Association of depression symptoms with receipt of healthcare provider advice on physical activity among US adults.

BACKGROUND: Given the high burden and prevalence of depression, various guidelines underscore the role of healthcare providers in supplying advice on physical activity (PA) as a potential modifying factor influencing the incidence and severity of depressive symptoms in adults. We aimed to investigate the extent to which healthcare providers provide PA advice to adults with depressive symptoms in the US. METHODS: Data on adults aged 20-64 years (n = 4971) in the National Health and Nutrition Examination Study between 2011 and 2016 were analysed. Depressive symptoms were assessed using the Patient Health Questionnaire and response options were categorised as "none or minimal", "mild", "moderate-severe". Receipt of PA advice from a healthcare provider was self-reported. We restricted our study sample to adults free from chronic diseases. RESULTS: Higher odds of receiving advice to exercise were reported among adults with mild (OR = 1.7, 95% CI: 1.3-2.3) and moderate-severe depressive symptoms (OR = 1.7, 95% CI: 1.0-2.8). Furthermore, exercise advice was more commonly reported among adults who were overweight, obese, Hispanic, Asian, being insured with private insurance, with education higher than high school, and had access to a routine place for health care. LIMITATIONS: Social and culutral aspects of overweight/obesity may prohibit generalizations. Cross sectional design does not allow for causal realtionships. CONCLUSIONS: In the US, fewer than one in three adults experiencing symptoms of depression report having received exercise advice from a healthcare provider. Providing such advice may be a sustainable clinical strategy in reducing the incidence and severity of depression symptoms.

[Neuropathic pain among hospital in-patients. Analysis of Austrian hospital discharge data]. / Neuropathischer Schmerz im stationären Bereich. Analyse der Osterreichischen Krankenhausentlassungsdaten.

BACKGROUND: Neuropathic pain is a common symptom of many diseases among in-patients in hospitals and neuropathic pain itself often requires hospitalisation. It was the aim of this study to examine epidemiological key data related to neuropathic pain among hospital in-patients. METHODS: The source of the data used was the ICD-10 coded main diagnoses with neuropathic pain of a complete data set of discharges obtained for every Austrian hospital for the year 2002. RESULTS: A total of 49,412 cases (614/100,000 inhabitants) with diagnoses always associated with neuropathic pain were recorded, representing 2.0% of all discharges from Austrian hospitals. Furthermore, there were as many as 353,893 cases with diagnoses which are possibly associated with neuropathic pain, like cancer, diabetes mellitus and stroke, representing 14.3% of all cases discharged from hospitals. Applying the proportion of those suffering from neuropathic pain among patients with these three diagnoses which is known from the literature would result in 5.8% of all hospital in-patients suffering from neuropathic pain. CONCLUSION: These data represent a first step in the assessment of the epidemiology of neuropathic pain and show the high extent of neuropathic pain in the Austrian in-patient setting.

Work-site hypertension prevalence and control in three Central European Countries.

Compared to Austria, cerebrovascular stroke (CVS) mortality is three times higher in Hungary, and twice as high in Slovakia. We hypothesized that this is due to better treatment and control of hypertension in Austria. To test this hypothesis, we carried out a cross-sectional survey of 'blue collar' employees on work sites in each of these countries. Blood pressure screening was carried out at three work sites in Austria, one in Hungary and one in Slovakia. A standardized protocol was followed in each of these countries. The Bp-TRU(TM) measuring instrument was used to provide accurate reproducible readings and eliminate interobserver error. After the exclusion of missing data and women, the study population included 323 males screened in Austria, 600 in Hungary, and 751 in Slovakia. The mean ages of the respondents ranged from 35 to 42 years. The prevalence of hypertension was 29% in Austria, 28% in Hungary and 40% in Slovakia. Of those identified as hypertensive, 73% in Austria, 45% in Hungary and 67% in Slovakia were newly diagnosed as a result of this screening. Of those treated for hypertension, 10% in Austria, 15% in Hungary and 5% in Slovakia were controlled. The differences in CVS mortality cannot be explained by better control of hypertension in Austria but indicate the involvement of other determinants.

[Primary prevention from the viewpoint of social medicine--examples of prevention projects]. / Primärprävention aus sozialmedizinischer Sicht--Beispiele für erfolgreiche Vorsorgeprojekte.

Life style factors play an essential role in etiology and prognosis of cardiovascular diseases; therefore, from a public health point of view, primary preventive measures are of especial importance. Health reports in the form of specific health reports (such as the Viennese Men's Health Report, the Lower Austrian Public Health Report) represent an important foundation for the matter of health promoting projects. In Austria, various preventive projects were suggested and successfully carried out because of these reports. Furthermore, the introduction of the WEBS organisation (scientific dietary counselling service) has shown that professional dietary counselling can indeed induce a change for the better in dietary behaviour and selection of foodstuffs. By the establishment of the first Austrian Institute for the Treatment of Tobacco and Nicotine Addiction (Nicotine Institute Vienna) not only is the diagnosis and treatment of tobacco addiction ensured, but it also provides information for the populace and those active in the health sector. These social public projects provide a valuable contribution to the prevention of cardiovascular diseases.

Nocturnal sleep-disturbing nicotine craving: a newly described symptom of extreme nicotine dependence.

In our research on smoking and nicotine dependence we have noticed a sleep disturbance, which is a further symptom of extreme nicotine dependence. We call this symptom "nocturnal sleep-disturbing nicotine craving" (NSDNC). NSDNC is characterised by craving for cigarettes during the individual sleep times. The smoker awakes (one or several times per week) during his regular sleep time, and has to smoke a cigarette before he/she continues sleeping. This symptom can be explained by the decreasing nicotine levels during the sleep time, which results in nicotine craving. However, NSDNC should be carefully separated from other sleep disturbances, or sleep disturbing events (nycturia, medication side effects), when nicotine craving is not the main reason for awakening.

[Social medicine aspects of the aging man]. / Sozialmedizinische Aspekte beim älteren Mann.

The potential for good health is largely dependent on the prevention and reduction of early onset of fatal disease and death. The male population, in particular, is at risk from early onset of fatal disease and death. Prevention strategies must be developed in order to reduce the risk factors leading to the currently most common causes of death (heart disease, cancer, accidents). Due to the increase in life expectancy, however, other illnesses generally affecting the elderly population (osteoporosis, dementia, cancer, heart attack, incontinence etc.) are gaining in significance. The above average reduction in life expectancy in men can be counteracted particularly through preventative measures and the active promotion of good health. In particular risk factors, such as, smoking, overweight, high blood pressure and metabolic disease, are responsible for the high mortality rate in men. New research areas must be defined for the male population, which particularLy focus on the ageing male. In the field of age related illness, gender specific investigations are definitely required. The main focus has to be on therapy and prevention of those diseases and their subsequent debilitating effects, that commonly effect the elderly. Particularly with men there is still a deficit of information with regards the role of hormones and their relationship with andropause and ageing.

Heroin and opiate emergencies in Vienna: analysis at the municipal ambulance service.

Vienna suffered an epidemic of heroin abuse in recent years, with drug-deaths due to opioids increasing from 62 in 1991 to 143 in 1993. The aim of this study was to make observations about illicit opioid-use with the ambulance service as a data source. From June 1994 to August 1995, the structured run records of the ambulance service were reviewed. Those with a presumptive diagnosis of "heroin or opiate" overdose were collected, characteristics of emergencies and patients were analyzed. The run records demonstrated a large number of non-fatal emergencies due to opioids, involving 528 men and 179 women in 1087 emergencies. These emergencies were on the average 6.8 times as prevalent as drug-fatalities. A group of 189 persons could be identified, who caused 52.2% of all emergencies and showed a threefold mortality rate during the observation period. In Vienna, the records of the municipal ambulance service provided valuable insights on opioid-abuse. We suggest local analysis of non-fatal emergencies due to opioids, as this might lead to a new source of information on illicit abuse of these drugs.

[Analysis of the needs for diagnosis and therapy of tobacco dependence in Austria]. / Diagnostik und Therapie der Tabakabhängigkeit--eine Analyse des Bedarfs in Osterreich.

In Austria we find 2.3 Mio. tobacco users (29% of the population). 1.3 Mio. are dissonant smokers, they want to stop (18%) or reduce (37%) tobacco consumption. The assumption that 10% of dissonant smokers (130,000 tobacco users) need a diagnosis and therapy leads to a bottleneck: 130,000 patients versus 20 therapists. Demanded consequences of this disproportion are training for health-care workers, implementation of diagnosis and treatment, financing and refunding. Diagnosis and therapy of tobacco dependence should be offered in highly specialised organisations such as the prototypical Nicotine Institute in Vienna, in hospitals and in primary health care.

[Reduced smoking--a possible strategy for control of tobacco-associated illnesses?]. / Reduziertes Rauchen--eine mögliche Strategie zur Kontrolle tabakassoziierter Gesundheitsstörungen?

The aim of the publication is to discuss reduced smoking as a concept to control tobacco-related diseases. New scientific studies show that nicotine-replacement medications may be an untapped source in efforts to reduce smoking. This new indication for nicotine-replacement therapy was licensed for the first time in Denmark by the registration authority. Austrian data have shown that approximately 10 years after implementation, a 1% reduction in smoking could prevent 14 male cancers deaths each year. A 50% reduction could save 700 male lives. 100,000 lives (male and females) could be saved in the European Union annually by a reduction like this including other tobacco-related diseases. Even a 1% reduction would save 1,000 lives. These data are supplemented by the new hypothesis of longer induction time (of lung cancer): Even if this theory fails for the individual smoker, a remarkable gain in years of life will result for society if illness is a probability-based event. A new term of delayed and/or reduced incidence will be a result of this hypothesis. Nevertheless, primary abstinence will remain the most desirable goal in efforts to control tobacco-related diseases. However, most primary prevention campaigns failed, and it will take 30-40 years to translate primary prevention into major health benefits. Reduced smoking should be licensed as a valid method for those unwilling or unable to stop smoking.

[European Medical Association Smoking or Health (EMASH)--consensus on smoking cessation: guidelines for physicians]. / European Medical Association Smoking or Health (EMASH)--Konsensuspapier Rauchertherapie: Richtlinien für Arzte.

The present study summarizes the latest scientific findings on smoking cessation and the various therapeutic possibilities. The guidelines presented here were compiled by the experts of EMASH (European Medical Association Smoking or Health). Accurate diagnosis and adequate treatment of nicotine dependence is essential for achieving sustained abstinence. Diagnostic procedures including the Fagerström Test for Nicotine Dependence (FTND) and various modes of nicotine replacement therapy (chewing gum, plaster, nasal spray and inhaler) are described. New symptoms of nicotine dependence (nocturnal sleep disturbing nicotine craving, nicotine pre-abstinence syndrome), that permit a more precise diagnosis, are discussed.

[Vienna standard in diagnosis of nicotine dependence: Vienna Standard Smoking Inventory]. / Wiener Standard zur Diagnostik der Nikotinabhängigkeit: Wiener Standard Raucher-Inventar (WSR).

The Standard Vienna Smokers' Inventory (VSSI) ("Wiener Standard Raucher-Inventar" [WSR]) is based on the authors' experience and was designed to optimize primary and additional diagnostic procedures associated with smoking cessation treatment. The aim of this inventory is to enable therapists interested in smoking cessation interventions to initiate diagnostic procedures as well as to use efficient therapeutic modalities. The study also highlights those areas of the patient's history which should be given special attention and the theoretical background of these areas. The various comprehensive sections of the WSR include general data pertaining to the patient's life, the basic situation (basic rate), especially with regard to nicotine dependence, pre-abstinence syndrome and "tar" exposition values, follow-up of smoking habits, earlier attempts to give up smoking, and possible barriers to cessation of smoking--such as insufficient motivation, "nocturnal sleep disturbing nicotine craving" or carbohydrate dependence. Furthermore, previous illnesses, pre-existing risk factors and regular intake of drugs are also discussed. Finally, the study emphasizes that the WSR should be used by the therapist according to his/her level of training and experience, thus providing the possibility to use specific, individual approaches to deal with specific individuals and situations.

Measurement of expired carbon monoxide among medical students to assess smoking behaviour.

CO-Measurement of medical students was taken during a compulsory public health training at the University of Vienna. The students were not informed previously, so a non-response bias was excluded. Measurements were done with Bedfont EC50-MICRO Carbon monoxide monitor. The cut off point was set at 11 ppM. One hundred and seventy-three students were measured. Define indication of active smoking was found in 9%. With exception of one student all the others with carbon monoxide over 10 ppM called themselves active smokers. CO measurement will replace at some stage the usual question regarding the number of cigarettes consumed. Students also had the opportunity to learn a new diagnostic technique.

Alternative nicotine delivery systems (ANDS)--public health-aspects.

This paper deals with a relatively new category of pharmaceuticals, namely alternative nicotine delivery systems (ANDS). We do not refer to products like smokeless tobacco or other smoking devices. ANDS are designed to provide nicotine without the harmful substances contained in cigarette smoke. Several different nicotine replacement preparations exist, which are used in nicotine replacement therapy to obtain tobacco abstinence. There is a bulk of scientific literature on the clinical use of ANDS, but very little has been published on the public health aspects of the same. Nicotine dependence is associated with heavy consumption, tolerance, regulation of intake and withdrawal. We described a new symptom of extreme nicotine dependence, namely the nocturnal sleep disturbing nicotine craving (NSDNC), and developed a concept of a nicotine pre-abstinence syndrome (NPAS). Five nicotine replacement preparations are currently available: gum, patch, nasal spray, oral inhaler and sublingual tablet. As far as safety issues are concerned, scientific evidence shows that the use of ANDS involves almost no risk for consumers and patients, especially when compared with the consumption of tobacco products. New concepts developed by our group are the following: definition of possible endpoints of smoking control measures, reduced smoking, nicotine dependence and preventive oncology, chemoprevention of lung cancer by ANDS, public health impact by OTC availability of ANDS and the "let them choose approach" of ANDS focusing on the specific preferences and needs of the individual client. One may also speculate whether ANDS will, at some stage, replace cigarettes as the major source of nicotine for people who need this psychoactive drug.

[Diagnosis and therapy of nicotine dependence]. / Diagnostik und Therapie der Nikotinabhängigkeit.

The 1988 Report of the US-Surgeon General states very clearly, that the use of tobacco products is not a matter of free choice, but is the result of an addiction as scientifically valid as the addiction to heroin and other narcotics. Using the Fagerström Test for Nicotine Dependence (FTND) to assess nicotine dependence in a population 6,000 randomly selected Austrians were interviewed. 42% of men and 27% of women were found to be smokers. 3 groups of smokers differing in dependence can be described: 36.5% are nicotine addicted; 30.2% must be psychosocial dependent because they show nearly no sign of nicotine dependence; and there is a group between. The scientific literature provides informations on many methods and techniques for a smoking cessation, both pharmacological approaches have been tried to treat nicotine dependence in man. According to scientific standards and many controlled studies, nicotine has been the only drug found to be effective in treating nicotine dependence. Many techniques, ranging from self help to sophisticated combined therapeutic approaches including pharmacological interventions, are now available to deal with the nicotine addiction.

[Epidemiology of health problems caused by passive smoking]. / Epidemiologie der Gesundheitsstörungen durch Passivrauchen.

Smoking has long been known to cause premature death and different illnesses. Each year 3 million people die from smoking related diseases worldwide. In recent years there has been concern that non-smokers may also be at risk for some of these adverse effects on health as a result of their exposure to tobacco smoke in various environments polluted by smokers. In 1986 the National Research Council and the Surgeon General of the U.S. Public Health Service independently assessed the health effects of exposure to environmental tobacco smoke (ETS). Both reports conclude that ETS can cause lung cancer in adult non-smokers and that children of parents who smoke have an increased frequency of respiratory symptoms and acute lower respiratory tract infections. The condition of asthmatic children improves significantly when they are removed from ETS. The most severe form of passive smoking is induced by smoking during pregnancy. The effects concern birth weight, complications of pregnancy and impaired development in childhood.

Problems in treatment and nursing of cancer patients.

Treatment and nursing of cancer patients place great demands on physicians, nurses and the patients' families. The enormous emotional strain on the patient may lead to frustration and 'burnout' among health-care professionals. This article consists of three steps: (a) a qualitative analysis based on a discussion with experts in oncology; (b) a questionnaire investigation of physicians and nurses; and (c) training courses for interested physicians and nurses. The majority of physicians and nurses pointed out that: the value of psychological support is generally underestimated, therapeutic complaints are often due to the patients' lack of information and administrative problems negatively influenced their relationship with patients.

[Blood pressure awareness in Austria: indicators of an increasing information deficit]. / Blutdruckbewusstein in Osterreich: Hinweise auf ein zunehmendes Informationsdefizit.

Attitudes and knowledge of the Austrian population concerning hypertension have been investigated on a regular basis for 15 years (1978-1993). In 1978 a public campaign of information on hypertension was conducted all over Austria. Between 1978 and 1993 four representative population surveys, based on random samples, were performed (1978, 1984, 1990, 1993). The four surveys showed that maximal blood pressure awareness after the campaign was followed by a decrease of awareness between 1984 and 1993. Above all, lack of knowledge of personal blood pressure increased markedly over the observation period. The determinant "don't know my blood pressure" was self reported by 10% in 1978, 7% in 1984, rising to 17% and 18% in 1990 and 1993, respectively. This increase was significant in females and males younger than 50 years. Nearly no differences were found in self-reported high blood pressure and antihypertensive drug intake between 1978 and 1993 (1978, 1984, 1990: 14%, 1993: 12% with respect to the former; 1978: 10%, 1990: 11%, 1993: 8% with respect to the latter). In 1993 significantly less people than in 1978 reported that their blood pressure had been measured within the past three months (1978: 49%; 1993: 34%). People estimated overweight, alcohol, mental stress, and cigarette smoking as the most important risk factors for hypertension (89%, 89%, 88%, 83%, respectively). The importance of these risk factors in the eyes of the questioned population increased between 1978 and 1993, significantly in the case of cigarette smoking. Primarily a lack of information was found in knowledge of personal values, whereas knowledge of risk factors for hypertension was considerably higher. The results of the four surveys lead to the conclusion that the population should be informed about the health hazards of high blood pressure more intensively and people should be motivated to take an interest in their blood pressure.