Nathalie Burkert

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.

Factors associated with the rejection of active euthanasia: a survey among the general public in Austria

BackgroundIn recent decades, the general public has become increasingly receptive toward a legislation that allows active voluntary euthanasia (AVE). The purpose of this study was to survey the current attitude towards AVE within the Austrian population and to identify explanatory factors in the areas of socio-demographics, personal experiences with care, and ideological orientation. A further objective was to examine differences depending on the type of problem formulation (abstract vs. situational) for the purpose of measuring attitude.MethodsA representative cross-sectional study was conducted across the Austrian population. Data were acquired from 1,000 individuals aged 16 years and over based on telephone interviews (CATI). For the purpose of measuring attitude toward AVE, two different problem formulations (abstract vs. situational) were juxtaposed.ResultsThe abstract question about active voluntary euthanasia was answered negatively by 28.8%, while 71.2% opted in favour of AVE or were undecided. Regression analyses showed rejection of AVE was positively correlated with number of adults and children in the household, experience with care of seriously ill persons, a conservative worldview, and level of education. Mean or high family income was associated with lower levels of rejection. No independent correlations were found for variables such as sex, age, political orientation, self-rated health, and experiences with care of terminally ill patients. Correlation for the situational problem formulation was weaker and included fewer predictors than for the abstract question.ConclusionsOur results suggest that factors relating to an individual’s interpersonal living situation and his/her cognitive convictions might be important determinants of the attitude toward AVE. If and to the extent that personal care experience plays a role, it is rather associated with rejection than with acceptance of AVE.

Self-perceived health, quality of life, and health-related behavior in obesity: is social status a mediator?

SummaryBackgroundObesity prevalence is increasing worldwide and is associated with a high health risk. Unfavorable psychological factors, lower self-ratings of health, and worse health-related behavior can be found in individuals with a low socioeconomic status (SES). Therefore, the aim of this study is to investigate whether obese subjects with a high SES differ from those with a low SES depending on these outcomes.MethodsData of the Austrian Health Interview Survey (ATHIS) 2006/2007—precisely of 760 obese subjects with a low SES and 851 with a high SES—were analyzed stratified by sex and adjusted by age with regard to differences in self-perceived health, quality of life (regarding physical and psychological health, environment, and social relationships), and health-related behavior (smoking, alcohol consumption, eating behavior, physical exercise).ResultsThe results have shown that obese subjects with a low SES differ significantly from those with a high SES in terms of self-perceived health, quality of life, and intensity of physical activities. Furthermore, differences were found in obese women as to smoking behavior, alcohol consumption, and continuance of physical exercise.ConclusionIt seems that not only obesity but also the socioeconomic status plays a role in health, and the risk assessment of obese individuals in the primary health care setting should include socioeconomic factors. Furthermore, public health programs which focus on obese subjects with a low SES are urgently needed.ZusammenfassungHintergrundDie Prävalenz der Adipositas nimmt weltweit zu und ist mit einem hohen Gesundheitsrisiko verbunden. Personen mit einem niedrigen sozioökonomischen Status (SES) weisen ein schlechteres Gesundheitsverhalten, ungünstige psychologische Faktoren und eine schlechtere subjektive Gesundheit auf. Daher war das Ziel dieser Untersuchung, Unterschiede zwischen adipösen Personen mit einem hohen vs. niedrigen SES zu analysieren.MethodenZur Prüfung der Fragestellung wurden die Daten der österreichischen Gesundheitsbefragung 2006/2007 analysiert. Unterschiede im Hinblick auf die subjektive Gesundheit, die Lebensqualität (in den Bereichen physische und psychische Gesundheit, Umgebungsfaktoren und soziale Beziehungen), sowie das Gesundheitsverhalten (Rauchen, Alkoholkonsum, Ess- und Bewegungsverhalten) von 760 adipösen Personen mit einem niedrigen SES und 851 mit einem hohen SES wurden geschlechtsstratifiziert und alterskorrigiert untersucht.ErgebnisseAdipöse Personen mit einem niedrigen SES unterscheiden sich signifikant von jenen mit einem hohen SES hinsichtlich der subjektiven Gesundheit, der Lebensqualität und der Intensität des Bewegungsverhaltens. Weiters wurden Unterschiede in Abhängigkeit vom SES bei adipösen Frauen in Bezug auf ihr Rauchverhalten, ihren Alkoholkonsum und die Häufigkeit ihres Bewegungsverhaltens, festgestellt.SchlussfolgerungDer sozioökonomische Status hat einen wesentlichen Einfluss auf die Gesundheit und das Gesundheitsverhalten bei Adipositas und diese Tatsache sollte in der primärmedizinischen Versorgung berücksichtigt werden. Weiters sind Gesundheitsprogramme, speziell für adipöse Personen mit niedrigem SES, dringend erforderlich.

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.

Structural hippocampal alterations, perceived stress, and coping deficiencies in patients with anorexia nervosa.

OBJECTIVE Anorexia nervosa (AN) is a severe mental illness that mainly affects young females. Studies have found a reduction of the hippocampus-amygdala formation in people with AN, a brain region that is especially vulnerable to stress. In addition, patients with AN were found to perceive higher stress levels and to have more coping deficiencies than healthy controls. No prior study has considered a connection between stress, coping, and the hippocampal volume in AN. Therefore, the purpose of our study was to analyze the volume of hippocampal substructures, and its relation to stress and coping. METHOD We tested 21 females currently affected by AN and 21 age-matched normal controls (NC). Demographic and behavioral data were assessed. A magnetic resonance (MR) scanner was used to collect data reflecting volume of cortical structures. We performed comparisons between groups and calculated correlations between the hippocampal volume and coping strategies or stress. RESULTS The results showed a significant reduction of the hippocampal fimbria and a significant enlargement of the hippocampal fissure in patients with AN compared to the NC. In addition, patients with AN were found to report higher stress levels and to have more coping deficiencies than healthy controls. The hippocampal volume showed a trend-level association with stress in patients with AN. DISCUSSION In sum, our study provides the first-available evidence that perceived stress in patients with AN could be related to hippocampal volume. Our results may contribute to a better understanding of the pathophysiology of AN and, therefore, help to improve the treatment.

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.

Quality of screening with conventional Pap smear in Austria – a longitudinal evaluation

BackgroundIn recent decades, the incidence of cervical cancer and cervical cancer mortality in Austria has declined by varying degrees. The Pap smear is to be considered a causal factor for this decline.MethodsThis longitudinal analysis is based on a data set of Pap smear assessments collected by the Committee for Quality Assurance of the Austrian Society of Cytology. Data from 15 laboratories participating in a voluntary self-monitoring program was analyzed for the time span 2004–2008. The data was analyzed in terms of smear quality and assessment quality.A rank-correlation-test for a monotonic trend analysis in the proportion of the three parameters Pap 0, “satisfactory, but limited/SBL”, and Pap IIID/IV for the timespan 2004 to 2008 was carried out.ResultsFor this study, we analyzed an average number of 730,000 smears per year over a five-year period. Specimens from all but two laboratories, i.e. < 2% of all smears, met the quality criterion for Pap 0 (Bethesda 2001 equivalent: Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality), whilst only four laboratories, i.e. < 10% of all smears, reached the national requirement for smears classified as “satisfactory, but limited/SBL”.When using the Pap IIID/IV ratio (LSIL: HSIL/AIS ratio) of 3:1 to 8:1 as a surrogate quality marker for the interpretation of smears, only five laboratories met this criterion during the survey period.The trend analysis indicated only that an increasing number of samples per year is correlated with an increased proportion of Pap 0 and “satisfactory, but limited/SBL” smears.ConclusionsAlthough participants get regular feedback about their results, no general improvements in smear taking or assessment were observed over the years, so mandatory quality management, including the possibility of sanctions, is suggested in order to reduce adverse health effects for women.

Health status and utilisation of the healthcare system by homeless and non-homeless people in Vienna.

This case-control study describes the health situation, internal and external resources, and utilisation of healthcare facilities by a marginalised population consisting of homeless people in Vienna, Austria, compared with a non-homeless control population. Among the homeless group, participants lived in halfway houses (70%) or permanent housing (30%) in Vienna. Personal interviews were conducted in July 2010 with 66 homeless individuals, and their data were compared with data from non-homeless subjects from the Austrian Health Interview Survey using conditional logistic regression. Compared with the control group, homeless persons suffered more often from chronic diseases (P < 0.001) and rated their health considerably lower than the comparison group (P < 0.001). Homeless people suffered significantly more often from psychiatric disorders, respiratory diseases, hypertension (P < 0.001), digestive system diseases (P = 0.002) and heart diseases (P = 0.015) in comparison with the control group. Additionally, among homeless and non-homeless individuals, the former more often consulted a general practitioner in a period of 28 days (P = 0.002). A significantly greater proportion of homeless people did not have any teeth (P = 0.024) and smoked significantly more (P = 0.002). The results demonstrate deficits in the areas of health, health behaviour, and individual and social resources of homeless people, even though homeless people seek medical care at a higher rate than controls. Continuing health promotion projects for this high-risk group and the strengthening of social resources are recommended.

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.