[Attitudes Towards End-of-Life Decisions and Long-Term Care Dependency: Results of a Representative Survey of Austrians Aged 50]. / Einstellungen zu Entscheidungen am Lebensende und Pflegebedürftigkeit: Ergebnisse einer repräsentativen Befragung der österreichischen Bevölkerung (50+).

AIM OF THE STUDY: Existing research on attitudes in the general population regarding end-of-life decisions has included neither old age long-term care dependency nor worries regarding age(ing). The aim of this study is to present first results from a recent survey on this topic. METHODS: A nationally representative cross-sectional survey of the population aged 50+was conducted in Austria (n=968) in 2015. RESULTS: 29.0% of the respondents indicated not wanting to live on as a severely care-dependent older person. In the case of an older care-dependent person, 48.5% approved of forgoing life-sustaining treatment, 41.7% of assisted suicide and 34.1% of euthanasia if requested. Worries about old age and ageing were widespread (53.7-83.0%) and highly worried respondents were more inclined to support assisted suicide and euthanasia compared to those less worried. CONCLUSIONS: Worries and negative stereotypes regarding age(ing) and long-term care dependency should be addressed by information campaigns.

Evidence-based information on mammography screening in Austria--reality or more pie in the sky?

INTRODUCTION: Health literacy is gaining increasing importance in prevention and health care. This is the case for patients and for health-care professionals. Information and risk communication should comply with defined criteria and strengthen health literacy as they are a prerequisite for informed decision making. METHODS: In this study, we analyse the content of the printed information material (brochures and pamphlets) on mammography screening for consumers that were distributed in Austria in 2011. RESULTS: The evaluation of the 11 brochures shows that the content does not comply with the prerequisites for informed decision making. CONCLUSIONS: Since the last study - published in 2004 - the situation has only slightly improved. The authors reemphasise the need for a targeted multimodal information campaign. This is particularly important as a systematic national mammography screening program in compliance with the guidelines of the European Commission will be introduced in Austria in 2013.

Social status as a mediator of self-perceived health, quality of life and health-related behaviour in obesity.

OBJECTIVES: Obesity prevalence is increasing worldwide and associated with a high health risk. Unfavourable psychological factors, lower self-ratings of health and worse health-related behaviour can be found in individuals with a low socioeconomic status (SES). Therefore, the aim of our study was to investigate whether normal weight vs. obese subjects with a high vs. low socioeconomic status (SES) differ with regard to self-perceived health, quality of life and health-related behaviour. METHODS: Data of the Austrian Health Interview Survey (ATHIS) 2006/07, precisely of 8015 subjects were analysed stratified by sex and adjusted by age concerning these outcomes. RESULTS: The results have shown that men and women with a low SES differ significantly from those with a high SES in terms of self-perceived health, quality of life, intensity of physical activities, alcohol consumption, and eating behaviour (men: p <0.001; women: p<0.001). A significant interaction between the body mass index (BMI) and SES occurred in men concerning quality of life in the domains physical (p<0.05) and psychological health (p<0.01), in women as to self-perceived health (p<0.01), quality of life in the domains physical health (p<0.01) and environment (p<0.05), as well as physical activities (p<0.01). CONCLUSION: The SES has a strong negative impact on health-related variables, especially in obese subjects, and therefore risk assessment in the primary health-care setting should include socioeconomic factors. Furthermore, a continued strong public health programme is required with an absolute priority placed on obese subjects of low SES.

The relationship between body weight and patterns of smoking in women and men.

BACKGROUND: In the scientific literature, studies of the relationship between cigarette smoking and body weight yield conflicting results. Weight-lowering effects in women and men have been associated with smoking, however, no effects on weight have been proven. The purpose of this study was to examine the gender-related association between cigarette smoking and relative weight in a rural population in Styria, Austria. METHODS: A database from a health survey conducted between 1989 and 1993 in 79 selected rural communities of Styria was used for these analyses. The sample consisted of 27,344 participants, 16,185 women and 11,159 men, aged > or = 15 years. We controlled for possible confounding factors such as age, years of education, alcohol consumption, regular physical activity, and chronic diseases. RESULTS: For women and men, in comparison to non- and ex-smokers, smoking is significantly correlated with lower body mass index (BMI). In contrast, heavy smoking and smoking cessation are significantly associated with higher relative weight. CONCLUSIONS: We found significant results confirming an association between cigarette smoking and lower BMI in women and men, whereas heavy smoking as well as smoking cessation were significantly correlated with higher relative weight. Health intervention programmes to quit smoking should take into account the underlying perceived benefits of smoking with regard to weight, especially its gender specificity.

Health behaviour and risk behaviour: socioeconomic differences in an Austrian rural county.

The aim of this study is to illustrate the impact of socioeconomic differences on two basic kinds of health-related behaviour defined as health behaviour (HB) and risk behaviour (RB). We analysed data derived from a health survey on health-related behaviour and self-reported morbidity in relation to demographic and socioeconomic factors. The survey consists of a random sample of 27,344 individuals taken from 79 communities from the rural population of Styria (Austria). Using directly standardised indicators both HB and RB revealed clear but inverse associations with education, SES and gender. HB rises and RB falls with years of schooling completed. HB is higher in women (103.5 versus 95.0, p < 0.01) whereas RB is higher in men (128.9 versus 80.1, p < 0.01). Different patterns of association with age were found. We conclude that both HB and RB should be considered as mediating factors between SES and health status.

[Risk of osteoporosis in women in 4 different occupational groups]. / Osteoporoserisiko von Frauen in vier unterschiedlichen Berufsgruppen.

Primary osteoporosis is common, with significant sociomedical consequences. This paper studies the prevalence of risk factors and risk behavior for osteoporosis in women of four different occupational groups: housewives, blue collar workers, white collar workers/civil servants and farmers. We analyzed risk factors and risk behavior associated with osteoporosis in the scientific literature. The sample comprises 9,939 women. The data set is based on a health survey conducted in 79 selected rural communities of Styria (Austria) between 1989 and 1993. Sociodemographic data, lifestyle, health complaints, chronic conditions and utilization of preventive and treatment services were surveyed by means of standardized personal interviews. The results show that the women of the four occupational groups were subjected to very different stresses. White collar workers/civil servants had the lowest risk with regard to osteoporosis. Our results suggest that efficient intervention programs to prevent osteoporosis need to specifically focus on the different social life styles of women.

[Representative early summer meningoencephalitis vaccination rates of school children in Styria]. / Repräsentative FSME-Impfquoten der Schulkinder in der Steiermark.

Since the introduction of the Austrian TBE (tick-borne encephalitis) vaccination program in 1981 immunization coverage of children has not been investigated sufficiently. We investigated the influence of geographic and sociodemographic factors on the immunization coverage of school children in order to identify subpopulations with low immunization coverage. To this end a representative cross-sectional study was carried out in the county of Styria, Austria. The target population were children in the first, fourth and seventh year of school education. Therefore, the sample consisting of 3,196 children was divided into three age groups. children aged around 7, 10 and 13 years. The information concerning the immunization status of each child was recorded by means of an anonymous questionnaire given to parents by the classroom teachers on advice of the supervisory school authority. This procedure ensured the high overall response rate of 85.0%. The prevalence of at least one TBE vaccination was 91.4% for the 7 year old, 97.3% for the 10 and 97.1% for the 13 year old. The prevalence of basic TBE immunization was 84.0%, 91.7% and 92.3% resp. The lowest vaccination rates were found in families with four or more children and for those children who had mothers of the lowest educational level. Thus, for the future management of immunization programs it is crucial to put special emphasis on the identified population groups with deficient immunization coverage. The overall vaccination rates can be judged as satisfactory in the 13 year old children.

[The distribution of selected cardiac risk factors in employed and studying youths in the rural region of Steiermark (Austria)]. / Die Verteilung von ausgewählten kardialen Risikofaktoren bei erwerbstätigen und lernenden Jugendlichen in ländlichen Regionen der Steiermark (Osterreich).

Demographic data, components of lifestyles such as risk behavior, health complaints, illnesses and utilization of preventive and curative services were surveyed through a health survey conducted in 79 selected rural communities of Styria between 1989 and 1933. Our research focussed on the stratification of cardiovascular risk factors such as smoking, high blood pressure, unhealthy nutrition, low physical activity and obesity in adolescents employed or attending school. The sample comprises 1239 adolescents divided into two groups: 651 were employed and 588 were in school. We could show that even at such a young age significant differences occur in the distribution of cardiovascular risk factors between these two groups. The employed adolescents were far more stressed than those of their age group attending school. Generally, the females are less strained than the males. Our results suggest that efficient programs to prevent cardiovascular disease need to specifically focus on the various life contexts of young people. Such programs should start at an early date.

[Use of unconventional therapies by cancer patients]. / Nutzung unkonventioneller Heilverfahren bei Krebserkrankungen.

Unconventional therapies are increasingly accepted and used by professionals and lay persons. In this study, we analyzed correlations between sociodemographic variables of cancer patients, their disease and use of unconventional therapies. In an oncological out-patient department we collected the data relevant for the study objectives by means of a questionnaire. The sample comprised of 154 persons. The younger age group, married individuals and those in mid level occupational positions had more experience with unconventional therapies. The strongest predictors for usage were "age", length of illness" and "being able to go to work or to do house work". Doctors should be familiar with these methods in order to support their oncologic patients. As unconventional therapies will be used more often research should be intensified.

Characteristics of women currently using hormone replacement therapy in rural areas of Styria, Austria.

There are no clear-cut guidelines on "hormone replacement therapy". Each women should be individually counselled regarding her risks and then given "therapy". We studied a rural population in Styria that uses non-contraceptive hormones. Our analyses were based on data drawn from a cross-sectional health survey between 1995 and 1996. Our study sample comprised 499 women 40 to 65 years old; 97 of the women were using hormones (19.4%). According to the univariate analysis, women currently using hormones had a higher level of psychosomatic complaints, a higher frequency of health check-ups and visits to physicians, and reported a higher use of vitamin supplements than the non-users. The results are significant. Compared with other studies, the direction of the selection effect is inverse. Doctors attribute complaints to the perimenopausal status of the women and prescribe hormones in the hope of alleviating the problems. Medical interventions may interfere with possible alternative ways of coping with the menopause allowing for change in different aspects of a woman's life.

Associations of income with self-reported ill-health and health resources in a rural community sample of Austria.

OBJECTIVES: Three levels of health indicators (1) self-reported ill-health, (2) internal health resources, and (3) external health resources were analysed in relation to a four-category house-hold income distribution in order to describe possible social gradients. The particular aim of this study was to obtain information on the association of income data with self-reported ill-health. METHODS: This cross-sectional study was based on a health survey. The sample represents around 10% of the rural population of some communities in Styria, randomly selected from the population registry. Interview data was collected from 3781 participants aged 15 years and older, 1559 males and 2222 females. RESULTS: The results show that individuals from lower house-hold income classes are disadvantaged with regard to indicators of ill-health, internal and external health resources. Overall, the link between low income and poor health is highly consistent within our data. CONCLUSIONS: Considering our results we conclude that internal and external health resources are as unequally distributed over income levels as health outcome indicators.

Gender equality in the work of local research ethics committees in Europe: a study of practice in five countries.

BACKGROUND: Funding organisations and research ethics committees (RECs) should play a part in strengthening attention to gender equality in clinical research. In the research policy of European Union (EU), funding measures have been taken to realise this, but such measures are lacking in the EU policy regarding RECs. OBJECTIVE: To explore how RECs in Austria, Germany, Ireland, The Netherlands and Sweden deal with gender equality issues by asking two questions: (1) Do existing procedures promote representation of women and gender expertise in the committee? (2) How are sex and gender issues dealt with in protocol evaluation? METHODS: Two RECs were selected from each country. Data were obtained through interviews with key informants and content analysis of relevant documents (regulations, guidelines and review tools in use in 2003). RESULTS: All countries have rules (mostly informal) to ensure the presence of women on RECs; gender expertise is not required. Drug study protocols are carefully evaluated, sometimes on a formal basis, as regards the inclusion of women of childbearing age. The reason for excluding either one of the sexes or including specific groups of women or making a gender-specific risk-benefit analysis are investigated by some RECs. Such measures are, however, neither defined in the regulations nor integrated in review tools. CONCLUSIONS: The RECs investigated in five European member states are found to pay limited attention to gender equality in their working methods and, in particular in protocol evaluation. Policy and regulations of EU are needed to strengthen attention to gender equality in the work of RECs.

Employment status and its health-related effects in rural Styria, Austria.

BACKGROUND: Unemployment has become a serious social problem in industrialized countries. Job loss produces health-related disorders. Health-related data of the unemployed are scarce and prompted us to survey this group. METHODS: A database of a health survey conducted between 1989 and 1993 in 79 selected rural communities of Styria (Austria) was used to analyze risk factors and employment status. The sample consisted of 8,747 individuals, 345 unemployed and 8,402 employed. RESULTS: Risk behavior is higher among unemployed individuals than among those employed, particularly for males. Unemployed males were significantly less motivated to reduce weight and to change dietary habits than their counterparts, and they had significantly more anxieties, sleeping disorders, and lack of appetite. A similar pattern was found with regard to gastrointestinal and chronic liver and respiratory diseases. In addition, the unemployed utilized medical services more often. CONCLUSIONS: This is the first study on health-related indicators and unemployment status in Austria. Job loss implies health-related disorders. The effectiveness of reducing the morbidity of the population in general is also dependent on intervention programs focusing on the specific needs of this high-risk group, e.g., adapting primary health care to its needs and fostering social support networks.

Educational status and resources for child care as predictors of TBE vaccination coverage in schoolchildren of an endemic area in Austria.

Since the introduction of the Austrian tick-borne encephalitis (TBE) vaccination program in 1981 vaccination coverage of children has not been investigated sufficiently. Numerous socioeconomic and demographic factors have been identified as being associated with low vaccination coverage in childhood for most vaccinations. This study focuses on parental educational status and on resources for child care as determinants of tick-borne encephalitis (TBE) vaccination coverage of schoolchildren in an endemic TBE area of Austria. The target population were children in the first, fourth and seventh year of school education in Styria, Austria. Therefore, the sample consisting of 2470 children was divided into three age groups, children aged 7, 10 and 13 years. We performed a representative cross-sectional study. The information concerning the vaccination status of each child was recorded by means of an anonymous questionnaire given to the parents by the classroom teachers. This procedure ensured a high overall response rate of 79.8%. The prevalence of at least one TBE vaccination was 93.9% for the 7 year old, 97.8% for the 10 and 97.9% for the 13 year old. The lowest vaccination rates were found in families with four or more children (94.0%) and for those children who had unemployed parents (92.9%). The multivariate analysis indicates that TBE vaccination coverage is affected by a large number of children in the family (p = 0.0003), an urban place of residence (p = 0.0001) and by a low level of education of the mother (p = 0.013). The results suggest that, though overall high coverage in schoolchildren, vaccination programmes should be focused on large and socially deprived families.

[Work and life style of homeopathic physicians in Austria. A descriptive study]. / Arbeits- und Lebensweise von homöopathisch tätigen Arztinnen und Arzten in Osterreich. Eine deskriptive Studie.

This study is based on a survey involving 117 physicians in Austria, working in private practice and under the National Health Plan on a homeopathic basis. The questionnaire covered such topics as socio-demographic data, individual methods of working, office organization, application of alternative therapies, health awareness, and perception of the general acceptance of homeopathy. The results showed that considerably more time is taken for treating patients homeopathically than for patients treated traditionally under the National Health Plan. More than half the physicians use homeopathic remedies exclusively, whereas homeopathic combination remedies were rarely administered. Neural therapy, microbiological therapy (bacterial immunostimulation) and phytotherapy are those alternative therapies most frequently used in addition. A spiritual approach seems to be a significant component of the working methods of these doctors. Their working method is generally traditional: exact medical history and physical examination are ranked high, whereas biochemical data are regarded to be less important for diagnosis.

[Problem orientation in social medicine--participation in social medicine]. / Problemorientierung im Fach Sozialmedizin--Sozialmedizin zum Mitmachen.

Problem-oriented learning is gaining increasing importance in medical education. The current discussion on reforming medical education in the medical schools in Austria reflects this importance. At the medical school in Graz for many years teaching the core module "social medicine" has been problem-oriented. Small groups of students work on selected topics of public health. The topics are related to every day practice and their particular psychosocial ramifications and consequences are illucidated. This subject is required in the last year of medical school. The students are not familiar with problem-based learning and have difficulties in adapting. To be better prepared for the coming changes in the discipline of medicine, the social dimension should be integrated earlier into medical education. The most efficient way of doing so should be clarified in the discussion of the reform in medical education.

[Different occupational groups of women and selected nutrition-related risk factors for osteoporosis]. / Unterschiedliche Berufsgruppen von Frauen und ausgewählte ernährungsbedingte Risikofaktoren für die Osteoporose.

This paper studies the prevalence of risk factors considered responsible for osteoporosis in women of 4 occupational groups: farmers, blue collar workers, white collar workers/civil servants and housewives. We analyzed nutritional factors associated with osteoporosis in the scientific literature. The total sample comprises of 2185 individuals of which 658 women were taken into the analyses. The data set was based on a health survey conducted in 10 selected rural communities of Styria in Austria between 1995 and 1996. Sociodemographic data, lifestyles, internal and external resources as well as indicators off ill-health were surveyed through standardized personal interviews. The results show that the women of the 4 occupational groups were differently strained regarding nutritional risk factors. Our results suggest that efficient intervention programs to prevent osteoporosis need to specifically focus on the various life contexts of women.