Effectiveness of Electronic Cigarettes in Smoking Cessation: A Systematic Review and Meta-analysis.

INTRODUCTION: Reports of the effectiveness of e-cigarettes (ECs) for smoking cessation vary across different studies making implementation recommendations hard to attain. We performed a systematic review and meta-analysis to assess the current evidence regarding effectiveness of ECs for smoking cessation. METHODS: PubMed, PsycInfo, and Embase databases were searched for randomized controlled trials comparing nicotine ECs with non-nicotine ECs or with established smoking cessation interventions (nicotine replacement therapy [NRT] and or counseling) published between 1 January 2014 and 27 June 2020. Data from eligible studies were extracted and used for random-effects meta-analyses (PROSPERO registration number: CRD42019141414). RESULTS: The search yielded 13 950 publications with 12 studies being identified as eligible for systematic review (N = 8362) and 9 studies for random-effects meta-analyses (range: 30-6006 participants). The proportion of smokers achieving abstinence was 1.71 (95 CI: 1.02-2.84) times higher in nicotine EC users compared with non-nicotine EC users. The proportion of abstinent smokers was 1.69 (95 CI: 1.25-2.27) times higher in EC users compared with participants receiving NRT. EC users showed a 2.04 (95 CI: 0.90-4.64) times higher proportion of abstinent smokers in comparison with participants solely receiving counseling. CONCLUSIONS: Our results suggest that nicotine ECs may be more effective in smoking cessation when compared with placebo ECs or NRT. When compared with counseling alone, nicotine ECs are more effective short term, but its effectiveness appears to diminish with later follow-ups. Given the small number of studies, heterogeneous design, and the overall moderate to low quality of evidence, it is not possible to offer clear recommendations. IMPLICATIONS: The results of this study do not allow for a conclusive argument. However, pooling current evidence points toward a potential for ECs as a smoking cessation tool. Though, given the overall quality of evidence, future studies should aim for more clarity in terms of interventions and larger study populations.

Impact of physical activity, protein intake and social network and their combination on the development of frailty.

BACKGROUND: Frailty is a geriatric condition associated with adverse health outcomes. As physical inactivity, low protein intake and poor social network are known risk factors, we aimed to assess the influence of these parameters and their interaction in an 11-year follow-up study on a Europe-wide level. METHODS: Data from the Study on Health, Ageing and Retirement in Europe were used, including 22 226 community-dwelling robust and prefrail persons aged ≥50 years, from 11 countries. Frailty was assessed with the 'Frailty Instrument for Primary care of the Survey of Health, Ageing and Retirement in Europe'. Additionally, self-reported physical activity (PA), protein intake and satisfaction with social network were assessed. The impact of these parameters on the development of frailty was calculated using multivariate cox regressions. RESULTS: Performing no regular PA, was associated with higher hazards ratio (HRs) for frailty compared with performing regular PA [men: 1.90 (95%CI: 1.50-2.42); women: 1.65 (95%CI: 1.25-2.18)]; HRs for low protein intake were 1.16 (95%CI: 0.93-1.46) for men and 1.05 (95%CI: 0.80-1.37) for women. And HR for poor social network were 0.92 (95%CI: 0.74-1.15) for men and 1.72 (95%CI: 1.31-2.27)] for women. In general, persons with a combination of two of the assessed risk factors had a higher risk for frailty compared with those with no or only one of the risk factors. However, no significant synergy index could be found. CONCLUSION: The results illustrate the importance of PA, but also of nutritional and social network to prevent frailty.

[Austrian Physical Activity Guidelines for Adults and Older Adults with and without Physical, Sensory, or Mental Disabilities, as well as for Adults with Chronic Diseases]. / Österreichische Bewegungsempfehlungen für Erwachsene und ältere Erwachsene ohne und mit Körper-, Sinnes- oder Mentalbehinderung sowie für Menschen mit chronischen Erkrankungen.

There is sound scientific evidence that regular physical activity enhances physical, psychological, and mental health. Specific physical activity guidelines for target groups make an essential contribution to the promotion of physical activity behavior at a population level. In this article, we introduce the updated Austrian physical activity guidelines for adults and older adults with and without physical, sensory, or mental disabilities, as well as for adults with chronic diseases. We have also added comments to key elements of the guidelines. The scientific basis of the physical activity guidelines is the scientific report by the US advisory committee, as well as the 2nd edition of the physical activity guidelines for Americans. Guidelines for a new target group - adults with chronic health conditions - have been included. Furthermore, people with disabilities are now explicitly part of the (older) adult target groups. Instead of providing one cut-off point to separate people into meeting the guidelines/not meeting the guidelines, a range of 150 to 300 minutes per week is now recommended. Placing the guidelines for strength training above those for aerobic training emphasizes the importance of this type of training. In addition, it is now recommended that prolonged sitting is avoided by regularl interruptions. We believe that the publication of the physical activity guidelines for Austria will make an important contribution to the promotion of health through regular physical activity. However, the promotion of regular physical activity will only be successful if all target groups have a fair chance to reach physical activity competence, and attractive environments are created for regular physical activity.

[Determinants of Exercise, Fulfilling the Recommendations for Aerobic Physical Activity and Health Status: Results of a Correlation Study in the Federal States of Austria]. / Bewegungsdeterminanten, Erfüllung der Empfehlungen für ausdauerorientierte Bewegung und Gesundheit: Ergebnisse einer Korrelationsstudie aus den österreichischen Bundesländern.

STUDY AIM: The aim of this study was to examine the association between the proportion of the population that fulfilled the endurance-based recommendations for health-enhancing physical activity and the proportion with correct knowledge of these recommendations, exercise-friendly culture and environment, and health status in the federal states of Austria. METHODS: The analysis is based on data from the Austrian Physical Activity Monitoring 2017, the Austrian Health Interview Survey 2014, the Austrian Mortality Register 2015, the database of Fit Sports Austria, the Austrian Chamber of Commerce, the Federal Ministry for Traffic, and an online platform for running events. Correlation coefficients (Pearson) for the various parameters and the proportion of the population that fulfilled the endurance-based recommendations for health-enhancing physical activity are presented. RESULTS: There is a significant correlation between endurance-based physical activity and the knowledge regarding the recommended extent of physical activity (0.91), the number of offers in sports clubs (0.87), the subjective accessibility of sports clubs (0.85), the accessibility of green spaces (0.84), the number of sports clubs with certified health-promoting programs (0.76), and the perceived possibilities to go running (0.72). In addition, endurance-based physical activity is significantly and negatively correlated with age-adjusted cardiovascular mortality (-0.96), total mortality (-0.95), the prevalence of obesity (-0.83), ischemic heart mortality (-0.76), and the prevalence of chronic diseases in total (-0.68), and is positively correlated with subjective health (0.79). CONCLUSIONS: The correlations show the significant associations between exercise behavior and health knowledge, the infrastructure for exercise, and culture. In addition, they show the significant correlation between exercise behavior and health status in the Austrian federal states. This information is important for tailored recommendations for the individual federal states.

[Exercise Behavior, Costs of Physical Inactivity, and Physical Activity Promotion in Austria]. / Bewegungsverhalten, Kosten mangelnder körperlicher Aktivität und Bewegungsförderung in Österreich.

In this article, we present the Austrian data on physical activity, the societal costs and outcomes of physical inactivity, and the areas of influence to promote physical activity. Based on an analysis of the status quo and its consequences, suggestions on relevant measures to counter physical inactivity are made. While the proportion of Austrians that do not fulfill the current recommendations on physical activity is high, the Austrian population is physically more active than many populations of other countries. In Austria, major differences in physical activity are associated with demographic, socio-economic, and geographic factors. The economic burden related to physical inactivity is considerable, with regard to both societal costs and outcomes. This includes major health and social care costs, productivity losses (estimated at around 248 million Euro in 2017 in Austria), and life years lost due to premature death. Evidence-based areas of influence to increase physical activity include kindergartens and schools, the workplace, communities, cities, long-term care facilities, and nature.

[Effects of Physical Activity on Health]. / Auswirkungen von Bewegung auf die Gesundheit.

Regular physical activity contributes to both maintaining and improving health, and is important for human development throughout the entire lifespan of a person. There is strong evidence for the beneficial effects of physical activity on health, in the areas of all-cause mortality, cancer, cardiovascular health, musculoskeletal health, metabolic health, and neurocognitive health. Physical activity includes any form of movement in which the contraction of skeletal muscles results in an increase in energy consumption. It is quantified and controlled via the frequency, duration, intensity, and weekly extent. All those forms of movement that improve health and in which the risk of injury is low are defined as health-enhancing physical activity. The Austrian recommendations for health-enhancing physical activity include endurance-oriented movement, plus strength and coordination training. Exercise is aimed at initiating adaptation processes, in order to improve functionality. Therefore, it has to be adapted to the different levels of individual performance ability, activity levels, and age, and should be carried out according to certain principles. Exercise leads to a positive change in physiological parameters, which in turn are closely linked to an improvement in the state of health. Through regular endurance-oriented and muscle-strengthening physical activity, far-reaching health effects can be achieved. Nevertheless, undesirable events can occur during activity, and the musculoskeletal and circulatory systems can be particularly affected. However, through adequate preparation, suitable equipment, and appropriate exercise, the personal and also the public health benefits of physical activity and sport can be increased.

Risk factors for subsequent work disability in patients with acute myocardial infarction.

BACKGROUND: Scientific knowledge on risk factors for work disability in terms of long-term sickness absence (SA) and disability pension (DP) following acute myocardial infarction (AMI) is limited. The study aimed to investigate socio-demographic, work-related and medical characteristics as risk factors for long-term SA (>90 days) and DP in patients with a first AMI. METHODS: This is a population-based cohort study of 8199 individuals aged 19-60 years who had a first AMI during 2008-10 and were alive 30 days after AMI. Univariate and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) with regard to long-term SA and DP with a 3-year follow-up were estimated by Cox regression. RESULTS: We found a higher risk of long-term SA and DP after AMI in women, those with lower education and previous SA (range of HRs: 1.29-7.34). Older age and being born in non-European countries were associated with a 2- to 3-fold higher risk of DP. Moreover, ST-elevation myocardial infarction (STEMI), musculoskeletal and common mental disorders (CMDs) were risk factors for long-term SA and DP, while diabetes mellitus and stroke were associated with a higher risk of DP (range of HRs: 1.12-2.98). Coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention was associated with a 2-fold higher risk of work disability. CONCLUSIONS: Older women, those with lower education and non-European immigrants had a higher risk of work disability after AMI, particularly permanent work disability. STEMI, CABG, diabetes mellitus, stroke, musculoskeletal disorders and CMDs provide important clinical information for work disability after AMI.

Synergistic effect between ischaemic heart disease and common mental disorders and the risk of premature exit from the labour market: a nationwide register based study from Sweden.

Aims: Common mental disorders i.e. depressive and anxiety disorders (CMD) are frequent comorbid conditions in individuals with ischaemic heart disease (IHD). Still, their effect on preterm exit from the labour market [i.e. disability pension (DP)] in individuals with IHD has to date not been scrutinized. The aim of this study was to investigate the separate and joint effect of IHD and CMD on the risk of DP for women and men of working age. Material and methods: This population-based cohort study included all non-pensioned 4 823 069 individuals, registered as living in Sweden 31 December 2004 and then 16-64 years of age. Individuals with IHD or CMD were identified through using data on sickness absence, prescribed medication or in- or specialized outpatient care in 2005. Crude and adjusted hazard ratios (HR) and 95% confidence intervals (CI) for being granted DP in 2006-10 were estimated by means of Cox proportional hazard regression. Results: In the fully adjusted models, HRs for DP were 2.84 (95% CI; 2.57-3.13) and 2.83 (2.66-3.01) in women and men with IHD, respectively. Hazard ratios for DP in women and men with CMD were 5.13 (5.03-5.24) and 6.08 (5.93-6.24). In women and men with both conditions, crude HRs for DP were 18.38 (15.01-22.50) and 25.58 (22.27-29.37). There was a significant synergistic effect between IHD and CMD in both sexes in the crude models, which disappeared in women after adjusting for socio-demographic variables, and in men after additionally adjusting for comorbid somatic disorders. Conclusion: A comorbid CMD worsens the prognosis of IHD in terms of early exit from the labour market. Processes leading to DP in individuals with IHD are multifactorial and may involve the presence of CMD as well as comorbidity with other somatic diseases.

Sexual health in patients with rheumatoid arthritis and the association between physical fitness and sexual function: a cross-sectional study.

The aim of this study was to examine sexual health in patients with rheumatoid arthritis (RA), and to analyse factors associated with sexual health with a focus on physical fitness. One hundred RA patients aged between 18 and 65 years were included in a cross-sectional study. Handgrip strength and knee extensor strength were measured with a dynamometer, and physical performance with the Short Physical Performance Battery (SPPB). Fifty-four patients, mean age 47.8 (SD 10.6) years, 61% female, answered a questionnaire about sexual health. Fifty-seven percent reported, at least, sometimes having difficulty with sexual intercourse (27.8% due to joint stiffness, 24.1% due to fatigue, 18.5% due to pain). Handgrip strength and knee extensor strength significantly correlated with the desire to engage in sexual intercourse, frequency of sexual contact and satisfaction with overall sex life. The SPPB total score correlated with satisfaction with overall sex life, and the SPPB repeated chair stands test with the desire to have sexual intercourse and satisfaction with overall sex life. After adjusting for age, gender, disease activity, comorbidity, co-medication and pain intensity, the repeated chair stands test remained significantly associated with the frequency of sexual contact (0.53; 0.01-1.05) and with satisfaction with overall sex life (1.39; 0.28-2.51). The results of this study show that problems with sexual health are highly prevalent in patients with RA. The ability to rise from a chair is associated with sexual function, independent of disease activity and pain intensity.

Changes of dietary patterns during participation in a web-based weight-reduction programme.

OBJECTIVE: To examine the weight-loss success associated with distinct dietary patterns and to determine changes of these dietary patterns during participation in a web-based weight-reduction programme. DESIGN: Factor analysis was used to identify the dietary patterns of twenty-two food groups that were administered in 14 d dietary protocols at baseline and after 3 months. Successful weight loss (≥5% of initial weight) and BMI were calculated. Logistic regression analyses were used to assess the rates of weight-loss success from each dietary pattern and changing or remaining in the initial dietary pattern. A generalised linear mixed model was used to estimate the effects of changing or staying in a dietary pattern on change in BMI. SUBJECTS: Adults (n 1635) aged 18-81 years. SETTING: Users of a web-based weight-reduction programme (2006-2012). RESULTS: Participants who aligned to a healthful dietary pattern at baseline (OR=1·8; 95% CI 1·5, 2·3) and after 3 months (OR=1·5; 95% CI 1·2, 1·9) had a greater chance of successfully losing weight. After adjusting for age, sex, initial dietary pattern and BMI, participants who started with or changed to the healthful dietary pattern had a greater chance of being successful (OR=1·4; 95% CI 1·1, 1·7) and a higher BMI reduction of 0·30 (95% CI 0·2, 0·5) kg/m(2) compared with those who started with or changed to the energy-dense or high-carbohydrate dietary pattern. CONCLUSIONS: A favourable healthful dietary pattern at the beginning and after 3 months was positively associated with anthropometry. However, successful weight loss was feasible in each dietary pattern.

Impairment in the activities of daily living in older adults with and without osteoporosis, osteoarthritis and chronic back pain: a secondary analysis of population-based health survey data.

BACKGROUND: Independence in performing activities of daily living (ADLs) is a central aspect of functioning. Older adults frequently experience impairments and limitations in functioning in various life areas. The aim of this survey was to explore the limitations in the ADLs in older adults in a population-based survey in Austria. METHOD: A population-based cross-sectional study in 3097 subjects aged ≥65 years who were included in the Austrian health interview survey was performed. Descriptive statistics were used to calculate frequencies of problems in the ADLs. A principal component analysis was applied to analyze the main dimensions of 19 ADL items. Binary logistic regression models were used with the ADL dimensions as the dependent variables and osteoarthritis, chronic back pain, osteoporosis, sex, education level, anxiety or depression, age and pain intensity as independent variables. RESULTS: People with musculoskeletal conditions were significantly more often affected by ADL problems than people without these diseases. The ADL domain which caused problems in the highest proportion of people was "doing heavy housework" (43.9 %). It was followed by the ADL domains "bending or kneeling down" (39.3 %), "climbing stairs up and down without walking aids" (23.1 %), and "walking 500 m without walking aids" (22.8 %). The principal components analysis revealed four dimensions of ADLs: (1) intense "heavy burden" ADLs, (2) basic instrumental ADLs, (3) basic ADLs and (3) hand-focused ADLs. The proportion of subjects who had problems with the respective dimensions was 58.2, 29.2, 23.0, and 9.2 %. Anxiety/depression (greatest effect), followed by the chronic musculoskeletal disease itself, female sex, higher age and pain intensity were significant predictors of ADL problems. CONCLUSION: This population-based survey indicates that older people have considerable ADL problems. More attention should be paid to the high impact of pain intensity, anxiety and depression on ADLs.

Health resorts as gateways for regional, standardised, sports club based exercise programmes to increase the weekly time of moderate- to vigorous-intensity physical activity: study protocol.

BACKGROUND: More than 10 % (approximately 60,000) of the adult population in Styria, a federal state in the south of Austria, is granted a residential stay in a health resort each year. The target group for these stays is the general population aged between 30 and 65 years with minor symptoms such as risk factors for cardio-metabolic diseases. Stays are financed by health insurance companies and last up to three weeks. The treatment during the stays consists of exercise and nutritional intervention as well as psychological support when needed. However, because of the absence of regional programmes linked with the residential stay, the sustainability of the interventions is questionable. METHODS/DESIGN: This prospective, controlled, multicentre, open-label study will compare two groups. Participants will be included in the study if they live in any of eight predefined Styrian regions and do not meet the minimal WHO physical activity guidelines. Those allocated to the intervention group will receive a voucher for 12 regional, standardised, sports club based exercise sessions. The members of the control group will come from different but matched Styrian regions and will receive an informative written brochure. The primary outcome will be the weekly level of health-enhancing physical activity, which will be objectively measured with an accelerometer and supplemented by an activity log book. Together with potential determinants of physical activity it will be assessed before, 10 weeks after and 12 months after the residential stay. Additionally, psychosocial determinants will be assessed by questionnaire and fitness (cardiorespiratory fitness, handgrip, balance) will be measured. In addition to the changes in measurable parameters, processes will be evaluated to learn about the facilitators and barriers of the implementation of the programme. DISCUSSION: It is known that during the residential stay, participants are receptive to new opportunities supporting health behaviour change, but that these measures are not sustained after discharge. The structured cooperation between the health sector that has to inform the participants and the sports sector that provides the wide network of standardised programmes is the strength of the study, but at the same time a challenge. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT02552134 ; date of registration: 15 September 2015).

Achievement of physical activity recommendation and activity levels in students of human medicine compared with the general Austrian population aged between 20 and 29 years.

Weekly 150 min of moderate to vigorous physical activity and muscle-strengthening activities are a major public health goal. The International Physical Activity Questionnaire-short form was applied in 467 students of the 4th year at the Medical University of Vienna and compared with subsamples of data from the Austrian Health Interview Survey, 795 subjects with and 1131 subjects without higher education aged 20-29 years. Median values for weekly total energy expenditure were 3083, 3048, and 3816 MET-minutes (P < 0.001) in medical students, higher and lower educated subjects of the general population. Energy expenditure with vigorous intensity was highest in medical students. A total of 39.4 % of medical students reached the minimum requirements of the national physical activity recommendations. Although medical students are taught those recommendation and are aware of their health benefits, only a minority reach them. If medical students engage in physical activity, they do it with higher intensity than the general population.

Contributions of ambient assisted living for health and quality of life in the elderly and care services--a qualitative analysis from the experts' perspective of care service professionals.

BACKGROUND: Because of the demographic change in industrial countries new technical solutions for the independent living of elderly will become important in the next years. Ambient Assisted Living seeks to address the upcoming challenges by providing technical aids for elderly and care givers. Therefore it is crucial to understand how those socio-technical solutions can address their needs and quality of life (QOL). The aim of this study was to analyse the main needs of dependent elderly and to investigate how different solutions can contribute to health and quality of life. METHODS: A qualitative study design consisting of interviews with 11 professionals of geriatric care organisations was chosen. The data analysis was done by applying the qualitative content analysis by Philipp Mayring. The analysis was based on the basic principle of the bio-psycho-social model of health RESULTS: Ambient Assisted Living solutions and assistive technologies can have positive impacts on different dimensions of health and quality of life. The needs and problems of elderly can be addressed by applying appropriate solutions which influence the physical, mental and social dimensions of quality of life. There are also benefits for social care providers, their staff and caring relatives of impaired elderly. Ambient Assisted Living solutions can also be used as a facilitator for operational optimization of care services. CONCLUSIONS: Solutions for telemedicine and telecare which are connected to Ambient Assisted Living solutions will have the biggest positive impact on care giving services. Also simple technical aids can be beneficial for elderly to enhance QOL by enabling autonomy in their familiar surroundings.

[Public health education in Austria. An overview]. / Public Health Ausbildung in Österreich. Ein Überblick.

The future challenges for the Austrian health care system require an increasing number of public health experts of different professions in all fields of public health. In this article the offer of public health education in Austrian universities and universities for applied sciences was searched based on the predominantly online available information on web platforms of the schools. Currently (2013), there are three postgraduate public health university courses and two public health doctoral programs in Austria. Additionally, 34 degree programmes could be identified, in which parts of public health are covered. But also in medical curricula at Austrian medical schools, public health contents have found their place. In Austria, there is already a multifaceted offer for public health education. However, to build an appropriate public health work force, capable to manage the public health challenges in all its dimensions in terms of health in all policies, this offer should still be intensified.

Differences in access points to the ambulatory health care system across Austrian federal states.

BACKGROUND: The nine Austrian regions differ according to demographic parameter, health status, and health care structure. It was the aim of this study to analyse whether there are also differences in access points towards the level of ambulatory care. METHOD: The Austrian Health Interview Survey (2006-2007) data with 15,474 participants were used for this cross-sectional analysis. Statistical analyses included descriptive statistics as well as multivariate logistic regression models and correlations. RESULTS: There were significant differences in patients with direct utilisation of specialists without having consulted a general practitioner (GP) in the same period in the Austrian regions, with highest proportions for women in Vorarlberg (20.3%) and men in Vienna (21.5%) and lowest in Burgenland (7.0 and 6.6%, respectively). The specialist/GP ratio correlated significantly with the direct specialist utilisation (Spearman correlation coefficient: 0.717). CONCLUSION: There are spatial differences in the health care utilisation within the Austrian regions, which partly can be explained by the disposal of health care structure. These findings are of special importance according to the ongoing debate concerning the topic strengthening the primary health care sector in Austria.

Preventive medicine: self-assessment of knowledge, skills and attitudes of medical students at the Medical University of Vienna.

Prevention and health promotion are gaining importance in modern medical curricula. Aim of this study was to evaluate the self-assessment of knowledge, skills and attitudes of medical students towards health promotion and prevention. In 2012, at the Medical University of Vienna, 27% of the 633 fourth-year medical students (50.3% male and 49.7% female; mean age: 24 years) completed a questionnaire. Results show a high assessment of prevention in most respondents. Knowledge gaps were detected on occupational health and mother-child pass examinations. However, almost all students reported sufficient knowledge on screening and risk assessment of developing cardiovascular diseases. Almost all respondents estimated to be able to identify risky behaviours. Overall, estimation towards prevention of tomorrow's physicians is very positive. However, only 40% believed to have been adequately trained on preventive medicine so far. Relevant preventive aspects were added to the medical curriculum in 2012-2013 with the new block 'Public Health'.

Health care utilisation in subjects with osteoarthritis, chronic back pain and osteoporosis aged 65 years and more: mediating effects of limitations in activities of daily living, pain intensity and mental diseases.

Musculoskeletal diseases (MDs) have major consequences for the individual, and also for society and may thus lead to increased use of health care. It was the aim of this study to explore health care utilisation in patients with self-reported osteoarthritis, chronic back pain or osteoporosis compared with people of the same age without those diseases, based on data of the Austrian health interview survey including 3,097 subjects aged ≥ 65 years. Patients with MDs in our study visited a general practitioner (GP) and were hospitalised significantly more often compared with persons without the respective diseases. Problems in the activities of daily living (ADLs), pain intensity and anxiety/depression influenced GP consultations. Complex factors explain the higher health care utilisation in subjects with MDs in our study. Our results indicate that integrated strategies are needed to manage those patients, which should focus on management of ADL problems, pain and mental health.