Franziska Großschädl

Validity of self-reported weight and height in Austrian adults: sociodemographic determinants and consequences for the classification of BMI categories

OBJECTIVE Epidemiological studies have shown that adults tend to underestimate their weight and overestimate their height. This may lead to a misclassification of their BMI in studies based on self-reported data. The aim of the present study was to assess the validity of self-reported weight and height in Austrian adults. DESIGN Data on weight, height, health behaviour and sociodemographic characteristics of adults were collected in a standardized procedure via a self-filling questionnaire and a medical examination including measurements of weight and height. SETTING A publicly accessible out-patient clinic in southern Austria. SUBJECTS Austrian residents (n 473) aged 18 years and older who attended a health check participated in the study. RESULTS The mean difference between reported and measured BMI was not significant in younger adults (<35 years: mean difference -0·21 kg/m2; P < 0·08) but increased significantly with age (≥55 years: mean difference -0·68 kg/m2; P < 0·001). The prevalence of normal weight (BMI = 18·5-24·9 kg/m2) and overweight (BMI = 25·0-29·9 kg/m2) was overestimated based on the self-reported data on BMI, while that for underweight (BMI < 18·5 kg/m2) and obesity (BMI ≥ 30·0 kg/m2) was underestimated (P < 0·001). The self-reported data showed an obesity prevalence of 12·5 %, while measurement showed a prevalence of 15·4 % (P < 0·001). CONCLUSIONS Our results indicate that prevalence rates of obesity are probably underestimated for Austrian adults when using self-reported weight and height information. The deviations from the measured data clearly increased with age. Analyses based on self-reported data should therefore be adjusted for the age dependency of the validity.

Nutrition and Health – The Association between Eating Behavior and Various Health Parameters: A Matched Sample Study

Population-based studies have consistently shown that our diet has an influence on health. Therefore, the aim of our study was to analyze differences between different dietary habit groups in terms of health-related variables. The sample used for this cross-sectional study was taken from the Austrian Health Interview Survey AT-HIS 2006/07. In a first step, subjects were matched according to their age, sex, and socioeconomic status (SES). After matching, the total number of subjects included in the analysis was 1320 (N = 330 for each form of diet – vegetarian, carnivorous diet rich in fruits and vegetables, carnivorous diet less rich in meat, and carnivorous diet rich in meat). Analyses of variance were conducted controlling for lifestyle factors in the following domains: health (self-assessed health, impairment, number of chronic conditions, vascular risk), health care (medical treatment, vaccinations, preventive check-ups), and quality of life. In addition, differences concerning the presence of 18 chronic conditions were analyzed by means of Chi-square tests. Overall, 76.4% of all subjects were female. 40.0% of the individuals were younger than 30 years, 35.4% between 30 and 49 years, and 24.0% older than 50 years. 30.3% of the subjects had a low SES, 48.8% a middle one, and 20.9% had a high SES. Our results revealed that a vegetarian diet is related to a lower BMI and less frequent alcohol consumption. Moreover, our results showed that a vegetarian diet is associated with poorer health (higher incidences of cancer, allergies, and mental health disorders), a higher need for health care, and poorer quality of life. Therefore, public health programs are needed in order to reduce the health risk due to nutritional factors.

A 35-Year Trend Analysis for Back Pain in Austria: The Role of Obesity

Background The prevalence of back pain is constantly increasing and a public health problem of high priority. In Austria there is a lack of empirical evidence for the development of back pain and its related factors. The present study aims to investigate trends in the prevalence of back pain across different subpopulations (sex, age, obesity). Methods A secondary data analysis based on five nationally representative cross-sectional health surveys (1973–2007) was carried out. Face-to-face interviews were conducted in private homes in Austria. Subjects aged 20 years and older were included in the study sample (n = 178,818). Obesity was defined as BMI≥30 kg/m2 and adjusted for self-report bias. Back pain was measured as the self-reported presence of the disorder. Results The age-standardized prevalence of back pain was 32.9% in 2007; it was higher among women than men (p<0.001), higher in older than younger subjects (p<0.001) and higher in obese than non-obese individuals (p<0.001). During the investigation period the absolute change in the prevalence of back pain was +19.4%. Among all subpopulations the prevalence steadily increased. Obese men showed the highest increase of and the greatest risk for back pain. Conclusion These results help to understand the development of back pain in Austria and can be used to plan controlled promotion programs. Further monitoring is recommended in order to control risk groups and plan target group-specific prevention strategies. In Austria particular emphasis should be on obese individuals. We recommend conducting prospective studies to confirm our results and investigate causal relationships.

The Influence of Socioeconomic Factors on Health Parameters in Overweight and Obese Adults

The prevalence of being overweight and of obesity is increasing worldwide, and is associated with a high risk to health. Therefore, the aim of our study was to investigate whether normal weight, overweight and obese subjects of low, middle or high socioeconomic status (SES) differ with regard to their health behavior, health, quality of life, and the use of medical care. Data from the Austrian Health Interview Survey (ATHIS) 2006/07, comprising 3 groups of 1,077 individuals, each of whom were normal weight, overweight, or obese, respectively, and matched according to their age, sex and SES, were analyzed concerning health outcomes. The results show that subjects with a low SES differ significantly from those of high SES in terms of their health behavior, self-perceived health, levels of impairment, chronic conditions, quality of life, and health care. Additionally, obesity in adults is associated with sub-optimal dietary practices and worse health, poorer quality of life and medical care than normal weight and overweight individuals. A significant interaction between the weight class and SES was found concerning physical exercise, impairment due to health problems and chronic diseases. A low SES has a strong negative impact on health, especially in obese individuals. Therefore a continuous target group-oriented, non-discriminatory public health program is required, prioritizing obese subjects with low SES.

Income Inequality as a Moderator of the Relationship between Psychological Job Demands and Sickness Absence, in Particular in Men: An International Comparison of 23 Countries

Objectives The aim of this study was to investigate whether more sickness absence is reported in countries with higher income inequality than elsewhere, and whether the level of income inequality moderates the association between psycho-social job demands and sickness absence. Methods Our analysis is based on the Fifth European Working Conditions Survey that compared 23 European countries. We performed multi-level regression analysis. On the macro-level of analysis we included the Gini-Index as measure of inequality. On the micro-level of analysis we followed the Karasek-Theorell model and included three scales for psychological job demands, physical job demands, and decision latitude in the model. The model was stratified by sex. Results We found that, in countries with high income inequality, workers report significantly more sickness absence than workers in countries with low income inequality. In addition we found that the level of income inequality moderates the relationship between psychological job demands and sickness absence. High psychological job demands are significantly more strongly related to more days of sickness absence in countries with low income inequality than in countries with high income inequality. Conclusions As the nature and causal pathways of cross-level interaction effects still cannot be fully explained, we argue that future research should aim to explore such causal pathways. In accordance with WHO recommendations we argue that inequalities should be reduced. In addition we state that, particularly in countries with low levels of income inequality, policies should aim to reduce psychological job demands.

Moderate- and vigorous-intensity exercise behaviour according to the Transtheoretical Model: associations with smoking and BMI among Austrian adults

SummaryIntroductionRegular physical activity leads to a number of physiological benefits, such as reduced risk of coronary heart disease, diabetes mellitus and obesity. In Austria, there is little information about the prevalence of physically inactive people, as well as about who is more likely to belong to the inactive or irregularly active groups. The aim of this study is to describe the socio-demographic distributions across the stages of behavioural change for moderate- and vigorous-intensity physical activity, according to the Transtheoretical Model, and to identify associations with smoking and body mass index (BMI).MethodData were collected in a standardised procedure using a self-report questionnaire from 489 adults who attended a health check in an outpatient clinic in southern Austria. Height and weight were measured by physicians. The subjects were categorised into the five stages of change (pre-contemplation, contemplation, preparation, action, maintenance), separately assessed for moderate- and vigorous-intensity physical activity.ResultsThe likelihood of being in the stage of maintenance of moderate-intensity physical activity was highest in older subjects (p < 0.05). Participants of a high educational level showed the highest likelihood of being physically active in vigorous-intensity physical activity (p < 0.05). Furthermore, the lowest stages of change behaviour were associated with higher BMI levels for vigorous-intensity physical activity (p < 0.05). Smokers were significantly (p < 0.05) more likely not to perform vigorous-intensity physical activity than non-smokers.ConclusionOur findings contribute to a better understanding of behavioural correlates of regular physical activity. The results may prove useful for developing promotion programmes for physical activity, allowing targeting of the identified risk groups.ZusammenfassungEinleitungRegelmäßige körperliche Aktivität führt zu einer Reihe von physiologischen Vorteilen wie einem geringeren Risiko für koronare Herzerkrankungen, Diabetes mellitus oder Adipositas. Für Österreich fehlt es an Informationen wie groß der Anteil derjenigen ist, welche keiner körperlichen Aktivität nachgehen beziehungsweise unregelmäßig physisch aktiv sind. Ziel dieser Studie ist es, soziodemographische Faktoren zu den Stufen der Verhaltensänderungen des Transtheoretischen Modells für körperliche und sportliche Aktivität zu beschreiben und die Assoziationen zu Rauchen und BMI zu identifizieren.MethodeSelbstberichtete Daten wurden in einem standardisiertem Verfahren mithilfe eines Fragebogens erhoben. 489 Erwachsene wurden im Rahmen einer ambulanten Gesundenuntersuchung, welche im Süden Österreichs durchgeführt wurde, befragt. Körpergröße und –gewicht wurden von ÄrztInnen abgemessen. Die TeilnehmerInnen teilte man fünf Verhaltensstufen (Absichtslosigkeit, Absichtsbildung, Vorbereitung, Handlung, Aufrechterhaltung), für körperliche und sportliche Aktivität, zu.ErgebnisseDie Ergebnisse dieser Studie zeigten, dass ältere Personen mit größter Wahrscheinlichkeit der Stufe Aufrechterhaltung (Bewegung mit mittlerer Intensität) angehörten (p < 0,05). Personen mit höchster Bildung waren am ehesten sportlich aktiv (p < 0,05). Weiters zeigte sich, dass die niedrigste Verhaltensstufe mit einem höheren BMI im Hinblick auf sportliche Aktivität assoziiert werden konnte und RaucherInnen eher sportlich inaktiv waren als NichtraucherInnen (p < 0,05).SchlussfolgerungUnsere Ergebnisse tragen dazu bei, das Verhalten von Personen, welche regelmäßig körperlich aktiv sind, besser zu verstehen. Die Resultate können für Bewegungsförderungsprogramme genützt werden, um Risikogruppen gezielt zu erreichen.

Erratum to: Female and male victims of violence in an urban emergency room—prevalence, sociodemographic characteristics, alcohol intake, and injury patterns

SummaryBackgroundViolence as well as alcohol-attributable injuries is a dominant public health issue worldwide. Victims, being injured, frequently visit emergency rooms (ER).MethodsWe interviewed all the patients seeking help in an urban emergency room reporting being victims of violent behavior over a period of 3 months (from November 2011 to January 2012).ResultsOur results showed that 1 out of 23 patients seeking help in our ER was due to forcible means. A total of 15 % of all victims reported domestic violence (75 % women) and others (90 % men) reported brawl as the reason for seeking help. Overall, 80 % of the victims were younger than 40 years. In case of domestic violence, two-third (only women) reported that they were hurt by their intimate partner. At total of 50 % were treated for head wounds and 35 % had injuries of their extremities. One-third of the patients were alcoholized. The victims of brawls mainly suffer from head injuries (69 %). Half of this patient group was under the influence of alcohol.ConclusionsTo conclude, victims of violence seek for help in emergency rooms daily. Alcohol consumption is the main factor for violent behavior. Public health programs to prevent alcohol related violence and therefore, alcohol-attributable injuries have to be implemented. Addressing the need to enhance the awareness of the health professionals has to be an imperative.ZusammenfassungGrundlagenGewalt und Verletzungen, die dem Einfluss von Alkohol zuzuschreiben sind, sind weltweit ein großes Public Health Problem. Die Opfer werden häufig in den Notaufnahmen einer Unfallchirurgie medizinisch versorgt werden.MethodikWir haben über einen Zeitraum von drei Monaten (November 2011 bis Januar 2012) in einer städtischen Notaufnahme all jene PatientInnen interviewt, die angaben, dass sie Opfer von gewalttätigem Verhalten sind.ErgebnisseUnsere Ergebnisse haben gezeigt, dass eine/-r von 23 PatientInnen aufgrund von äußerer Gewalteinwirkung medizinische Hilfe benötigt. 15 % aller Opfer (75 % Frauen) beanspruchen Hilfe aufgrund von häuslicher Gewalt, die anderen (90 % Männer) hauptsächlich aufgrund von Raufhandel. Insgesamt waren 80 % der Opfer jünger als 40 Jahre. Im Fall von häuslicher Gewalt gaben zwei Drittel (nur Frauen) an, dass sie von ihrem Lebenspartner verletzt wurden. 50 % wurden aufgrund von Kopfverletzungen versorgt, 35 % litten an Verletzungen an den Extremitäten. Ein Drittel der PatientInnen war alkoholisiert. Die meisten Opfer von Raufhandel litten an Kopfverletzungen (69 %) und die Hälfte von ihnen war alkoholisiert.SchlussfolgerungenZusammenfassend werden Opfer von Gewalt täglich in der Notaufnahme medizinisch versorgt. Public Health Programme, die Gewalt und alkoholbedingte Verletzungen verhindern, müssten implementiert werden. Das medizinische Personal für dieses Problem zu sensibilisieren ist dringend erforderlich.

Determinants of acceptance of end-of-life interventions: a comparison between withdrawing life-prolonging treatment and euthanasia in Austria

BackgroundEnd-of-life decisions remain a hotly debated issue in many European countries and the acceptance in the general population can act as an important anchor point in these discussions. Previous studies on determinants of the acceptance of end-of-life interventions in the general population have not systematically assessed whether determinants differ between withdrawal of life-prolonging treatment (WLPT) and euthanasia (EUT).MethodsA large, representative survey of the Austrian adult population conducted in 2014 (n = 1,971) included items on WLPT and EUT. We constructed the following categorical outcome: (1) rejection of both WLPT and EUT, (2) approval of WLPT but rejection of EUT, and (3) approval of both WLPT and EUT. The influence of socio-demographics, personal experiences, and religious and socio-cultural orientations on the three levels of approval were assessed via multinomial logistic regression analysis.ResultsHigher education and stronger socio-cultural liberal orientations increased the likelihood of approving both WLPT and EUT; personal experience with end-of-life care increased only the likelihood of approval of WLPT; and religiosity decreased approval of EUT only.ConclusionThis study found evidence for both shared (education, liberalism) and different (religiosity, care experiences) determinants for the acceptance of WLPT and EUT.

The impact of the HDI on the association of psychosocial work demands with sickness absence and presenteeism

BACKGROUND The purpose of this study was to determine whether psychosocial work demands have a different impact on sickness absence and presenteeism in countries with a high vs. countries with a low Human Development Index (HDI). METHODS This article is based on an analysis of the fifth European Working Conditions Survey. We investigated single items as well as complex constructs and indices. Sickness absence and presenteeism were measured as outcome variables. Following the model of Karasek and Theorell, we measured the HDI at the macro level and psychosocial job demands at the micro level as independent variables. RESULTS The multivariate multilevel analysis reveals a significant association between the HDI and the number of days recorded for sickness absence. In countries with a higher HDI, people report a lower number of days with sickness absence. Higher psychosocial job demands are associated with poorer health. There are significant cross-level interaction effects between psychosocial job demands and the HDI for these associations. Psychosocial job demands are stronger associated with sickness absence and presenteeism in high-HDI than in low-HDI countries. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH We argue that Public Health Actions that are connected to work characteristics need to take into consideration the level of HDI of the countries. In low- and high-HDI countries, different actions could be necessary to reach the needs of the working population.

Prevalent Long-Term Trends of Hypertension in Austria: The Impact of Obesity and Socio-Demography.

Background Globally there are only less long-term-studies on hypertension available to provide reliable estimates and identify risk groups. This study aims to analyse the prevalence and long-term-trend of hypertension in Austria, recognize affected subpopulations and investigate social inequalities. Methods This representative population-based study is based on self-reported data of adults (mean age: 47.7 ± 17.5; n = 178,818) that were taken from five health surveys between 1973 and 2007. An adjustment of self-reported BMI was performed based on a preliminary validation study. Absolute changes (AC) and aetiologic fractions (AF) were calculated from logistic regressions in order to measure trends. To quantify the extent of social inequality, a relative index of inequality (RII) was computed. Results During the study period the age-standardized hypertension prevalence increased from 1.0% to 18.8%, with a considerable rise from 1991 onwards. There was a positive trend in all subpopulations, with the highest AC among obese women (+50.2%) and obese subjects aged 75 years and older (+54.4%), whereas the highest risk was observed among the youngest obese adults (AF: 99.4%). The RII for hypertension was higher for women than men, but in general unstable during the investigation period. Conclusions Obesity and older age are significant factors for increased morbidity of hypertension. The most undesirable trends occurred in obese women and obese subjects aged 75 years and older. These risk groups should be given special attention when planning hypertension prevention programs. The high increase in the prevalence of hypertension is due to different aspects, e.g. a demographic change and a change in the definition of hypertension. These findings help to understand why hypertension is becoming more common in the Austrian population.