected by obstetricians and midwives prospectively during pregnancy and after birth. The Adequacy of Prenatal Care Utilization Index was applied. Chi-squared tests and bivariate and multivariable logistic regression models were used., Main Outcome Measures: Stillbirth rates., Results: In crude analyses, inadequate utilization of prenatal care (OR = 1.86, 95% CI 1.52, 2.28), and origin from Central and Eastern Europe (OR = 2.05, 95% CI 1.63, 2.58), the Mediterranean (OR = 1.77, 95% CI 1.38, 2.65), the Middle East (OR = 2.63, 95% CI 2.24, 3.09) and other countries (OR = 1.79, 95% CI 1.10, 2.89) were related to stillbirths. After adjustment for age, parity, smoking, inter-pregnancy interval, employment status and year of observation, compared to Germans with adequate utilization of prenatal care, women with adequate utilization of care from Central and Eastern Europe (OR = 1.74, 95% CI 1.33, 2.29) and the Middle East (OR = 1.98, 95% CI 1.64, 2.39) and women with inadequate utilization of prenatal care from the Mediterranean (OR = 3.00, 95% CI 1.71, 5.26) were at higher risk for stillbirths., Conclusion: There are inconsistent relation patterns between stillbirth, area of origin and utilization of prenatal care. Among women from the Mediterranean, increasing utilization of prenatal care may result in lower stillbirth rates.

Background: Recently, attention has been focused on subsequent pregnancies among teenage mothers. Previous studies that compared the reproductive outcomes of teenage nulliparae and multiparae often did not consider the adolescents' reproductive histories. Thus, the authors compared the risks for adverse reproductive outcomes of adolescent nulliparae to teenagers who either have had an induced abortion or a previous birth., Methods: In this retrospective cohort study we used perinatal data prospectively collected by obstetricians and midwives from 1990-1999 (participation rate 87-98% of all hospitals) in Lower Saxony, Germany. From the 9742 eligible births among adolescents, women with multiple births, >1 previous pregnancies, or a previous spontaneous miscarriage were deleted and 8857 women <19 years remained. Of these 8857 women, 7845 were nulliparous, 801 had one previous birth, and 211 had one previous induced abortion. The outcomes were stillbirths, neonatal mortality, perinatal mortality, preterm births, and very low birthweight. Bivariate and multivariable logistic regression models were conducted., Results: In bivariate logistic regression analyses, compared to nulliparous teenagers, adolescents with a previous birth had higher risks for perinatal [OR = 2.08, CI = 1.11,3.89] and neonatal [OR = 4.31, CI = 1.77,10.52] mortality and adolescents with a previous abortion had higher risks for stillbirths [OR = 3.31, CI = 1.01,10.88] and preterm births [OR = 2.21, CI = 1.07,4.58]. After adjusting for maternal nationality, partner status, smoking, prenatal care and pre-pregnancy BMI, adolescents with a previous birth were at higher risk for perinatal [OR = 2.35, CI = 1.14,4.86] and neonatal mortality [OR = 4.70, CI = 1.60,13.81] and adolescents with a previous abortion had a higher risk for very low birthweight infants [OR = 2.74, CI = 1.06,7.09] than nulliparous teenagers., Conclusion: The results suggest that teenagers who give birth twice as adolescents have worse outcomes in their second pregnancy compared to those teenagers who are giving birth for the first time. The prevention of the second pregnancy during adolescence is an important public health objective and should be addressed by health care providers who attend the first birth or the abortion and the follow-up care. Also, health care workers should attempt to improve the pregnancy outcomes of subsequent teenage pregnancies by addressing modifiable risk factors, for example, supporting smoking cessation and utilization of prenatal care.

Previous studies reported differences in clinical treatments provided to ethnic minority children and white children. We examined whether there were differences in clinical treatments provided to Aboriginal and White infants in Canadian Neonatal Intensive Care Units (NICU) and whether these potential differences could be explained by differences in population characteristics, community size, maternal neighbourhood income and hospital treatment policies. The study population included 10 166 infants (n = 784 Aboriginal and n = 9382 white) admitted to 17 NICUs from all geographical regions of Canada participating in the Canadian Neonatal Network during January 1996-October 1997. We used logistic regression analyses to examine the association between ethnicity and each of seven clinical practices (surfactant treatment, antenatal steroids, blood transfusions, surgery, assisted ventilation, incubator use and transparental nutrition), after adjustment for potential confounders. We repeated theses analyses restricted to infants born <32 weeks gestation. In crude analyses, in the full sample, Aboriginal infants were less likely than white infants to receive surfactants, antenatal steroids, surgery, assisted ventilation, incubator and transparental nutrition. Among infants born <32 weeks gestation, Aboriginal infants were less likely than white infants to receive antenatal steroids, assisted ventilation, incubator and transparental nutrition. In both groups, adjusting for illness severity, gestational age and multiple births separately (model 2) and in combination with neighbourhood income and community size (model 3) resulted in non-significant associations between ethnicity and some of the treatments, but the addition of adjustment for the hospital variation in frequency of use of different treatments resulted in non-significant associations between ethnicity and all seven treatments. Additional studies are needed to explore the significance of hospital frequency of treatment and its relationship to ethnicity.

Background: The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada., Methods: All women planning a hospital birth attended by a midwife during the 2-year study period who were of sufficiently low-risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n=488). The comparison group included women meeting the same eligibility requirements but planning a physician-attended birth in hospitals where midwives also practiced (n=572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data., Results: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39-0.86), narcotic analgesia (OR 0.26, 95% CI 0.18-0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16-0.30), amniotomy (OR 0.74, 95% CI 0.56-0.98), and episiotomy (OR 0.62, 95% CI 0.42-0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04-0.83) in the midwifery group., Conclusions: A shift toward greater proportions of midwife-attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity.

Background: Delays in seeking emergency care when experiencing serious symptoms may increase morbidity and mortality. Understanding the reasons for such delays may result in interventions to reduce them. We examined the relationship between ethnicity and the reluctance to use an emergency department (ED)., Methods: An exploratory multilingual telephone survey was completed in Greater Vancouver, British Columbia, with randomly selected men and women, aged 40 years and older, listed in the BC Ministry of Health Services Client Registry Database. Survey items included whether the respondents were "somewhat," "very" or "not" reluctant to use an ED. Reasons for reported degree of reluctance and potential correlates were explored including age, gender, income, education, anxiety, vulnerability, self-reported health status, life stress, and satisfaction with a previous ED visit. Multiple logistic regression analysis was conducted., Results: Among 973 (56% response rate) participants (56.3% female) were 149 Chinese, 67 South Asian, 221 foreign-born (not Chinese or South Asian), and 536 Canadian-born participants (not Chinese or South Asian). Controlled for all potential confounders, Chinese (OR = 0.30, 95% CI = 0.19, 0.48) respondents were less likely than Canadian-born participants to report reluctance to use an ED. Anxiety (OR = 1.05, 95% CI = 1.02, 1.09) and dissatisfaction with a previous ED visit (OR = 1.85, 95% CI = 1.27, 2.68) were significant correlates., Conclusions: Canadian-born participants may be at higher risk of delaying necessary treatment from EDs that have been publicized to have long waiting times. Further studies are needed to understand the role ethnicity plays in ED utilization.

The objective of this study was to determine the negative and positive outcomes of providing mammographic breast density (MBD) information to participants of a screening program. A randomized experiment was conducted with a sample of 618 women 50 years or older with MBD greater than 50% of breast volume. The intervention consisted of reporting the presence of MBD in the screening mammography results letter that was sent along with an information pamphlet. Compared to the controls, more women in the intervention group described the term breast density correctly and recognized it as a risk factor for breast cancer. Although at the 4-week follow-up the intervention group indicated that they were "very likely" to have an annual clinical breast examination more frequently than controls, no differences were detected at 6 months. There were no significant differences on other behavioural or psychological measures, although at the 4-week follow-up the control group perceived their risk for breast cancer, relative to other women their age, as "a lot lower" than did women in the intervention group. The results demonstrate a feasible and non-threatening way to provide women with important personalized information about breast cancer risk.

Study Objective: To find out if gender and ethnicity are associated with acute myocardial infarction (AMI) symptom recognition and the recommendation of enlisting emergency medical services., Design: In an experiment, a random sample of the public was provided a scenario of a person experiencing symptoms of AMI; the gender of the character (male, female, or indeterminate) was manipulated., Setting: Vancouver, Canada, Participants: 976 people from a population based random sample of 3419 people, 40 years of age and older, participated in a telephone survey given in English, Cantonese, Mandarin, and Punjabi., Main Results: 78% of the respondents identified the symptoms as heart related. Unadjusted analyses showed that ethnicity, education, income, and AMI knowledge were significantly associated with symptom recognition (Chinese respondents were least likely to identify the symptoms as heart related). Thirty seven per cent recommended calling emergency services, which was associated with symptom recognition, ethnicity (Chinese respondents were least likely to make the recommendation), AMI knowledge, having an immediate family member with AMI, and having talked with a health professional about the signs and symptoms of AMI. Neither the gender of the respondent nor of the affected person in the scenario was associated with symptom recognition., Conclusions: Heart health education must be targeted to and tailored for ethnic communities. Health professionals must discuss the signs and symptoms of AMI, and the correct course of action, with their patients.

This study examines whether the association between social inequalities and low birth weight (LBW) (occurring in both pre- and full-term births) in Germany can be explained by several potentially confounding factors. These include maternal age, occupational status, marital status, nationality, employment status, smoking, prenatal care, psychosocial stress, obesity, short stature, short inter-pregnancy interval, chronic conditions, and several obstetrical risk factors such as pregnancy induced hypertension. We also examined how the risk for LBW varies over time within each socioeconomic group. We analyzed routinely collected perinatal data on singletons born in the federal state of Lower Saxony, Germany, in 1990, 1995, and 1999 (n = 182,444). After adjustment for all potentially confounding factors in multivariate logistic regression models, working class women, unemployed women, single mothers, and women over 39 years of age were at increased risk for pre- and full-term LBW infants. Migrant status was not related to LBW. We examined variations in the risk for LBW over time within groups, using the 1990 birth cohort as the referent group for the 1995 and 1999 birth cohorts. Compared to 1990, in 1999 women aged 19-34 years, housewives, unemployed women, women of German nationality and women with partners had higher risks for pre- and full-term LBW infants; the eldest subgroup had lower risks for LBW after adjustment for confounding factors. The factors we examined partly explain the social inequalities in LBW occurring in pre- and full-term infants. The subgroups with higher rates of LBW in 1999 compared to 1990, included women experiencing childbirth in an optimal stage of life or in a privileged social context. Public health policies in Germany should target social inequalities contributing to the aetiology of LBW and to the factors that result in increased LBW rates.

Diffraction enhanced imaging (DEI) uses refraction of x-rays at edges, which allows pronounced visualization of material borders and rejects scattering which often obscures edges and blurs images. Here, the first evidence is presented that, using DEI, a destruction-free evaluation of the quality of integration of metal implants into bone is possible. Experiments were performed in rabbits and sheep with model implants to investigate the option for DEI as a tool in implant research. The results obtained from DEI were compared to conventional histology obtained from the specimens. DE images allow the identification of the quality of ingrowth of bone into the hydroxyapatite layer of the implant. Incomplete integration of the implant with a remaining gap of less than 0.3 mm caused the presence of a highly refractive edge at the implant/bone border. In contrast, implants with bone fully grown onto the surface did not display a refractive signal. Therefore, the refractive signal could be utilized to diagnose implant healing and/or loosening.

Purpose: To test the relationships among particular motives for smoking cessation, stage of readiness to quit (preparation or contemplation), and sociodemographic characteristics., Design: A cross-sectional study to examine attitudes toward and use of health promotion at the worksite, using a self-administered questionnaire., Setting: Two German metal companies., Subjects: Of 1641 responding employees (response rate 65% in company A and 44% in company B), 360 smokers who intended to quit immediately (n = 105) or in the near future (n = 255) were analyzed., Measures: The questionnaire comprised of sociodemographic characteristics, smoking behavior, smoking history, readiness to quit smoking, motives to quit, such as coworkers' complaints and health-related or financial concerns. Chi-squared tests and multiple logistic regression analyses were performed., Results: Health-related reasons (94%) predominated financial (27%) or image-related (14%) reasons for smoking cessation. Participants in the cessation preparation group were more likely to report an awareness of being addicted (79.6% vs. 58.2%; p < .001) and the negative public image (22.5% vs. 11.6%; p < .01) as reasons for quitting compared with those in the contemplation group. In multivariable regression models, the motives for smoking cessation, including reduced performance, family's and coworkers' complaints, pregnancy/children, and negative public image, but not health-related and financial concerns, differed significantly by gender, age, marital status, education, and occupational status., Conclusions: Motives for smoking cessation vary according to the individual's level of readiness to quit and sociodemographic background.

The purpose of this study was to compare satisfaction with the birth experience among a population of women planning birth at home versus in hospital. In British Columbia, Canada, all midwives offer women meeting eligibility requirements for homebirth the choice to give birth in hospital or at home. Therefore, satisfaction can be attributed to planned place of birth, as the caregivers were the same in both settings. The mean overall score on the Labour Agentry Scale among women who had planned a homebirth (n = 550), 188.49 +/- 16.85, was significantly higher than those who planned birth in hospital (n = 108), 176.60 +/- 23.79; P < .001. Overall satisfaction with the birth experience was higher among women planning birth at home, 4.87 +/- 0.42 versus 4.80 +/- 0.49 on a scale of 1 to 5, although this difference was not statistically significant; P = .06. Among women whose actual place of birth was congruent with where they had planned, overall satisfaction was higher in the homebirth group, 4.95 +/- 0.20 versus 4.75 +/- 0.53; P < .001. Although satisfaction with the birth experience was high in both the home and hospital settings, women planning birth at home were somewhat more satisfied with their experience, particularly if they were able to complete the birth at home.

This paper describes the development and psychometric assessment of a scale to measure satisfaction with intrapartum and postpartum care in hospital: The Care in Obstetrics: A Measure For Testing Satisfaction (COMFORTS) scale. A sample of 415 participants completed the 40-item scale. Cronbach's alpha for the scale was .95. Evaluation of construct validity through principal components factor analysis with varimax rotation yielded six subscales: confidence in newborn care, postpartum nursing care, provision of choice, the physical environment, respect for privacy, and labor/delivery nursing care. The COMFORTS scale was able to discriminate between multiparous versus primiparous women, and between women cared for in single room maternity care versus in separate labor/delivery and postpartum rooms. Pending further validation, the COMFORTS scale has potential to measure women's satisfaction with childbirth care and contribute to an assessment of the quality of care provided., (Copyright 2006 Wiley Periodicals, Inc.)

Aims and Objectives: To evaluate the success of a competency-based nursing orientation programme for a single-room maternity care unit by measuring improvement in self-reported competency after six months., Background: Single-room maternity care has challenged obstetrical nurses to provide comprehensive nursing care during all phases of the in-hospital birth experience. In this model, nurses provide intrapartum, postpartum and newborn care in one room. To date, an evaluation of nursing education for single-room maternity care has not been published., Design: A prospective cohort design comparing self-reported competencies prior to starting work in the single-room maternity care and six months after., Methods: Nurses completed a competency-based education programme in which they could select from a menu of learning methods and content areas according to their individual needs. Learning methods included classroom lectures, self-paced learning packages, and preceptorships in the clinical area. Competencies were measured by a standardized perinatal self-efficacy tool and a tool developed by the authors for this study, the Single-Room Maternity Care Competency Tool. A paired analysis was undertaken to take into account the paired (before and after) nature of the design., Results: Scores on the perinatal self-efficacy scale and the single-room maternity care competency tool were improved. These differences were statistically significant., Conclusions: Improvements in perinatal and single-room maternity care-specific competencies suggest that our education programme was successful in preparing nurses for their new role in the single-room maternity care setting. This conclusion is supported by reported increases in nursing and patient satisfaction in the single-room maternity care compared with the traditional labour/delivery and postpartum settings., Relevance to Clinical Practice: An education programme tailored to the learning needs of experienced clinical nurses contributes to improvements in nursing competencies and patient care.

Objective: To compare family physicians', obstetricians' and midwives' self-reported practices, attitudes and beliefs about central issues in childbirth., Design: Mail-out questionnaire. SETTING/POPULATION; All registered midwives in the province, and a sample of family physicians and obstetricians in a maternity care teaching hospital. Response rates: 91% (n = 50), 69% (n = 97) and 89% (n = 34), respectively., Methods: A postal survey., Main Outcome Measures: Twenty-three five-point Likert scale items (strongly agree to strongly disagree) addressing attitudes toward routine electronic fetal monitoring, induction of labour, epidural analgesia, episiotomy, doulas, vaginal birth after caesarean section (VBACs), birth centres, provision educational material, birth plans and caesarean section., Results: Cluster analysis identified three distinct clusters based on similar response to the questions. The 'MW' cluster consisted of 100% of midwives and 26% of the family physicians. The 'OB' cluster was composed of 79% of the obstetricians and 16% of the family physicians. The 'FP' cluster was composed of 58% the family physicians and 21% the obstetricians. Members of the 'OB' cluster more strongly believed that women had the right to request a caesarean section without maternal/fetal indications (P < 0.001), that epidurals early in labour were not associated with development of fetal malpositions (P < 0.001) and that increasing caesarean rates were a sign of improvement in obstetrics (P < 0.001). The 'OB' cluster members were more likely to say they would induce women as soon as possible after 41 3/7 weeks of gestation (P < 0.001) and were least likely to encourage the use of birth plans (P < 0.001). The 'MW' cluster's views were the opposite of the 'OBs' while the 'FP' cluster's views fell between the 'MW' and 'OB' clusters., Conclusions: In our environment, obstetricians were the most attached to technology and interventions including caesarean section and inductions, midwives the least, while family physicians fell in the middle. While generalisations can be problematic, obstetricians and midwives generally follow a defined and different approach to maternity care. Family physicians are heterogeneous, sometimes practising more like midwives and sometimes more like obstetricians.

Objective: To determine the feasibility of detecting the structural orientation in cartilage with Diffraction Enhanced X-Ray Imaging., Design: Human tali and femoral head specimens were Diffraction Enhanced X-Ray Imaged (DEI) at the SYRMEP beamline at Elettra at various energy levels to detect the architectural arrangement of collagen within cartilage. DEI utilizes a monochromatic and highly collimated beam, with an analyzer crystal that selectively weights out photons according to the angle they have been deviated with respect to the original direction. This provides images of very high contrast, and with the rejection of X-ray scatter., Results: DEI allowed the visualization of articular cartilage and a structural orientation, resembling arcades, within., Conclusion: Our diffraction enhanced images represent the first radiographic detection of the structural orientation in cartilage. Our data are in line with previous studies on the structural organization of joint cartilage. They confirm the model of a vaulting system of collagen fiber bundles interrupted by proteoglycan aggregates.

Intravenous coronary angiography with synchrotron radiation is a novel and minimally invasive technique for coronary imaging. At the Hamburger Synchrotronstrahlungslabor HASYLAB at DESY, a dedicated angiography system has been developed, which has been shown to provide detailed images of coronary artery segments. For each scan, two monochromatic X-ray images below and above the K-edge of iodine were recorded simultaneously. The two images were subtracted logarithmically to produce a maximal contrast enhancement of the iodine. To date, the procedure has been carried out on 379 outpatients. No complications occurred during or after the angiographic procedure, and hospitalization was not required in any subject. The acceptance by patient is extremely high. Five outside reviewers, blinded as to the clinical data or prior angiographic interpretation, reviewed the images for the presence or absence of 70% or more occlusion of a vessel. They reached a sensitivity of 79% and a specificity of 99%. The study has demonstrated that the synchrotron method has satisfactory sensitivity and very high specificity for severe stenoses. The new method has several advantages over magnetic resonance imaging (MRI), electron beam computed tomography (EBCT), and multi-slice computed tomography (MSCT). Neither vascular calcification (CT) nor the presence of metal stents (MRI) impairs the evaluation of perfusion of segments of the coronary arteries. Furthermore, the spatial resolution is three or four times higher using synchrotron angiography, and problems due to respiratory motion are eliminated.

Our study tested the discriminant validity of burnout in contrast to depression using the Maslach Burnout Inventory (MBI, Maslach u. Jackson 1986) and the Allgemeine Depressionsskala (ADS, Hautzinger u. Bailer 1993). Furthermore the relationships between burnout and depression to social support, occupational and health variables were examined. Pre-school teachers (n = 101), physician-assistants (n = 81) and their intimates were asked to complete a self-administered questionnaire. Spearman-correlations and factor analysis were conducted with SPSS. The results indicate validity for the burnout construct.

Background: Nutrition has been found to be associated with sociodemographic characteristics and concern about health. There is limited knowledge, however, of associations between blue-collar worker's diet, morbidity, and health care utilization., Methods: We conducted a survey on eating habits, physical symptoms, health care utilization, health status, and concern about health in two German metal companies. A self-administered questionnaire was mailed to employees of whom 1641 participated in the study (response rate 54. 7%)., Results: Most employees were characterized by a combination of healthy and unhealthy eating elements. Using linear regression analyses adjusted for age, gender, and occupational status, healthy eating was negatively associated with stomach aches and headaches, but not with cardiovascular disease. Restricted activity days and days in hospital were associated with healthy eating, but self-assessed health status and physician consultations were not. Using stepwise multiple regression analysis, age, gender, and concern about health were strongly and morbidity was weakly related to diet. Occupational status, marital status, and number of children were not associated with nutrition., Conclusions: Health promotion programs should motivate younger and male employees to participate in and aim toward increasing concern about health., (Copyright 2000 American Health Foundation and Academic Press.)

In a cross-sectional health survey among employees of a large German metal company with 974 study participants, attitudes and aspects of the individual health status were identified which predispose employees to take part in individual health promotion activities. Apart from higher participation rates in women and white collar employees, participants reported on average a less favourable subjective health status, more complaints and diseases, better health related behaviours, and a more intensive utilization of curative and preventive medical services than nonparticipants. Among men, participation in all types of courses increased from the youngest to the oldest group, among women only until the middle-aged groups with a consequent decline thereafter. In men, the image of a person living health-consciously showed the strongest positive association with participation, and not the degree of internal control and responsibility with respect to the maintenance of health or the acquisition and overcoming of disease. The low participation of blue collar workers compared to white collar employees could be attributed to group specific differences in individual health consciousness only to a very small extent. Blue collar participants reported a positive image of a person living health-consciously that was more similar to that of white collar participants than to that of nonparticipants of their own occupational group. Advertisement for health promoting activities should place more emphasis on increasing the image of personal health promotion than on internal control and responsibility for health.

We analysed data of a cross-sectional survey of 974 employees in the German metal industry to determine the degree to which worksite health promotion matches the needs of employees. 27% of study participants have already taken part in individually oriented health promotion, and another 48% want to participate most readily in activities aiming at preventing and reducing musculo-skeletal complaints. Recent participation (within a fourteen-month period) in these classes was low among male blue collar workers (7%) compared to male and female white collar employees (18 and 26%). Among blue collar workers the percentage of subjects who suffered from chronic back pain and did not recently participate in the relevant classes of the company health insurance plan (unserved prevalence) was 30%, compared to 17 and 26% in male and female white collar employees. Participants were less exposed to work-related predictors of chronic back pain than non-participants. Participants were, however, more often afflicted with chronic back pain than non-participants. In addition, the intention to participate was strongly associated with this type of complaint. Shift work was the most important single explanation for the low participation rates of blue collar workers. Suggestions are advanced to neutralise the adverse effects of shift work on participation, to strengthen the primary preventive functions of individual worksite health promotion, and to integrate it with structural measures of health and safety at work.

Using data from a cross-sectional survey of 974 employees of a metal company in Germany, we analysed the frequency of chronic back pain, ist associations with working conditions, and the requests for workplace modifications, expressed by persons afflicted with chronic back pain. With a prevalence of 32% chronic back pain was the most common health problem. Physical work exposures, such as lifting and carrying as well as working in an awkward position, were strongly (multivariable odds ratios > or = 2.8) associated with chronic back pain, whereas environmental factors were moderately (multivariable odds ratios = 1.6) associated. Most psychosocial stressors, such as time pressure, and conflicts with co-workers and superiors, were moderately associated with chronic back pain as well (age-adjusted odds ratios between 1.4 and 1.8). Stress symptoms, such as irritation and strain, are rated as mediators by possibly linking psychosocial stressors to chronic back pain. If the individual subject is compelled to perform monotonous or repetitive work, he feels underrated, and this has proved to be a risk factor in its own right. Prolonged exposure to physical stressors (> 7 years) was associated with a strongly elevated risk for chronic back pain (age-adjusted odds ratios > or = 4.0 compared to the nonexposed). Blue collar workers afflicted with chronic back pain requested a reduction of their physical work load significantly more often than their non-afflicted colleagues. In contrast, female white collar employees with chronic back pain layed most emphasis on more physical exercise at work. Worksite health promotion programmes should consider these differences in order to meet the specific needs and preferences of different occupational groups.

We conducted a survey on chances and barriers of occupational health promotion and health behaviour including diet in two South German metal companies. Only a small percentage of the 1641 participants consumed healthy food each day, but many avoided eating unhealthy food. Most employees are characterized by a combination of healthy and unhealthy elements. The group of "healthy eaters" consists of more women than men, more older than younger people and more non-manual than manual workers. The level of education and number of children have not been associated with eating habits. Healthy eaters consumed less alcohol and tobacco and were more engaged in sports and in health promotion programmes than unhealthy eaters.

Dichromography represents a digital subtraction angiography mode based on energy substraction which allows imaging of fast moving subjects like the heart. For logarithmic subtraction 2 images with X-rays just below and above the iodine K-edge (33.17 keV) are simultaneously obtained in a line scan mode. Monochromatic X-rays of sufficient intensity to visualize coronary arteries of 1 mm diameter with extremely low iodine concentrations (1 mg/cm2) after venous injection is only provided by synchrotron radiation. The system NIKOS (non-invasive coronary arteriography with synchrotron radiation) at the Deutsches Elektronen Synchrotron (DESY) consists of 6 components: a wiggler, a monochromator, a safety system, a scanning device, a detector and a computer system. After experimental studies in dogs patients are imaged since 1990. Initial results demonstrate feasibility and safety of synchrotron radiation coronary angiography. Large scale studies are designed to further evaluate sensitivity and specificity. When compact synchrotron radiation sources become available, this technique could be used for follow-up studies and for evaluation of certain high coronary risk populations.