Willibald J. Stronegger

Descriptive epidemiology of thyroid carcinoma in Carinthia, Austria: 1984-2001. Histopathologic features and tumor classification of 734 cases under elevated general iodination of table salt since 1990: population-based age-stratified analysis on thyroid carcinoma incidence.

INTRODUCTION The aim of the study was to investigate the current thyroid carcinoma (TC) incidence in Carinthia, a former iodine-deficient, goiter-endemic region in Austria with approximately 550,000 inhabitants from 1984 to 2001. Using age-cohort analysis we analyzed the TC incidence under the impact of two regional risk factors: the contamination of Austrian soils by the radioactive fallout in from Chernobyl 1986 and the increased iodination of table salt in a general program of goiter prophylaxis begun in 1991. To evaluate the characteristics of TC incidence, we compared the results of the periods 1984-1989, 1990-1995, and 1996-2001. RESULTS A total of 734 TC cases were diagnosed. Papillary, follicular, medullary, oxyphilic, and anaplastic TC accounted for 76%, 18%, 3%, 1%, and 2%, respectively. The female to male ratio was 3:1. The annual incidence rate increased by 8.05% in females and 11.6% in males. TC cases younger than 40 years of age accounted for 22.6%, with a rate increase of 18% per year in young males, the female-to-male ratio decreased from 8.3, 6.1, 2.7 younger than 40 in the compared periods. Along with a further increase in papillary TC incidence and papillary thyroid carcinoma (PTC) follicular thyroid carcinoma (FTC) ratio in the adult population, the ratio tended to decrease in the younger than 40-year-old population. T4 class TC and loco-regional lymph node involvement increased significantly. INTERPRETATION The observed changes in TC incidence, particularly in the young population, as in adults, could be linked to the abovementioned risk factors involved in the initiation and early growth of TC, and iodine may play a role in stimulating overall thyroid activity.

Objectively measured walkability and active transport and weight-related outcomes in adults: a systematic review

ObjectivesThe aim of this study was to investigate which GIS-based measures of walkability (density, land-use mix, connectivity and walkability indexes) in urban and suburban neighbourhoods are used in research and which of them are consistently associated with walking and cycling for transport, overall active transportation and weight-related measures in adults.MethodsA systematic review of English publications using PubMed, Science Direct, Active Living Research Literature Database, the Transportation Research Information Service and reference lists was conducted. The search terms utilised were synonyms for GIS in combination with synonyms for the outcomes.ResultsThirty-four publications based on 19 different studies were eligible. Walkability measures such as gross population density, intersection density and walkability indexes most consistently correlated with measures of physical activity for transport. Results on weight-related measures were inconsistent.ConclusionsMore research is needed to determine whether walkability is an appropriate measure for predicting weight-related measures and overall active transportation. As most of the consistent correlates, gross population density, intersection density and the walkability indexes have the potential to be used in planning and monitoring.

The impact of socio-economic status on pain and the perception of disability due to pain.

Pain is a major burden for society and a great challenge for public health. The aim of this study was to evaluate the association of socio‐economic status (SES) with pain, and assess if there were socio‐economic differences in the impairment due to pain, even when the same level of pain was reported. Data were sourced from the Austrian Health Interview Survey 2006–2007, a population based nation‐wide survey with 15,474 respondents. SES, based on education, income and profession was inversely and gradually associated with the prevalence of severe pain, with the number of indicated painful body sites, the intensity of pain, and with the subjective level of feeling disabled through pain. In a stepwise logistic regression model, adjusted for age, gender, diseases, number of painful body sites and intensity of pain, people with lower SES gradually reported greater disability through pain. Even at the same intensity of pain and the same number of painful body sites, people in the lowest as compared to the highest socio‐economic class were twice to three times more likely to feel disabled through pain. Adjusted odds ratios for the lowest group of SES was 2.80 (95% CI, 1.93–4.06) in terms of education, 1.83 (95% CI, 1.40–2.41) in terms of income and 2.05 (95% CI, 1.32–3.19) in terms of profession. This unexplained socio‐economic gradient contributes to the confirmation of the social component in a bio‐psycho‐social model of pain.

Perceived characteristics of the neighborhood and its association with physical activity behavior and self-rated health.

The aim of our study was to identify perceptions of the residential environment and their association with physical activity for specific purposes and with self-rated health in an urban context. A representative survey of inhabitants of Graz (a mid-sized Austrian city) aged 15-60 years (n=997) was conducted. We found a perceived high social-environmental quality of the residential environment to be associated with higher levels of self-rated health and leisure time physical activity. Both leisure time physical activity and satisfaction with environmental quality were independently linked with self-rated health. Furthermore, a high level of satisfaction with the individuals local infrastructure may support the residents to engage in higher levels of physical activity for transportation, whereas the preferred mode of transportation may be gender-specific: men tend to use the bicycle while women walk. Our results suggest that local infrastructure facilities should be designed so as to ensure accessibility by both walking and cycling.

Effects of a lifestyle physical activity intervention on stages of change and energy expenditure in sedentary employees.

Abstract Objectives: To assess the effects of an intervention in a worksite setting on changes in physical activity. It was expected that an intervention with an emphasis on daily life activities, such as brisk walking, would increase the proportion of individuals expending more than 1000 kcal per week in activities with at least moderate intensity, or influence individuals to change from one stage of the Transtheoretical Model of Behaviour to a higher one. Design: Quasi-experimental. Data were collected before and after a 4 month intervention period in 6 offices ( n =211) of the Swiss federal administration. Two offices ( n =168) served as controls. Methods: Participants completed a 7 day recall questionnaire on physical activities (daily life activities, leisure time activities, and sport) and stages of readiness for change, along with questions on demographic variables. Components of the intervention programme were: information, actions for daily life activities, fitness lessons, and counselling. Results: Between precontemplation/contemplation, preparation, and action/maintenance there was a significant difference of more than 850 kcal of energy expenditure. Baseline and follow-up examinations revealed a significant progression across the stages of change in the intervention offices. Subgroup analyses showed that the level of physical activity at baseline influenced the effect of the intervention. Exclusively in worksites with a lower proportion of sufficiently active individuals, the intervention was able to substantially increase the proportion by 21%. Conclusions: A diversified intervention programme in a worksite setting encourages participants to become more physically active during work and leisure time.

Mini Mental State Examination: Influence of Sociodemographic, Environmental and Behavioral Factors, and Vascular Risk Factors

Age and education have been found to affect the Mini Mental State Examination (MMSE) score of elderly normals, but there have been no studies assessing the influence of environmental and behavioral factors on this test. We therefore administered the MMSE to 1437 normal elderly subjects in the setting of a stroke prevention study and correlated their results to 16 sociodemographic, environmental, and behavioral factors, and vascular risk factors. Study statistics composed of a multiple logistic regression analysis and graphical models revealed the relations between variables in greater detail. Logistic regression yielded education level, occupational status, living as a single, general life stress, physical strain, and physical inactivity to be independent predictors of the MMSE score. Age was not included in this model. Graphical models demonstrated similar results, but did not include living as a single and physical inactivity. As shown in our independence graph, general life stress is the crucial predictor and links other environmental and sociodemographic variables with the test performance of elderly normals.

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.

Factors influencing transcutaneous oxygen and carbon dioxide measurements in adult intensive care patients

Transcutaneus PO2 (PtcO2) is suggested to reflect tissue oxygenation in intensive care patients, whereas transcutaneous PCO2 (PtcCO2) is advocated as a noninvasive method for assessing PaCO2. In 24 critically ill adult patients (mean Apache II score 14.2, SD 4.7) we investigated the impact of variables that are commonly thought to determine PtcO2 and PtcCO2 measurements. A linear correlation was found between PtcO2 and PaO2 (r=0.6;p≤0.0001) and between PtcO2 and mean arterial blood pressure (MAP;r=0.42;p≤0.003). Cardiac index (CI) correlated with tc-index (PtcO2/PaO2;r=0.31;p≤0.03). There was no relationship between PtcO2 and hemoglobin concentration (Hb) and the position of the oxygen dissociation curve (ODC). Stepwise multiple regression analysis demonstrated a significant influence of PaO2 and MAP on PtcO2. The contribution of CI, Hb and the ODC was not significant. Only 40% of the variability of a single PtcO2 measurement could be explained by PaO2 and MAP. A significant linear correlation was demonstrated between PtcCO2 and PaCO2 (r=0.76;p≤0.0001) but not between PtcCO2 and CI, MAP and arterial base excess (BEa). Stepwise multiple regression analysis revealed an influence of PaCO2 and of CI on PtcCO2; 66% of the variability of a single PtcCO2-value could be explained by PaCO2 and CI. Our data demonstrate that transcutaneous derived gas tensions result from complex interaction between hemodynamic, respiratory and local factors, which can hardly be defined in ICU-patients.

Social capital affects the health of older people more strongly than that of younger people

ABSTRACT The study examines whether social capital affects health of older people more strongly than it affects health of younger individuals. Following Pierre Bourdieus concept, social capital has been analysed on a cognitive dimension, distinguishing between institutional and informal social capital. The analysis is based on the data of the Austrian Health Interview Survey 2006–07 with a representative sample of 15,575 people. Multivariate linear regression models were calculated. Measures of health and social capital were operationalised by indices based on the quality of life inventory of the World Health Organization, the WHOQOL-Brief questionnaire. The analysis has shown institutional social capital to be significantly more important for health of older people (60 years or older) than for younger people. There is a gender difference in the interaction between informal social capital and age in their association with psychological health. In contrast to the sub-sample of women, the psychological health of older men is more strongly affected by a lack of informal social capital than that of younger men. Institutional social capital is of special importance for the health of older people. Therefore health-promotion activities for older people should include activities to strengthen their social capital.

Socio-economic determinants of health behaviours across age groups: results of a cross-sectional survey

SummaryBackgroundThe aim of this study was to analyse the impact of different socio-economic variables on the lifestyle factors, like lack of physical activity, diet rich in meat, and smoking, across sex and age groups in the general Austrian population to formulate more targeted public health measures.MethodsThe Austrian Health Interview Survey 2006–07 contains data of 15,474 people, representative for the general population. Statistical analyses included linear and logistic regression models.ResultsLack of physical activity was more prevalent in women, while unhealthy nutrition and daily smoking were more prevalent in men. Overall, profession was the strongest predictor for health behaviour in men, while the educational level played the most significant role in women. Subjects in higher age groups had a more healthy nutrition and were less likely to smoke, but had a higher chance for lack of physical activity.DiscussionSocio-economic factors predict lifestyle choices differently in different age groups. For example, in men, the highest percentage of daily smokers was found in the middle age, while the youngest age group was the one that smoked the most in women. Furthermore, the educational level had a reverse effect on women in the oldest age group, where those with tertiary education smoked three times more than those with less education. Our results emphasise the importance of taking a holistic approach towards health, including educational, cultural and age-specific policies to improve the overall health status and health equality of a population.ZusammenfassungHintergrundZiel dieser Studie war es, den Einfluss verschiedener sozio-ökonomischer Determinanten auf die Lebensstilfaktoren ‚fehlende körperliche Bewegung‘, ‚fleisch-reiche Ernährung‘, und ‚Rauchen‘ nach Geschlecht und in verschiedenen Altersgruppen zu analysieren, um gezieltere Public Health Maßnahmen zu formulieren.MethodenDer Austrian Health Interview Survey 2006–07 beinhaltet Daten von 15.474 Personen, und ist für die österreichische Bevölkerung repräsentativ. Statistische Auswertungen beinhalteten lineare und logistische Regressionsanalysen.ErgebnisseFrauen wiesen öfter mangelnde körperliche Bewegung auf, während bei Männern eine ungesunde Ernährung und Rauchen häufiger vorkamen. Der Beruf war der stärkte Prädiktor bei Männern, während bei Frauen die Bildung den größten Einfluss hatte. Personen in den höheren Altersgruppen hatten eine gesündere Ernährung und rauchten weniger, hatten aber auch eine größere Wahrscheinlichkeit für fehlende körperliche Bewegung.DiskussionSozio-ökonomische Determinanten haben unterschiedliche Auswirkungen auf Lebensstilfragen in unterschiedlichen Altersgruppen. Zum Beispiel fanden sich die meisten täglichen Raucher bei Männern in der mittleren Altersgruppe, während es bei den Frauen die jüngste Altersgruppe war, die am meisten rauchte. Außerdem hat Bildung einen umgekehrten Effekt bei Frauen, wo solche mit tertiärer Bildung dreimal mehr rauchten als jene mit weniger Bildung. Unsere Ergebnisse betonen, wie wichtig es ist, einen ganzheitlichen Zugang zu Gesundheit zu haben, welcher bildungspolitische, kulturelle und altersspezifische Maßnahmen umfasst, um einen einheitlichen und gerechten Gesundheitszustand in der Bevölkerung zu erreichen.