Trajectories of loneliness, depressive symptoms, and anxiety symptoms during the COVID-19 pandemic in Austria.

OBJECTIVE: There is considerable heterogeneity within populations regarding the effects of the COVID-19 pandemic on mental health. This study aimed at identifying latent groups of individuals within the older Austrian population that differ in their mental health trajectories across three phases of the pandemic. STUDY DESIGN: Data were gathered from a longitudinal survey study among a sample of older adults in Austria. The survey was carried out in May 2020 (N1 = 556), March 2021 (N2 = 462), and December 2021 (N3 = 370) via either computer-assisted web or telephone interviewing. METHODS: Latent class growth analysis was conducted to explore different homogenous groups in terms of non-linear trajectories of loneliness, depressive symptoms, and anxiety symptoms as well as potential correlates thereof. RESULTS: We identified four latent classes. The vast majority of individuals belong to two classes that are either resilient (71%) or that have recovered relatively quickly from an initial COVID-19 shock (10.2%). Deterioration in mental health after the first phase of the pandemic (13.4%) or a generally high mental health burden (5.4%) characterizes the other two classes. CONCLUSIONS: About 19% of individuals showed increasing or elevated levels in loneliness, depressive symptoms, and anxiety symptoms across the COVID-19 pandemic. The feeling of being socially supported and in control over one's own life emerged as potentially protective factors.

Longitudinal effects of COVID-19-related loneliness on symptoms of mental distress among older adults in Austria.

OBJECTIVE: COVID-19-related social restrictions resulted in more loneliness, but whether this had further effects on mental health remains unclear. This study aimed at examining the longitudinal effects of COVID-19-related loneliness on mental health among older adults (aged ≥60 years) in Austria. STUDY DESIGN: Survey data were gathered from a longitudinal observational study among a random sample of older Austrian adults. The first survey wave was conducted in May 2020 (N1 = 557), and the second wave was conducted in March 2021 (N2 = 463). METHODS: Data collection was based on either computer-assisted web or telephone interviewing. For statistical analysis, we used a cross-lagged panel analysis. RESULTS: The results showed the perceived COVID-19-related social restrictions to predict loneliness, which in turn predicted depressive and anxiety symptoms 10 months later. CONCLUSIONS: COVID-19-related loneliness emerged as a risk factor for subsequent mental distress among older adults in Austria.

[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.

[Perception of hearing problems in the older population]. / Wahrnehmung von Hörproblemen bei älteren Menschen.

BACKGROUND: Age-related hearing loss is one of the most common chronic sensory impairments in the older population. This chronic condition is associated with bio-psychosocial consequences such as cognitive decline, depression, withdrawal, isolation, and reduced wellbeing. OBJECTIVE: This study aimed to investigate the perception of hearing problems among older women and men (≥55 years) with age-related hearing loss. Furthermore, the association between functional hearing loss and perceived hearing problems was examined. Lastly, this study undertook a detailed investigation of subjective experiences in order to better understand the consequences of age-related hearing loss for daily life. MATERIALS AND METHODS: With the aid of mixed methods, quantitative data were gathered from 65 participants with age-related hearing impairment in Austria using the Hearing Handicap Inventory for the Elderly (HHIE). Moreover, qualitative data regarding experiences with hearing problems were collected by performing semi-structured problem-centered interviews and analyzing the results of a further 14 older adults with hearing loss. RESULTS: On average, participants assessed their hearing handicap as mild and perceived consequences on emotional, social, and communication levels. Moreover, feelings of insecurity were evident. In addition, the findings indicate a relationship but also a discrepancy between hearing loss and hearing handicap, i. e., not all participants perceived a hearing handicap. CONCLUSION: Patient-centered care encompassing (1) objective and self-report measures for assessing hearing problems, (2) involvement of family members and significant others, (3) counseling and exchange of information, and (4) a shared decision-making approach could enhance quality of life and quality of care.

Differentiating health statuses using positive health indicators in an occupational context.

OBJECTIVES: To identify different health statuses beyond the dichotomy of 'health' vs 'illness'. To achieve this, positive indicators based on current scientific definitions and concepts were constructed. STUDY DESIGN: Data were collected between 2008 and 2010 in a nationwide representative cross-sectional survey. METHODS: Data for approximately 11,800 wage or salary earners were analysed. Health statuses were modelled using hierarchical cluster analysis, and the relationships between clusters and working conditions were tested using discriminant analyses. RESULTS: According to response patterns in the various health dimensions, four health statuses were found: individuals who were holistically healthy; individuals with multiple health impairments; individuals with stagnating potential for development; and individuals with higher tendency to wear out. CONCLUSIONS: The use of positive health concepts enables better differentiation of health statuses. Under existing working conditions, it is possible to identify group-specific needs for the working population, and to derive appropriate measures as part of workplace health promotion.

Manpower and portfolio of European ENT.

The aim of this study is to evaluate highly variable ENT manpower among European countries. A descriptive study design is used. Manpower in medicine is highly variable among European countries. EU and associated countries are keeping officially appointed representatives to the European Union of medical specialists--otorhinolaryngology section (UEMS--ORL section). UEMS--ORL section is running a working group for manpower in ENT collecting data regarding demographics and ENT manpower in European countries. These ENT manpower data are presented in this paper and compared to available data concerning manpower in European medicine in general. To further evaluate these huge differences, representatives of the particular countries were also asked to fill out a questionnaire concerning specifics of ENT healthcare in their country. Furthermore, typical tasks of ENT doctors based on the official UEMS logbook for ENT training were listed and could be rated regarding their frequency, performed in everyday routine of an average ENT doctor of the country. Divergences in doctors/inhabitants ratios were remarkable within European countries, but disparities in ENT manpower were even more so. The ratio of ENT doctors/inhabitants was the lowest in Ireland (1:80,000) and Great Britain (1:65,000). Greece (1:10,000), Italy, Czech Republic, Lithuania, Poland and Slovakia (1:12,000) were--at the time of the study--the countries with the highest density of ENT doctors. The EU average for 2009 was (1:21,000). The presence of non-surgical working ENT doctors was significantly associated with higher densities of ENT doctors, whereas the necessity of being referred to an ENT doctor (gatekeeping or similar measures) was not. Estimated average waiting times for an appointment in non-urgent, chronic conditions, respectively, diseases were highly variable and predominantly showed a significant correlation to the ENT doctors/inhabitants ratio in the investigated countries. But also for acute conditions like acute hypacusis, dysphonia and hemoptysis, significant differences correlating to the ENT doctors/inhabitants ratio in waiting times for an ENT appointment were found. Estimated frequencies of different ENT tasks in everyday routine were extremely diverse as well, however, without detectable correlations to the ENT doctors/inhabitants ratio. In countries like Great Britain, Ireland, Malta and The Netherlands ENT doctors are primarily seen and serving as surgeons. In most Central European countries like Germany, Austria, Czech Republic, Poland and Slovakia, ENT doctors aside of surgery are also dealing with high percentages of conservative medicine, which may include vast fields like the management of Allergology, Phoniatrics, Audiology, etc. In some countries ENT doctors are even playing a significant role in primary health care as well. These various portfolios of ENT may be one explanation for the huge difference in numbers of European ENT manpower.

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.

Stalking and health ­ an Austrian prevalence study.

OBJECTIVE: The aim of this study was to estimate the prevalence of stalking and related subjective health impairment, based on concrete definitions of stalking, for a representative random sample of the female population in the Austrian Federal State of Styria. METHODS: A representative random sample (randomised last digits procedure) of 2000 women selected from the female population of Styria aged 18 years or older underwent a computer-aided phone interview survey (CATI). Questions centred on the occurrence of stalking, the exact period of stalking, the gender of the stalker, the subjective impairment through stalking, addressing the aspects of life-style and the subjectively perceived state of health, and socio-demographic variables. For data analyses descriptive statistics, and chi(2)-tests and t-tests were applied. RESULTS: Lifetime prevalence varies between ca. 6% and 18%, depending on definition levels. The annual prevalences reveal a range of 1-4%. 39-43% of the stalked women feel they are impaired in their life-style, and 32-40% feel impaired in their health. Higher age and living in a partnership reduce the likelihood of being stalked. 81% of the stalked women are stalked by a male person. CONCLUSION: The prevalences found in this study are in line with other international studies, although, in a direct comparison, they are in the lower range. However, these data document the relevance of the phenomenon of stalking for the female Austrian population.

Attitude toward xenotransplantation of patients prior and after human organ transplantation.

Xenotransplantation is a potential strategy to overcome the shortage of human donor organs. As this technique has a major medical and psychological impact on patients and their family and friends, the attitude of patients currently waiting for organ transplantation is important. Therefore, we conducted a survey on the attitude toward xenotransplantation of patients on the waiting list and already transplanted patients. Patients received detailed information before being asked to fill in the questionnaire. We found that 65% would accept xenotransplantation, irrespective of gender, education level or if the patients were on the waiting list or already transplanted. The most common concern was transmission of diseases or genetic material, followed by psychological concerns and ethical issues. More patients had a positive attitude toward accepting cell or tissue transplantation when compared to whole organs. Pig pancreas islet cell transplantation is generally well accepted, patients with diabetes mellitus show even higher acceptance rates than patients without diabetes. In conclusion, xenotransplantation seems to be well accepted in patients who are potential future candidates for organ transplantation. Informing patients about the current status of research tended to decrease acceptance rates slightly.

[Gender specific differences in the frequency of admission to intensive care units, duration of stay and the application of intensive medical care measures in men and women aged 75 years and above in an Austrian region]. / Geschlechtsspezifische Unterschiede bezüglich Aufnahmeraten auf Intensivstationen, Aufenthaltsdauer und durchgeführten intensivmedizinischen Massnahmen bei Personen im Alter ab 75 Jahren in einer Osterreichischen Region.

OBJECTIVE: It was the aim of this study to evaluate the frequency of admission to intensive care units, duration of stay and application of intensive care treatments in patients aged 75 years and above and to analyse possible gender specific differences. METHODS: Analysis of hospital in-patient data of all hospitals of a southern Austrian region (federal state of Carinthia). RESULTS: In the year 2003, 4.7% of the men and 3.2% of the women aged 75 years and above were treated in intensive care units (p<0.001). This gender specific difference was independent of the reason for the intensive care admission. The mean duration of stay in intensive care units was longer for 75-79 year old men compared to women (6.38 vs. 4.91 days, p<0.01). Typical intensive care treatments like mechanical ventilation, artificial airways and vasoactive medication were applied more often to men than to women. CONCLUSION: In the aged there are marked gender specific differences in the application of intensive care treatments, especially in the end-of-life state in Austria. The reasons for these differences should be subject of future research.

Visual rating of age-related white matter changes on magnetic resonance imaging: scale comparison, interrater agreement, and correlations with quantitative measurements.

BACKGROUND AND PURPOSE: To provide further insight into the MRI assessment of age-related white matter changes (ARWMCs) with visual rating scales, 3 raters with different levels of experience tested the interrater agreement and comparability of 3 widely used rating scales in a cross-sectional and follow-up setting. Furthermore, the correlation between visual ratings and quantitative volumetric measurement was assessed. METHODS: Three raters from different sites using 3 established rating scales (Manolio, Fazekas and Schmidt, Scheltens) evaluated 74 baseline and follow-up scans from 5 European centers. One investigator also rated baseline scans in a set of 255 participants of the Austrian Stroke Prevention Study (ASPS) and measured the volume of ARWMCs. RESULTS: The interrater agreement for the baseline investigation was fair to good for all scales (kappa values, 0.59 to 0.78). On the follow-up scans, all 3 raters depicted significant ARWMC progression; however, the direct interrater agreement for this task was poor (kappa, 0.19 to 0.39). Comparison of the interrater reliability between the 3 scales revealed a statistical significant difference between the scale of Manolio and that of Fazekas and Schmidt for the baseline investigation (z value, -2.9676; P=0.003), demonstrating better interrater agreement for the Fazekas and Schmidt scale. The rating results obtained with all 3 scales were highly correlated with each other (Spearman rank correlation, 0.712 to 0.806; P< or =0.01), and there was significant agreement between all 3 visual rating scales and the quantitative volumetric measurement of ARWMC (Kendall W, 0.37, 0.48, and 0.57; P<0.001). CONCLUSIONS: Our data demonstrate that the 3 rating scales studied reflect the actual volume of ARWMCs well. The 2 scales that provide more detailed information on ARWMCs seemed preferential compared with the 1 that yields more global information. The visual assessment of ARWMC progression remains problematic and may require modifications or extensions of existing rating scales.

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.

Functioning in daily living and psychological well-being of female cancer patients.

The objective of this prospective study was to compare outcomes concerning psychological and physical functioning of patients with various gynecological malignancies. A sample of 119 newly diagnosed cancer patients completed two questionnaires evaluating psychological well-being and functioning in daily living. Outcome measures were obtained at three time points: before surgery, 3 months after surgery, and 1 year after surgery. The results showed that the psychological well-being improved significantly from the first to the third time point for the sample as a whole. After surgery, patients with ovarian and cervical cancer showed slightly lower scores than patients with endometrial cancer. The level of functioning in daily living declined 3 months after surgery for all except endometrial cancer patients, but increased significantly at the 1 year follow-up. At all three time points the mean differences for psychological well-being and functioning in daily living were not statistically significant among subgroups. Physical and psychological well-being of the patients treated for gynecological malignancies is affected independently of age, cancer site and stage of disease. However, throughout the observational period the psychological well-being scores were lower than those of patients with other chronic illnesses or healthy subjects. Therefore, we conclude that psychological interventions for patients facing gynecological cancer treatment should be provided as an integral component of cancer management.

[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.

[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.

[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.

[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.

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.