Body image disturbances, fear and associations with the amygdala in anorexia nervosa.

BACKGROUND: Anorexia nervosa (AN) is a severe illness with a high mortality rate which mainly affects young women. Studies found a localized volume loss of the amygdala in patients with AN, a brain region responsible for affective responses. Patients with AN were found to have body image distortions, and suffer from the comorbid disorders depression, anxiety disorder, and obsession. Therefore, the purpose of this study was to analyze a possible connection between comorbidities, body image disturbances, and the volume of the amygdala in patients with AN. METHODS: In this study 21 females suffering from restrictive-type AN and 21 age-matched normal controls (NC) were tested. Demographic data as well as body image perceptions and comorbidities were assessed. Volumes of cortical structures were measured with a magnetic resonance (MR) scanner. Analyses of variance were conducted to analyze group differences, and correlations between the volume of the amygdala and comorbidities and body image perceptions were calculated. RESULTS: The results showed a significantly lower grey matter volume in the amygdala in AN patients compared to the NC. Persons with AN showed more body image disturbances and suffered more often from depression, and phobias than NC. The volume of the amygdala showed a non-significant mid-level association with phobia and with uncertainty concerning their body in AN patients. CONCLUSION: The study indicates that phobic anxiety and body image in patients with AN could be related to the volume of the amygdala. The results contribute to a better understanding of the pathophysiology of the disease.

Structural hippocampal alterations, perceived stress, and coping deficiencies in patients with anorexia nervosa.

OBJECTIVE: Anorexia nervosa (AN) is a severe mental illness that mainly affects young females. Studies have found a reduction of the hippocampus-amygdala formation in people with AN, a brain region that is especially vulnerable to stress. In addition, patients with AN were found to perceive higher stress levels and to have more coping deficiencies than healthy controls. No prior study has considered a connection between stress, coping, and the hippocampal volume in AN. Therefore, the purpose of our study was to analyze the volume of hippocampal substructures, and its relation to stress and coping. METHOD: We tested 21 females currently affected by AN and 21 age-matched normal controls (NC). Demographic and behavioral data were assessed. A magnetic resonance (MR) scanner was used to collect data reflecting volume of cortical structures. We performed comparisons between groups and calculated correlations between the hippocampal volume and coping strategies or stress. RESULTS: The results showed a significant reduction of the hippocampal fimbria and a significant enlargement of the hippocampal fissure in patients with AN compared to the NC. In addition, patients with AN were found to report higher stress levels and to have more coping deficiencies than healthy controls. The hippocampal volume showed a trend-level association with stress in patients with AN. DISCUSSION: In sum, our study provides the first-available evidence that perceived stress in patients with AN could be related to hippocampal volume. Our results may contribute to a better understanding of the pathophysiology of AN and, therefore, help to improve the treatment.

The relation of weight to women's health: a matched sample study from Austria.

While being underweight, overweight, or obese has been associated with higher rates of morbidity and mortality, such relations have not been studied in Austrian women. Therefore, the aim of this study was to analyze differences in health, health behaviors, and quality of life among women of various weight status categories, using data from the Austrian Health Interview (AT-HIS) 2006/07. First, women between 20 and 60 years of age, from four different weight status groups (underweight, normal weight, overweight, and obese) were matched case to case on age and socioeconomic status. After matching, the total number of women included in the analyses was 516 (N = 129 per). Differences in health status among women in different weight status categories were calculated using multiple conditional logistic regression analyses. Compared to females in the other three groups, women with normal weight had the best state of health: they had better self-reported health, suffered from fewer chronic conditions (e.g., sacrospinal complaints or migraines), and needed medical treatment less often. Moreover, they had better self-reported quality of life. In contrast, women who were underweight or obese showed worse health than women of normal weight. Appropriate health programs for weight risk groups are needed.

[Analysis of type 2 diabetes-induced late effects based on administrative data of social insurance in Austria and implications for the evaluation of the DMP diabetes mellitus]. / Analyse Diabetes mellitus Typ 2-induzierter Spätfolgen auf Basis von Routinedaten der Sozialversicherung in Österreich und Implikationen zur Evaluierung des DMP Diabetes mellitus.

The present study analyses administrative data of medical services related to the distribution of diabetes mellitus type 2-induced late effects. Pseudonymous statutory health insurance data of all Austrian social security institutions for the years 2006/2007 in outpatient and inpatient (performance and diagnostic data) setting were used. Type 2 diabetics have been identified by prescribed medication. The specific late effects were defined as endpoints and the respective diagnoses and health performances were extracted. The study population included 7,945,774 insured. The percentage of the defined late effects was significantly higher in diabetics than in persons from the general population, with exception for kidney transplantation. The risk of a late effect was greatest among diabetics for an amputation. The results of this study can be used as a baseline for the evaluation of DMP diabetes. The administrative data used are limited for answering the defined research questions. Anyway, the data quality must be improved and unified in Austria.

Trends in inequalities in health, risk and preventive behaviour among the advanced-age population in Austria: 1983-2007.

BACKGROUND: Although a number of previous research studies have focused on the long-term analysis of the health and health behaviour of the elderly, there is still a shortage of information in relation to the long-term trends regarding health or risk and preventive behaviour in the elderly population taking into account gender differences and differences in educational level. METHODS: The database comprised subsamples of the Austrian Micro-Census, including individuals aged 65 years and older, for the years 1983, 1991, 1999, and subsamples of the ATHIS (Austrian Health Interview Survey) 2007. A trend analysis was conducted for four health-related variables with the year of the survey and education as predictors. The analysis was stratified by sex. RESULTS: We found a general trend towards better self-rated health, better preventive and less risk behaviour among the elderly, while the body mass index has been increasing over the years. There are indeed gender differences regarding the trend in smoking behaviour. While the prevalence of male smoking has been steadily decreasing, female smoking prevalence has not changed. At all points in time, individuals with higher education had significantly better self-rated health than those with lower education but the association between education and preventive behaviour significantly decreased over the years. CONCLUSION: We agree with previous research in concluding that preventive action and health promotion should aim in particular to support older women and men with lower education.

Nutrition and health - the association between eating behavior and various health parameters: a matched sample study.

Population-based studies have consistently shown that our diet has an influence on health. Therefore, the aim of our study was to analyze differences between different dietary habit groups in terms of health-related variables. The sample used for this cross-sectional study was taken from the Austrian Health Interview Survey AT-HIS 2006/07. In a first step, subjects were matched according to their age, sex, and socioeconomic status (SES). After matching, the total number of subjects included in the analysis was 1320 (N = 330 for each form of diet - vegetarian, carnivorous diet rich in fruits and vegetables, carnivorous diet less rich in meat, and carnivorous diet rich in meat). Analyses of variance were conducted controlling for lifestyle factors in the following domains: health (self-assessed health, impairment, number of chronic conditions, vascular risk), health care (medical treatment, vaccinations, preventive check-ups), and quality of life. In addition, differences concerning the presence of 18 chronic conditions were analyzed by means of Chi-square tests. Overall, 76.4% of all subjects were female. 40.0% of the individuals were younger than 30 years, 35.4% between 30 and 49 years, and 24.0% older than 50 years. 30.3% of the subjects had a low SES, 48.8% a middle one, and 20.9% had a high SES. Our results revealed that a vegetarian diet is related to a lower BMI and less frequent alcohol consumption. Moreover, our results showed that a vegetarian diet is associated with poorer health (higher incidences of cancer, allergies, and mental health disorders), a higher need for health care, and poorer quality of life. Therefore, public health programs are needed in order to reduce the health risk due to nutritional factors.

Good practice models for public workplace health promotion projects in Austria: promoting mental health.

Promoting mental health is a central public health issue since the Jakarta statement in 1997. In Austria, the nationwide organisation for health promotion is the 'Fonds Gesundes Österreich' (FGÖ), which has been established in 1998. The FGÖ funds and supports workplace health promotion projects; therefore, it co-operates with the Austrian Network on Workplace Health Promotion. In 2011, among others, two Austrian companies were honoured as best practice models for promoting mental health in the project 'Work. In tune with life. Move Europe'. One of their central key success factors are the provision of equal opportunities, engagement, their focus on overall health as well as the implementation of behavioural and environmental preventive measures. Since mental health problems in the population are still rising, public health promotion projects which orientate on the best practice models have to be established in Austria.

Factors associated with the rejection of active euthanasia: a survey among the general public in Austria.

BACKGROUND: In recent decades, the general public has become increasingly receptive toward a legislation that allows active voluntary euthanasia (AVE). The purpose of this study was to survey the current attitude towards AVE within the Austrian population and to identify explanatory factors in the areas of socio-demographics, personal experiences with care, and ideological orientation. A further objective was to examine differences depending on the type of problem formulation (abstract vs. situational) for the purpose of measuring attitude. METHODS: A representative cross-sectional study was conducted across the Austrian population. Data were acquired from 1,000 individuals aged 16 years and over based on telephone interviews (CATI). For the purpose of measuring attitude toward AVE, two different problem formulations (abstract vs. situational) were juxtaposed. RESULTS: The abstract question about active voluntary euthanasia was answered negatively by 28.8%, while 71.2% opted in favour of AVE or were undecided. Regression analyses showed rejection of AVE was positively correlated with number of adults and children in the household, experience with care of seriously ill persons, a conservative worldview, and level of education. Mean or high family income was associated with lower levels of rejection. No independent correlations were found for variables such as sex, age, political orientation, self-rated health, and experiences with care of terminally ill patients. Correlation for the situational problem formulation was weaker and included fewer predictors than for the abstract question. CONCLUSIONS: Our results suggest that factors relating to an individual's interpersonal living situation and his/her cognitive convictions might be important determinants of the attitude toward AVE. If and to the extent that personal care experience plays a role, it is rather associated with rejection than with acceptance of AVE.

The influence of socioeconomic factors on health parameters in overweight and obese adults.

The prevalence of being overweight and of obesity is increasing worldwide, and is associated with a high risk to health. Therefore, the aim of our study was to investigate whether normal weight, overweight and obese subjects of low, middle or high socioeconomic status (SES) differ with regard to their health behavior, health, quality of life, and the use of medical care. Data from the Austrian Health Interview Survey (ATHIS) 2006/07, comprising 3 groups of 1,077 individuals, each of whom were normal weight, overweight, or obese, respectively, and matched according to their age, sex and SES, were analyzed concerning health outcomes. The results show that subjects with a low SES differ significantly from those of high SES in terms of their health behavior, self-perceived health, levels of impairment, chronic conditions, quality of life, and health care. Additionally, obesity in adults is associated with sub-optimal dietary practices and worse health, poorer quality of life and medical care than normal weight and overweight individuals. A significant interaction between the weight class and SES was found concerning physical exercise, impairment due to health problems and chronic diseases. A low SES has a strong negative impact on health, especially in obese individuals. Therefore a continuous target group-oriented, non-discriminatory public health program is required, prioritizing obese subjects with low SES.

Self-perceived health, quality of life, and health-related behavior in obesity: is social status a mediator?

BACKGROUND: Obesity prevalence is increasing worldwide and is associated with a high health risk. Unfavorable psychological factors, lower self-ratings of health, and worse health-related behavior can be found in individuals with a low socioeconomic status (SES). Therefore, the aim of this study is to investigate whether obese subjects with a high SES differ from those with a low SES depending on these outcomes. METHODS: Data of the Austrian Health Interview Survey (ATHIS) 2006/2007-precisely of 760 obese subjects with a low SES and 851 with a high SES-were analyzed stratified by sex and adjusted by age with regard to differences in self-perceived health, quality of life (regarding physical and psychological health, environment, and social relationships), and health-related behavior (smoking, alcohol consumption, eating behavior, physical exercise). RESULTS: The results have shown that obese subjects with a low SES differ significantly from those with a high SES in terms of self-perceived health, quality of life, and intensity of physical activities. Furthermore, differences were found in obese women as to smoking behavior, alcohol consumption, and continuance of physical exercise. CONCLUSION: It seems that not only obesity but also the socioeconomic status plays a role in health, and the risk assessment of obese individuals in the primary health care setting should include socioeconomic factors. Furthermore, public health programs which focus on obese subjects with a low SES are urgently needed.