Anita Rieder

Prevalence of self-reported neuropathic pain and impact on quality of life: a prospective representative survey

Background: Data on the incidence of neuropathic pain (NeP) in Austria, its general characteristics and consequences for the quality of life (QOL) are still lacking. The prevalence in the United Kingdom is 8%.

Supplementation with Mixed Fruit and Vegetable Juice Concentrates Increased Serum Antioxidants and Folate in Healthy Adults

Objective: Epidemiological studies have shown that low plasma levels of antioxidant micronutrients, which are commonly found in fruit and vegetables, are associated with increased risk for diseases such as heart disease, cancer, metabolic disorders and the like. The aim of this study was to monitor the dietary habits of a group of healthy, middle-aged, men and women and to assess the effect of supplementation with a natural phytonutrient preparation from fruits and vegetables, on plasma levels of various antioxidant micronutrients and oxidative stress assessed by measuring 8-oxodGuo (8-oxo-7,8-dihydro-2′-deoxyguanosine) in urine. Methods: The study followed a double-blind randomized cross-over design involving 59 healthy men and women (40–60 years of age). The supplement or a placebo was given to two groups for a total period of 14 weeks (crossover week 7). Blood levels of β-carotene, vitamin C, vitamin E, selenium and folate were measured at 0, 7 and 14 weeks. Fruit and vegetable consumption was monitored by means of a retrospective food frequency questionnaire at week 0, 7 and 14. Urinary 8-oxodGuo was also determined at these time points. Results: Significant increases in blood nutrient levels after active supplementation were observed for β-carotene, vitamin C, vitamin E, selenium and folate. Ranges measured, after supplementation, often fell into those associated with a reduced risk for disease. Our data suggests that, although generally health conscious, participants still fell short of the recommended five portions of fruit and vegetables per day. No significant group changes were noted for 8-oxodGuo concentration in urine. Conclusion: Supplementation with mixed fruit and vegetable juice concentrates effectively increased plasma levels of important antioxidant nutrients and folate.

Is interview a reliable method to verify the compliance with antihypertensive therapy? An international central-European study

Background Non-compliance with prescribed antihypertensive medication is an important contributor to the failure of antihypertensive therapy. Objective To assess the validity of a short questionnaire in the identification of non-compliant patients. Methods In three central-European countries, work-site screening for hypertension was conducted. Blood pressure was measured using an automatic electronic blood pressure measuring device (BpTRU). Respondents were interviewed by trained personnel and a short questionnaire focused on blood pressure awareness and treatment compliance was completed. Results A total of 2812 persons were screened: 841(29.9%) respondents were hypertensive, and out of these the total number of treated hypertensive subjects was 359 (42.6%). Mean systolic blood pressure and diastolic blood pressure were significantly lower in the compliant group than the non-compliant group (systolic blood pressure, 139.4 and 146.2 mmHg, respectively, P = 0.002; and diastolic blood pressure, 89.2 and 92.3 mmHg, respectively, P < 0.01). The non-compliant group was younger than the compliant group (mean age, 46.7 versus 48.9 years, respectively, P = 0.01). Females, patients on combined therapy and non-smokers were more compliant than males, those on mono-therapy and smokers (P = 0.01, P = 0.004 and P = 0.005, respectively). Conclusion Patients reporting strict compliance with prescribed drug therapy have significantly lower systolic blood pressure and diastolic blood pressure than those who admit even an occasional lapse in taking medication. A properly formulated questionnaire can identify non-compliant patients.

Public health aspects of diabetes mellitus – epidemiology, prevention strategies, policy implications: the first Austrian diabetes report

The worldwide trend to an increase in diabetes prevalence is alarming and the World Health Organisation (WHO) expects diabetes to be one of the greatest challenges to public health services over the coming decades [1]. Serious calls for action in public health have been made. The Centres for Disease Control published a report on diabetes research and its impact on public health over the past 25 years [2] with one of the main conclusions being that the knowledge accumulated up until now must be translated into practice. For this a cooperative partnership between patients, service providers, sponsors, policy makers and political decision makers is required [3]. Furthermore, based on the available epidemiological data, the Centres for Disease Control established strategies for the prevention of type 2 diabetes in the United States [4]. Knowledge of frequency of occurrence of the disease in the population, as well as in special risk groups, is crucial for the instigation of fundamental public heath action in the direction of disease management and prevention. It is the aim of this article to outline the available epidemiological data for Austria, discuss strategies for prevention of type 2 diabetes based on the epidemiological data and highlight public health perspectives on management of the public burden diabetes presents.

The effect of structured strength and balance training on cognitive function in frail, cognitive impaired elderly long-term care residents

Background and aims: The aim of the study was to assess the effect of structured strength and balance training on cognitive function in frail, geriatric, long-term care facility residents, aged 75 years or older, and additionally to evaluate the influence of training on various functional, physical and psychological parameters. Methods: Participants were randomly assigned to a training group or a control group. Physical training was performed three times a week for ten weeks in the training group. Muscle function was assessed by manual examination on a scale of 0–5. Cognitive function was tested with the Mini Mental State Examination (MMSE). In addition, scores for activities of daily living, mobility and depression were assessed. Results: 30 subjects with a mean age of 86.8 years completed the study. After 10 weeks of intervention in the training group, muscle strength increased from a mean of 3.75 to 4.44 points (p<0.001) and the mean MMSE score increased from 20.9 to 23.9 points (p=0.023). In the training group,the change in the MMSE score correlated significantly with change in muscle function, with a Pearson correlation coefficient of 0.750 (p=0.002). An increase in mean BMI from 23.8 to 25.0 kg/m2 (p=0.013) was also found in the training group, but no significant changes in scores for activities of daily living, mobility or depression. Compared with the control group, the change in the mean scores over the ten-week training period was significantly higher for the trained group with regard to muscle scores, BMI and lean body mass, but not for MMSE scores. Conclusions: Our findings reinforce the recommendation that structured strength and balance training should be implemented in long-term care facilities. Besides the well-known benefits of physical training, our findings showed that an improvement in cognitive function may also be possible.

Women show a closer association between educational level and hypertension or diabetes mellitus than males: a secondary analysis from the Austrian HIS

BackgroundLifestyle diseases and cardiovascular complications are dramatically increasing, but little is known about the impact of educational level and health behaviour in men and women in different populations. Therefore, we aimed to investigate the association between educational level (EL) and self-reported chronic diseases and health behaviour in both sexes.MethodsData were derived from the Austrian Health Interview Surveys 2006/2007, which includes 13 558 persons (50.9% females). The associations between EL and the risk of obesity, hypertension, diabetes, myocardial infarction, stroke and anxiety disorders or depression, nutrition, exercise, and smoking were evaluated. University education served as the reference category (EL4), the lowest educational level was required schooling only (EL0).ResultsOnly among women did the risk for diabetes mellitus and hypertension increase with decreasing educational level with the highest rates for EL0 OR [95% CI] adjusted for age, income, family status and lifestyle: 3.7 [1.7-8.0], and 2.5 [1.8-3.5], respectively. Only among the men, however, did the risk for stroke increase with decreasing educational level adjusted OR for EL0: 8.5 [1.7-42.7]. For anthropometric measures and lifestyle factors in both sexes the risk increased with decreasing EL.ConclusionEL affects lifestyle, overweight and obesity in both sexes. The apparent sex-specific differences in the association between the prevalence of some chronic disease with EL call for further investigation.

Body mass index and the risk of infections in institutionalised geriatric patients.

The objective was to examine the effect of BMI on the incidence of various infectious diseases in institutionalised, geriatric subjects. In a retrospective cohort study we analysed medical records of 619 patients aged 75 years and older (mean age 87.6 (sd 6.4) years) who were treated in a geriatric hospital in Vienna, Austria. The total incidence rate of infection in this population was 0.80 per person-year. The most frequent infections were urinary tract infections (0.30 per person-year), followed by infections of the lower respiratory tract (0.19 per person-year), diarrhoea (0.12 per person-year) and other infections (0.20 per person-year). Incidence risk ratios were obtained by a multiplicative Poisson regression model. There was a J-shaped curve in the incidence of infections recorded by BMI with a nadir at 27-28 kg/m2. Compared with the reference group with a BMI of 24-27.9 kg/m2, subjects with a lower BMI had a higher incidence rate of infections. The incidence risk ratios, adjusted for sex, age and chronic diseases, were 1.62 (95 % CI 1.21, 2.17) for those with a BMI of < 20 kg/m2 and 1.84 (95 % CI 1.40, 2.42) for those with a BMI of 20-23.9 kg/m2. However, also patients with a BMI of 28 kg/m2 and above had a higher incidence rate of infections, with an incidence risk ratio of 1.54 (95 % CI 1.07, 2.22). These results show that both underweight and obesity are associated with a higher risk of infections in institutionalised geriatric patients.

Austrian Osteoporosis Report: epidemiology, lifestyle factors, public health strategies.

ZusammenfassungDer erste Österreichische Osteoporosebericht wurde initiiert, um ein umfassendes Referenzdokument für Pathogenese, Diagnose, Therapie und Rehabilitation bei Osteoporose zu schaffen. Weiters war es Ziel dieses Berichts, Ausmaß und Gewichtigkeit von Osteoporose und den damit assoziierten Komplikationen für Österreich darzustellen. Basierend auf aktuellen internationalen Prävalenzerhebungen kann für Österreich geschätzt werden, dass etwa 740.000 Personen über 50 Jahren von Osteoporose betroffen sind, davon 617.000 Frauen. Eine Analyse der Krankenhausentlassungen aus dem Jahr 2005 zeigte, dass in diesem Jahr 1382 männliche und 8080 weiblich Fälle mit der Hauptdiagnose Osteoporose in Österreich entlassen wurden. Hinzu kommen noch 9711 männliche und 54.840 weibliche Fälle mit Osteoporose in einer Nebendiagnose. In Österreich erleiden rund 16.500 Personen jährlich eine Hüftfraktur. Somit liegt Österreich mit einer Rate von 19,7 Hüftfrakturen pro 10.000 Einwohner im Bereich der europäischen Spitze. Die Spitalsmortalitätsrate bei Oberschenkelfrakturen beträgt in Österreich 3,8 % bei Männern und 3,2 % bei Frauen. Die Knochengesundheit kann durch einen vorteilhaften Lebensstil positive beeinflusst werden, der Osteoporosebericht hat allerdings Risikofaktoren bezüglich Lebensstils in der Österreichischen Bevölkerung aufgezeigt. Die mittlere Kalziumaufnahme bei Österreichischen erwachsenen Frauen und bei männlichen und weiblichen Seniorinnen und Senioren ist niedriger als empfohlen, lediglich erwachsene Männer erreichen eine Kalziumaufnahme etwa den Empfehlungen entsprechend. Die durchschnittliche Vitamin D Aufnahme in Österreich ist sehr gering, besonders bei Vorschulkindern und Seniorinnen und Senioren. Der Anteil an österreichischen Personen, die angeben, regelmäßig körperlich aktiv zu sein ist verbesserungsbedürftig, besonders bei älteren Menschen. Die Daten aus dem Österreichischen Osteoporosebericht sind nützlich um die Entwicklung von Public Health Strategien zu ermöglichen und Methoden zu entwickeln, um einige der identifizierten Problemfelder zu lösen, um somit letztendlich zu einer verbesserten Knochengesundheit in Österreich beizutragen.SummaryThe first Austrian Osteoporosis Report was initiated to create a comprehensive reference document for the pathogenesis, diagnostics, therapy, and rehabilitation of osteoporosis. Furthermore, the aim was to present the extent and severity of osteoporosis and the associated complications in Austria. On the basis of current international prevalence, it can be estimated that approximately 740,000 of people in Austria over 50 years are affected by osteoporosis, of whom around 617,000 are women. A special analysis of the hospital discharge statistics showed that, in the year 2005, 1382 men and 8080 women were discharged from Austrian hospitals with the main diagnosis, osteoporosis. Added to these 9711 male cases and 54,840 females cases were documented with osteoporosis as a secondary diagnosis. In Austria around 16,500 people suffer a hip fracture each year. Thus, with a fracture rate of 19.7 fractures per year per 10,000 inhabitants over the age of 65 years, Austria lies within the peak for Europe. The hospital mortality rate amongst patients with fracture of the femur is 3.8% in men and 3.2% in women in Austria. Everybodys bone health can be positively influenced by a healthy lifestyle; however, the Osteoporoses Report revealed insufficiencies regarding lifestyle risk factors in the Austrian population. Average calcium intake amongst Austrian adult women and amongst male and female seniors is lower than recommended and only adult men achieve around the recommended amount. The mean vitamin D intake in Austria is very poor, especially amongst pre-schoolers and seniors. The rate of Austrians reporting regular physical exercise is in need of improvement, especially amongst elderly people. The data presented in the Austrian Osteoporosis Report are useful to enable the development of public health strategies and methods to help resolve some of these problems, and ultimately contribute to improved bone health in the nation.

Epidemiology of allergies in Austria. Results of the first Austrian Allergy Report

ZusammenfassungDer erste Österreichische Allergiebericht fasst alle zur Verfügung stehenden epidemiologischen Daten zu Allergien in Österreich zusammen. Demnach beträgt die kumulative Prävalenz von Allergien in der Wiener Bevölkerung 27,6 % bei den Männern und 32,2 % bei den Frauen und die Periodenprävalenz im Jahr vor der Befragung 19,6 % bzw. 22,4 %. Bei Gesundenuntersuchungen berichteten 20,8 % der Männer und 23,1 % der Frauen über Allergien. Eine durch Prick-Test nachweisbare allergische Sensibilisierung gegenüber mindestens einem Inhalationsallergen ist jedoch bei 50,8 % der Allgemeinbevölkerung und bei 39,3 % der beschwerdefreien Personen nachweisbar. Eine Auswertung der Krankenhausentlassungen aller österreichischen Krankenhäuser zeigt, dass im Jahr etwa 12.000 Personen aufgrund einer Allergie in Krankenhäuser aufgenommen werden. Übereinstimmend mit internationalen Studien sind manche Bevölkerungsschichten in Österreich häufiger betroffen als andere. Frauen sind von Allergien etwas häufiger betroffen als Männer, das Geschlechtsverhältnis ist bei Kindern jedoch umgekehrt. Allergien kommen in allen Altersgruppen vor, wie aus den meisten internationalen Studien hervorgeht, sind am häufigsten Personen in der 3. Lebensdekade betroffen. Personen in höher gebildeten Schichten, höher qualifizierten Berufen und städtischen Regionen sind häufiger von Allergien betroffen als Personen aus niedrigeren sozio-ökonomischen Schichten und Gemeinden mit hoher Agrarquote. Der international aufgezeigte steigende Trend ist auch für Österreich nachvollziehbar mit einer Steigerung der Prävalenz von Heuschnupfen, Asthma und atopischem Ekzem, bei den Stellungsuntersuchungen um jeweils das 2fache, 3,6fache und 4,6fache zwischen 1986 und 2003/04. Zwischen 2003/04 und 2005 ist jedoch ein deutlicher Rückgang in der Allergieprävalenz zu verzeichnen. Gesundheitsberichte wie der erste österreichische Allergiebericht liefern die Basis für die internationale Vergleichbarkeit von Eckdaten. Die Auswirkungen von Erkrankungen auf das Gesundheitswesen können abgeschätzt und basierend auf den Daten Public Health Strategien entwickelt werden.SummaryThe first Austrian Allergy Report is a compilation of all available epidemiological data relating to allergies in Austria. According to this report the cumulative prevalence of allergies in the Viennese population is 27.6% for men and 32.2% for women and the period prevalence in the year before questioning 19.6% and 22.4% respectively. 20.8% of men and 23.1% of women reported about allergies at health examinations. However, an allergy sensitivity to at least one inhalation allergen, verifiable by means of a prick test, is detectable in 50.8% of the general population and in 39.3% of those free from ailments. Analysis of the hospital discharge statistics of all Austrian hospitals shows that around 12,000 people per year were admitted on grounds of an allergy. In accordance with international studies some population sub groups are more often affected than others. Women suffer from allergies somewhat more frequently than men, although the sex difference is reversed among children. Allergies occur in all age groups, with most studies showing that people in their twenties are most frequently affected. People with higher levels of education, in more highly qualified jobs and living in urban areas are more commonly affected by allergies than people from lower socio-economic levels and rural communities. The internationally identified increase in trend can also be identified in Austria with a 2fold, 3.6fold, and 4.6fold increase in the prevalence of hay fever, asthma and atopic eczema respectively, determined from the military health examinations of all recruits for national service between 1986 and 2003/04, although a clear decline in allergy prevalence was registered between 2003/04 and 2005. Health reports like the first Austrian Allergy Report provide the basis for international comparison of basic data. These data also enable the evaluation of the impact of different diseases on the health system as well as the development of public health strategies.

Methodologic and Ethical Ramifications of Sex and Gender Differences in Public Health Research

BACKGROUND Experience and investigative studies have shown that inequalities still exist between the sexes as well as in how public health policies and strategies approach the needs of the sexes. Sufficient attention has not been given to gender in public health research. Gender-based differences and similarities need to be promoted, and more structured guidelines are needed to build gender into public health research models. OBJECTIVE The aim of this review was to investigate and discuss public health research and to answer several related questions on gender biases, ethics and methodologies, and the establishment of guidelines. METHODS Using the search terms public health research and gender , or ethics , gender , and public health, a literature search was conducted predominately with, but not limited to, the PubMed database. English- or German-language articles were identified that examined the current status of gender in public health research as well as any relevant ethical guidelines. RESULTS A review of the current literature showed that much work has been undertaken to promote the inclusion of gender in health research. However, deficiencies in the extent of gender-oriented research have been found in a number of key areas, including ethics committees and public health research methodology. Women were found to be underrepresented in ethics committees, which lack clear guidance, particularly in the European Union, to ensure the inclusion of gender issues in public health research. Data are often not sex disaggregated, and information on gender and social circumstances are frequently lacking. Furthermore, some methodologies, such as those used in the field of occupational health, underestimate mens or womens burden of disease. CONCLUSIONS Recommendations include establishing guidelines for researchers on how to incorporate gender in health research, ensuring that the composition of ethics committees is more representative of society, and recommending that data collection systems or bodies ensure that data are disaggregated by sex and include socioeconomic aspects.