[Physio- and occupational therapy pathways of stroke patients and stroke mortality]. / Physio- und ergotherapeutische Versorgungsverläufe und Mortalität im ersten Jahr nach Schlaganfall.

AIMS: This study examines the relationship between adherence to clinical guidelines and survival time in the first year after stroke. METHODS: The sample comprises all clients of the Deutsche BKK, a large German health insurance company, who received acute inpatient care for stroke in 2007, who survived the hospital stay by at least 14 days, and who had motor deficits at the end of their acute treatment (n=1 791). 3 types of treatment that differ in the degree of adherence to clinical guidelines are identified ("Frühreha-Plus">"Standard-Plus">"Nur Akut"). RESULTS: There is a positive relationship between adherence to clinical guidelines and survival time, even when relevant covariates are controlled. The hazard-ratios are 0.49 for "Frühreha-Plus" and 0.65 for "Standard-Plus" compared to "Nur Akut". CONCLUSIONS: Healthcare processes should be organized on the basis of cross-sector collaboration and in line with the recommendations of the guidelines.

[Health-care reforms and insurees' preferences: a cluster analysis with data from the representative KBV survey 2010]. / Gesundheitsreformen und Versichertenpräferenzen. Eine Clusteranalyse mit Daten der bevölkerungsrepräsentativen KBV-Befragung 2010.

This study examines insurees' knowledge of and attitudes towards a number of recent reforms of the German healthcare system (electronic health insurance card, reimbursement tariff, etc.). It further examines whether it is possible to identify groups of respondents with similar patterns of preferences and knowledge. The analysis draws on a representative survey conducted by the German National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV, 2010), in which 6 065 respondents aged between 18 and 79 years were interviewed. 4 groups of respondents can be distinguished: the "quality oriented," the "uninformed," the "internet savvy," and the "informed." The most striking finding is that members of the "uninformed" group, who knew the least about recent reforms, tended to be employed middle-aged men with a high level of formal education. To foster the successful implementation of reforms in the health-care system and their communication to specific target groups, it is recommended to take into account not only specific social determinants, but the full personal circumstances and situation of insurees.

[Are complaints an element for health-care monitoring? Analysis of the user statistics of the federal commissioner for patient issues between 2004 and 2007]. / Beschwerden als Baustein eines gesundheitlichen Versorgungsmonitorings? Eine Nutzeranalyse des Amtes der Bundespatientenbeauftragten für den Zeitraum 2004 bis 2007.

BACKGROUND: The inclusion of patient perceptions in the assessment of health-care quality has gained in importance in recent years. The main instruments applied for this purpose are different types of patient interviews. Complaint data have rarely been used thus far. METHODS: On the basis of 19 117 complaints and inquiries to the office of the federal government commissioner for patient issues, this article examines to what extent this data source can be systematically used in health-care research and describes which groups of persons addressed their concerns to the commissioner for patient issues between the years 2004 and 2007. In this context, an investigation is done to determine whether reported or reconstructed data on sociodemographic characteristics are sufficient for analysis. A comparison with population-wide data also indicates to what extent the results can be considered representative for the concerns of patients or insurants in Germany. The letters and inquiries were subjected to a quantitative content analysis. RESULTS: The terms "gender", "region" and "insurance status" can be consistently encoded in a high percentage of those who make complaints and inquiries. The items "age" and "employment status" can be reconstructed to a lesser degree. However, a structural comparison of "responders" and "non-responders" shows that the results from the sample with these characteristics can be generalised for all concerns addressed. Data on the education and migration background were insufficient for analysis. Compared to the general population, a disproportionately high number of older and/or retired people (EM/EU pension) as well as unemployed persons and persons from Berlin and the new federal states contact the commissioner for patient issues. However, changes over time show a successive approach to population-wide distributions. CONCLUSIONS: The results recommend this unique data source for continuous coverage. The data documentation should thus be further standardised and integrated into a complaint management system that includes all relevant complaint offices in Germany.

[Do gatekeeping programs increase equality of health care in Germany? A comparison of the health care situation of participants and nonparticipants]. / Führt das Hausarztmodell zu mehr Gleichheit im Gesundheitssystem? Ein Vergleich der Versorgungssituation von Hausarztmodellteilnehmern und Nichtteilnehmern.

This article compares the health care situation of participants in programs of general practitioner-centered health care (gatekeeping) in Germany (participants) with that of statutory health insurance holders who are not participating in such programs (nonparticipants). Because a key objective of the general practitioner model is to reduce the number of visits to specialists, the article also examines factors influencing frequent utilization of specialists in both groups. The analysis draws on a survey conducted by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, 2010) based on a sample representative of the German population. In this context, 5,232 holders of statutory health insurance aged between 18 and 79 years were interviewed on health care policy issues. The results show that regulating the utilization of specialists through the gatekeeping function of general practitioners succeeds in facilitating similar utilization rates across educational levels, between cities and towns, and between men and women. Thus, gatekeeping programs contribute to the reduction of health care inequalities.

[Knowledge and evaluation of health-system reforms as reflected in social determinants]. / Kenntnisstand und Bewertung gesundheitspolitischer Reformen im Spiegel sozialer Determinanten.

Significant reforms have been instituted in Germany's health system in recent years. Although a number of studies have examined the population's knowledge of and attitudes towards the new regulations, little information is available on status-specific differences. This article examines the extent to which knowledge and evaluation of health policy measures is influenced by social determinants. The analysis draws on a survey conducted by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, 2009) based on a sample representative of the German population. In this context, 2 032 respondents aged between 18 and 79 years were interviewed on health-care policy issues. Results of bivariate analysis and logistic regression show that knowledge of the reform measures is significantly associated with educational level, age, and nationality. For example, respondents with the lowest level of formal education have an approximately four times higher risk as those with a higher level of formal education of not knowing about the health fund, and non-Germans have around twice the risk as Germans of not knowing about the reform measures. The main difference to emerge in respondents' EVALUATION of the reform measures is between East and West Germans. West Germans are significantly more likely than East Germans to evaluate the reform measures in negative terms. These status-specific differences in respondent knowledge can be attributed at least to some extent to the information asymmetry between patients and physicians/health-care providers. There is an urgent need for policy makers and care providers to render the reform measures transparent, accessible and comprehensible - especially to disadvantaged groups - to facilitate their effective implementation and positive evaluation.

CO2, nitrogen, and diversity differentially affect seed production of prairie plants.

Plant species composition and diversity is often influenced by early life history stages; thus, global change could dramatically affect plant community structure by altering seed production. Unfortunately, plant reproductive responses to global change are rarely studied in field settings, making it difficult to assess this possibility. To address this issue, we quantified the effects of elevated CO2, nitrogen deposition, and declining diversity on inflorescence production and inflorescence mass of 11 perennial grassland species in central Minnesota, U.S.A. We analyzed these data to ask whether (1) global change differentially affects seed production of co-occurring species; (2) seed production responses to global change are similar for species within the same functional group (defined by ecophysiology and growth form); and (3) seed production responses to global change match productivity responses: We found that, on average, allocation to seed production decreased under elevated CO2, although individual species responses were rarely significant due to low power (CO2 treatment df = 2). The effects of nitrogen deposition on seed production were similar within functional groups: C4 grasses tended to increase while C3 grasses tended to decrease allocation to seed production. Responses to nitrogen deposition were negatively correlated to productivity responses, suggesting a trade-off. Allocation to seed production of some species responded to a diversity gradient, but responses were uncorrelated to productivity responses and not similar within functional groups. Presumably, species richness has complex effects on the biotic and abiotic variables that influence seed production. In total, our results suggest that seed production of co-occurring species will be altered by global change, which may affect plant communities in unpredictable ways. Although functional groups could be used to generalize seed production responses to nitrogen deposition in Minnesota prairies, we caution against relying on them for predictive purposes without a mechanistic understanding of how resource availability and biotic interactions affect seed production.

Cognitive functioning in the last year of life as a function of age, gender, and race.

Research has shown that many factors affect cognitive functioning. In this study cognitive functioning was analyzed using proxy reports concerning 17,135 decedents included in the 1993 National Followback Mortality Study conducted for the National Center for Health Statistics. These responses form a representative sample of all U.S. residents over age 15 who died in 1993 (except for those in South Dakota, which did not participate). Decedents had more difficulty understanding where they were than remembering what year it was or in recognizing family members. Logistic regression models found that age, gender, and race were the most important predictors of these basic cognitive functions. Although increasing age was associated with more cognitive difficulties, men had fewer deficits than women and Black Americans tended to have fewer deficits than White Americans. Possible reasons for these findings are discussed as well as some general implications for health service provision.

Comparison between hypertonic saline and mannitol in the reduction of elevated intracranial pressure in a rodent model of acute cerebral injury.

Clinically both mannitol and hypertonic saline (HTS) have been used successfully to treat elevated intracranial pressure (ICP), although which therapy is superior is yet unclear. Most experimental data have been derived from animal models of brain injury using general anesthesia, which may not be applicable under other conditions. Our laboratory compared the efficacy of single, equi-osmolar bolus doses of HTS and mannitol in reducing elevated ICP in a lightly sedated, unrestrained rodent model of acute brain injury. Sprague-Dawley rats were mask anesthetized for craniectomy and placement of invasive monitors. Following emergence from anesthesia, continuous sedation was provided (0.25% halothane in oxygen). A focal, liquid nitrogen cold lesion was introduced to the right parietal cortex. Animals were continuously monitored and then treated with a single bolus of 0.9% saline (control group) or 11.0 mOsm/kg equivalents of either mannitol or HTS (experimental groups) at time of maximal ICP increase (60 minutes). Both mannitol and HTS reduced ICP, but HTS was more effective-53.9% reduction versus 35.0% (P < .01). The therapeutic action of HTS was also more durable, lasting up to 500 minutes whereas the mannitol treated animals were observed to return to, and overshoot the baseline elevated ICP by 10% to 25% by 120 minutes following dosing (P < .01). Despite these differences, brain water content was similar between groups. We conclude that HTS was more effective in reducing elevated ICP in this awake model of traumatic brain injury.

Inhibition of Nb2 T-lymphoma cell growth by transforming growth factor-beta.

Transforming growth factor-beta (TGF-beta) inhibits proliferation of Nb2 cells, a rat T lymphoma, in response to lactogens and interleukin-2. Prostaglandins may play an important role in the pathway through which TGF-beta exerts its inhibitory actions, because prostaglandin E2 also inhibits proliferation of Nb2 cells, and indomethacin, an inhibitor of prostaglandin synthesis, reverses the inhibitory effects of TGF-beta on Nb2 cell proliferation.

Visual sensitivity to orientation of rectangles in mice with retinal degeneration.

C3H/HeJ male mice, an inbred strain showing retinal degeneration (rd), and normal-eyed DBA/IJ male mice were studied in a task requiring discrimination of horizontally and vertically oriented rectangles. The apparatus was modified Yerkes discrimination apparatus. The mice were given 30 days of discrimination training, 10 trials/day, after which 10 more trails were given on the 31st day with positive and negative cues reversed. Both strains showed a highly significant decrease in errors during acquisition, the rd strain making significantly fewer errors than the DBA/IJ animals. Reversal of the cues brought about a sharp increase in percentage of errors.