Thomas Waldhoer

Sequential Treatment of Anemia in Ulcerative Colitis with Intravenous Iron and Erythropoietin

Background: Intravenous iron and erythropoietin have been shown to be effective in Crohn’s disease-associated anemia. The aim of this study was to test the sequential treatment of anemia in ulcerative colitis with intravenous iron in the first phase and erythropoietin in the second. Patients and Methods: Twenty patients with ulcerative colitis-associated anemia (hemoglobin ≤10.5 g/dl) entered this open-label trial. In the first phase all patients received intravenous iron saccharate for 8 weeks. A response was defined as an increase in hemoglobin ≥2.0 g/dl; a final hemoglobin >10.5 g/dl was regarded as full response, ≤10.5 g/dl as partial response. A hemoglobin increase <2.0 g/dl was regarded as nonresponse. In the second phase (n = 4) erythropoietin was initiated in patients without response. Patients with partial response were continued on iron saccharate for another 8 weeks. Results: During the first phase the hemoglobin increased from 8.3 to 11.9 g/dl (mean hemoglobin difference 3.6 ± 2.3 g/dl, p < 0.001). Fifteen patients (75%) showed a full response (mean hemoglobin difference 4.5 ± 1.5 g/dl), 1 (5%) a partial response (hemoglobin difference 2.1 g/dl) and 4 no response (mean hemoglobin difference 0.4 ± 1.8 g/dl) with a need for blood transfusions in a single patient. In the second study phase erythropoietin was highly effective in previous nonresponders (mean hemoglobin difference 3.3 ± 1.9 g/dl). The single patient with partial response had a minor hemoglobin increase (hemoglobin difference 1.0 g/dl). Conclusion: Most patients with ulcerative colitis-associated anemia improve on intravenous iron alone. Erythropoietin is effective in those who do not respond.

Prediction of response to iron sucrose in inflammatory bowel disease-associated anemia.

OBJECTIVE:Inflammatory bowel disease (IBD)-associated anemia responds to i.v. iron therapy. However, because of concurrent chronic inflammation, some patients do not respond adequately. Erythropoietin therapy has been shown to be effective in the latter cohort. Our goal was to find parameters that can predict the effectiveness of iron sucrose in IBD-associated anemia.METHODS:One hundred three patients with severe IBD-associated anemia (Hb ≤ 10.5 g/dl) were treated prospectively for 4 wk with iron sucrose (total iron dose = 1.2 g) in an open label, multicenter trial. Treatment response was defined as an increase in Hb of ≥2.0 g/dl. A logistic regression analysis was performed with treatment response as the dependent variable and the following independent variables: serum erythropoietin, mean corpuscular Hb, transferrin, ferritin, soluble transferrin receptor (sTfR), C-reactive protein, interleukin 6 (IL-6), and disease activity.RESULTS:Sixty-seven of 103 patients (65%) responded to iron sucrose. From the variables under investigation, erythropoietin, sTfR, transferrin, and IL-6 were significantly associated with treatment response. The R2 values showed that erythropoietin (8.0%), sTfR (11.4%), and transferrin (10.4%), but not IL-6 (1.3%), contribute a relevant amount of information to the model. An estimated 80% probability of treatment response was found at erythropoietin levels of >166 U/L, sTfR levels of >75 nmol/L, or transferrin levels of >3.83 g/L.CONCLUSIONS:Serum erythropoietin, sTfR, and transferrin concentrations have the potential to predict the response to iron sucrose therapy in IBD-associated anemia. These parameters may help to identify individuals who benefit the most from additional erythropoietin treatment.

The prevalence of lower urinary tract symptoms in Austrian males and associations with sociodemographic variables

The aim of our study was to assess the prevalence of lower urinary tract symptoms (LUTS) in Austrian males and to correlate the findings with sociodemographic variables. In a population-based cross-sectional study in Austria in the year 1995, data on voiding symptoms were collected from a representative sample of men by using the International Prostate Symptom Score (IPSS). Only 28.6% of the males aged 15 to 89 years (total n = 939) reported no LUTS at all (IPSS = 0). In the group of males who report symptoms, a positive correlation of the IPSS with age is found. Furthermore IPSS correlates with weekly alcohol and nicotine consumption, but not with the respondents body-mass index (BMI), educational status and monthly household income. The bothersomeness of LUTS increases with age, leaving more than 12% of the males aged 40 to 89 dissatisfied with urinary symptoms. Extrapolated to population numbers, more than 87,000 males in Austria (aged 15 to 89 years) would feel ‘terribly’ if they were to spend the rest of their lives with urinary symptoms as they were at the time of the survey. Due to an estimated future increase of the proportion of older people in Austria, the number of males with LUTS will rise significantly, thereby placing increased burden on medical resources in the future.

Under-reporting of direct and indirect obstetrical deaths in Austria, 1980-98

Background.u2003 Under‐reporting and misclassification of maternal deaths are common, even in countries with a high quality of death statistics. The aims of this study were to determine to what extent maternal deaths are under‐reported in Austria and to determine factors that might explain under‐reporting.

Rates of postmortem examination in Austria The effect of distance between location of death and site of examination

BACKGROUND AND OBJECTIVEnDespite the importance of autopsies for diagnosing disease and determining cause of death, autopsy rates are decreasing in many countries. Furthermore, autopsy rates are often not distributed randomly between different regions within countries. In this study we analyzed an apparent nonrandom spatial distribution of autopsy rates in Austria for the period 1991-2000. We tested the new hypothesis that the rate of autopsies performed on people who die at home depends on the distance from the residence to the hospital or forensic institute where autopsies are performed.nnnMETHODSnData were extracted from the official mortality records for the years 1991-2000. Only persons who deceased in private residences were included. A logistic regression model was used.nnnRESULTSnEven controlling for variability in sex, age, date of death, and family status, the effect of distance significantly implied lower autopsy rates in the alpine parts of Austria.nnnCONCLUSIONSnThis effect of distance may lead to artificially nonrandom mortality patterns in disease maps. As a consequence, the possibility of hypothesizing incorrect health risks to explain nonrandom mortality patterns increases.

Small area variation in childhood diabetes mellitus in Austria: links to population density, 1989 to 1999

We analyzed the associations of environmental factors with the regional distribution of Type 1 diabetes mellitus in Austria. All newly diagnosed cases (n=1449) from 1989 to 1999 were allocated to districts using the postal code. Nitrate content of the water was measured by the Austrian Federal Environmental Agency. Data on infant mortality, population density, and percentage of employment by industry were derived from Statistics Austria. An inverse effect was seen between the proportion of children younger than 15 years of age and the risk ratio (P<.01). Infant mortality, population density, and percentage of persons with employment in industry were not of significant influence. The mean nitrate level was positively associated (P=.07). In regions with a higher percentage of children younger than 15 years of age, fewer children developed diabetes, which is in agreement with the observation that early social mixing is a protective factor. Nitrate levels may have a confounding effect.

The impact of sociodemographic variables on immunization coverage of children

The dependence of immunization coverage of children in the municipalities of Vienna and Klagenfurt on the sociodemographic variables of their parents is investigated. According to the Austrian vaccination program, the following vaccinations are recommended: diphtheria/tetanus (DT), measles/mumps (MM), poliomyelitis (oPV), tickborne encephalitis (TBE), tuberculosis (BCG) and whooping cough (P). The aim of the study is to identify risk groups, as are children that are not well covered. A cross-sectional study using vaccination certificates of second grade schoolchildren in Vienna and Klagenfurt was performed. A multivariate logistic regression model is used. In Vienna a representative sample of second grade schoolchildren (n = 585) was investigated, in Klagenfurt all second grade schoolchildren (n = 824). The investigation took place during the 1993/1994 schoolyear. In Vienna 34.8% of the children have all the vaccinations recommended, in Klagenfurt 59.6%. Children of Austrian mothers have the best immunization coverage, followed by children whose mothers are from ‘other countries’, ‘not stated’, and ‘former Yugoslavia’. The immunization rate increases with the motherÕs increasing age. It is lower if the father is unemployed. The effects of the variables age and unemployment are not dependent on nationality. Children from Klagenfurt are more often completely immunized than children from Vienna. The mothers education does not have a significant influence. The Austrian immunization program is not sufficient to provide a high level of herd immunity. The immunization program recommends vaccinations but does not include a system for finding and recording riskgroups (non-immunized). To improve the situation eight steps needed for a setup of surveillance and containment system are recommended.

The Lunar Cycle and the Number of Deliveries in Austria between 1970 and 1999

The effect of the moon on the number of newborns has been investigated extensively with contradictory results but with few significant findings. In this paper, a possible lunar effect is analyzed by a nonlinear Poisson regression model similar to a Fourier analysis based on all children (n = 2,760,362) born in Austria between 1970 and 1999, i.e. 371 lunar cycles. We found no significant effect even when considering the influence of parity and gestation. Our study is in contrast to a French study using a similarly large data base which showed a weak but significant effect. Nevertheless, significant p values based on very large samples must be interpreted cautiously. Our study is in concordance with other studies which often use small and selected samples or rather inefficient statistical methods. We conclude that there is no significant effect of the lunar cycle on the number of deliveries in Austria.

Unexpected out-of-hospital deaths in persons aged 85 years or older: an autopsy study of 1886 patients

PURPOSEnThe aim of this study was to determine the causes of death in the very elderly.nnnMETHODSnWe reviewed 24,081 consecutive autopsies performed over 10 years (1989 to 1998) at the Institute of Forensic Medicine, Vienna, Austria. We focused on autopsies of people aged 85 years or older who died unexpectedly out of hospital.nnnRESULTSnThe mean age of the 1886 patients (561 men and 1325 women) at the time of death was 88 +/- 3 years (range, 85 to 108 years). Thirty-one percent (n = 588) of those who died were described as having been previously healthy. Cardiovascular disease was the most common cause of death (n = 1465 [77%]). Thirteen percent (n = 246) died of respiratory illness, 5% (n = 94) of gastrointestinal disorders, and 3% (n = 53) of diseases of the central nervous system. Genitourinary and metabolic diseases were uncommon.nnnCONCLUSIONnAlthough this out-of-hospital sample is not representative of the entire elderly population, postmortem examinations emphasize the importance of cardiovascular diseases in causing unexpected deaths in older persons.

Long-Term Patterns in Seasonality of Insulin-Dependent Diabetes Mellitus Diagnosis in Austrian Children

The analysis of the seasonal pattern of incidence of childhood insulin-dependent diabetes mellitus in Austria was carried out among cases where the child was under the age of 15 when diagnosed between 1979 and 1993. The cases are registered in the nationwide population-based Austrian insulin-dependent diabetes mellitus registry. Seasonal variation was compared between boys and girls and between three 5-year age groups. We also tested whether the seasonal pattern changed over the 15-year observation period. We found a significant seasonal variation among boys aged 10-14 and girls aged 5-14, while in the 0-4 years age group no seasonal pattern could be demonstrated. Two peaks in incidence were identified during a calendar year (February-March and September-October) for girls aged 5-14. For boys aged 10-14, a yearly cycle was found with a peak in January and October. An extension of the Poisson regression model for testing seasonality by Jones et al. was developed to allow for estimation of a time-dependent amplitude of the seasonal component. The annual incidence rate increased by 36% during the observation period, but no significant change in seasonal pattern could be demonstrated.