[Working in the provision of psychosocial care to children, adolescents and families during the Covid-19 pandemic-results of a qualitative interview-study in Vienna and Lower Austria]. / Arbeit in der psychosozialen Versorgung von Kindern, Jugendlichen und Familien während der Covid-19-Pandemie ­ Ergebnisse einer qualitativen Interviewstudie in Wien und Niederösterreich.

The requirements of "social distancing" during the Corona pandemic raised challenges for the implementation of psychosocial care services for children, adolescents, and families, which are traditionally reliant on face-to-face contact. Between March and October 2020, this qualitative study investigated the impact of the pandemic on the provision of psychosocial care at three points in time. We examined how staff and managers of psychosocial institutions experienced their work under the changing circumstances and what opportunities as well as risks they perceived for their work with clients. Their work situation is investigated by means of the concepts of the "Arbeitskraftunternehmer" and of vulnerability. This paper presents two topics that emerged from the analysis of the first two waves of data collection. The first expresses a conflict between practitioners need to protect their own health and their aspiration to maintain services. The second addresses practitioners' experiences of stress due to their own affectedness by the crisis as well as significant changes in work realities. Our data show the strong effort of professionals to maintain supportive services during the crisis despite difficult conditions. However, it also shows the strain on social workers in the field and that adequate framework conditions are necessary both to strengthen psychosocial care in general and to cope with social crises on this scale.

Provision of Psychodynamic Psychotherapy in Austria during the COVID-19 Pandemic: A Cross-Sectional Study.

The COVID-19 pandemic has brought massive changes in the provision of psychotherapy. To avoid or reduce the risk of infection, many therapists switched from face-to-face sessions in personal contact to remote psychotherapy, i.e., psychotherapy delivered by telephone or videoconferencing. This study examined the attitudes toward and practice of remote psychotherapy among Austrian therapists with a psychodynamic orientation at the onset of the pandemic as well as changes in the therapeutic process that were experienced by the therapists due to switching to a remote setting. A total of 161 therapists with psychodynamic orientation took part in an online survey. The results show that attitudes toward remote psychotherapy changed positively in psychodynamically orientated therapists and most are willing to switch to remote settings, if necessary. However, many therapists reported negative effects of remote psychotherapy and prefer seeing their patients in-person. The strongest changes were experienced with regard to transference/countertransference, the therapeutic process and the intensity of session. The analysis further revealed an overall decrease in the number of patients treated, indicating an undersupply of psychotherapy, at least during the first wave of COVID-19 infection in Austria. In summary, the experience during the first COVID-19 lockdown has led to an increase in remote psychotherapy and more openness toward these treatment modalities among psychodynamically oriented therapists. However, in-person therapy will remain the first choice for most therapists.

Psychodynamic Therapist's Subjective Experiences With Remote Psychotherapy During the COVID-19-Pandemic-A Qualitative Study With Therapists Practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation.

The COVID-19-pandemic brought massive changes in the provision of psychotherapy. To contain the pandemic, many therapists switched from face-to-face sessions in personal contact to remote settings. This study focused on psychodynamic therapists practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation and their subjective experiences with psychotherapy via telephone and videoconferencing during the first COVID-19 related lockdown period in March 2020 in Austria. An online survey completed by 161 therapists produced both quantitative and qualitative data with the latter being subject to a qualitative content analysis. Our research suggests that telephone and videoconferencing are considered valuable treatment formats to deliver psychodynamic psychotherapy. However, therapists' experiences with remote psychotherapy are multifaceted and ambiguous. In particular, the findings raise questions concerning the maintenance of the therapeutic alliance, the development of the analytic process, the sensitivity to unconscious communication, and the indication for certain types of patients that still need further investigation. Our research indicates that the long-standing reticence toward remote treatments offers among psychodynamic therapists is becoming more differentiated and partially dissolves as therapists gain experiences in their use. Attitudes are becoming more open. At the same time, the way is being prepared to take a closer look at the specific processes and dynamics of remote psychotherapy and to examine them critically in future studies.

Individual Cognitive Social Capital and Its Relationship with Pain and Sick Leave Due to Pain in the Austrian Population.

BACKGROUND: Individual cognitive social capital has repeatedly been shown to be linked to health disparities in many dimensions. The aim of the study was to investigate the association between social capital and pain-related measures. METHODS: 15,474 subjects older than 15 years were personally interviewed on subjective health, quality of life, health behaviour, and utilisation of healthcare in the Austrian Health Interview Survey. An indicator for cognitive social capital at the individual level consisting of nine questions targeted at different social resources was built and its association with pain-related items analysed. RESULTS: Odds ratios, adjusted for age, chronic diseases, and educational level for having suffered from severe pain in the last 12 months were 2.02 (95% CI 1.77-2.03) in the lowest tertile and 1.30 (95% CI 1.14-1.47) in the middle tertile of social capital for men. The corresponding odds ratios for women were 2.28 (95% CI 2.01-2.59) and 1.30 (95% CI 1.15-1.46). In both sexes, pain intensity increased significantly with decreasing level of social capital. The proportion of subjects that have been on sick leave in the last 12 months due to pain were 16.3%, 12.0%, and 7.7% (P<0.001) from lowest to highest tertile of social capital in men, and 16.5%, 12.3%, and 6.7%, respectively (P<0.001) in women. CONCLUSION: Our findings indicate that low cognitive social capital at individual level is significantly associated not only with higher prevalence of pain and higher pain intensity, but also with a higher chance for sick leave due to pain in employed subjects.

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.

A 35-year trend analysis for back pain in Austria: the role of obesity.

BACKGROUND: The prevalence of back pain is constantly increasing and a public health problem of high priority. In Austria there is a lack of empirical evidence for the development of back pain and its related factors. The present study aims to investigate trends in the prevalence of back pain across different subpopulations (sex, age, obesity). METHODS: A secondary data analysis based on five nationally representative cross-sectional health surveys (1973-2007) was carried out. Face-to-face interviews were conducted in private homes in Austria. Subjects aged 20 years and older were included in the study sample (n = 178,818). Obesity was defined as BMI≥30 kg/m2 and adjusted for self-report bias. Back pain was measured as the self-reported presence of the disorder. RESULTS: The age-standardized prevalence of back pain was 32.9% in 2007; it was higher among women than men (p<0.001), higher in older than younger subjects (p<0.001) and higher in obese than non-obese individuals (p<0.001). During the investigation period the absolute change in the prevalence of back pain was +19.4%. Among all subpopulations the prevalence steadily increased. Obese men showed the highest increase of and the greatest risk for back pain. CONCLUSION: These results help to understand the development of back pain in Austria and can be used to plan controlled promotion programs. Further monitoring is recommended in order to control risk groups and plan target group-specific prevention strategies. In Austria particular emphasis should be on obese individuals. We recommend conducting prospective studies to confirm our results and investigate causal relationships.

[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.

Income inequality as a moderator of the relationship between psychological job demands and sickness absence, in particular in men: an international comparison of 23 countries.

OBJECTIVES: The aim of this study was to investigate whether more sickness absence is reported in countries with higher income inequality than elsewhere, and whether the level of income inequality moderates the association between psycho-social job demands and sickness absence. METHODS: Our analysis is based on the Fifth European Working Conditions Survey that compared 23 European countries. We performed multi-level regression analysis. On the macro-level of analysis we included the Gini-Index as measure of inequality. On the micro-level of analysis we followed the Karasek-Theorell model and included three scales for psychological job demands, physical job demands, and decision latitude in the model. The model was stratified by sex. RESULTS: We found that, in countries with high income inequality, workers report significantly more sickness absence than workers in countries with low income inequality. In addition we found that the level of income inequality moderates the relationship between psychological job demands and sickness absence. High psychological job demands are significantly more strongly related to more days of sickness absence in countries with low income inequality than in countries with high income inequality. CONCLUSIONS: As the nature and causal pathways of cross-level interaction effects still cannot be fully explained, we argue that future research should aim to explore such causal pathways. In accordance with WHO recommendations we argue that inequalities should be reduced. In addition we state that, particularly in countries with low levels of income inequality, policies should aim to reduce psychological job demands.

The impact of the HDI on the association of psychosocial work demands with sickness absence and presenteeism.

BACKGROUND: The purpose of this study was to determine whether psychosocial work demands have a different impact on sickness absence and presenteeism in countries with a high vs. countries with a low Human Development Index (HDI). METHODS: This article is based on an analysis of the fifth European Working Conditions Survey. We investigated single items as well as complex constructs and indices. Sickness absence and presenteeism were measured as outcome variables. Following the model of Karasek and Theorell, we measured the HDI at the macro level and psychosocial job demands at the micro level as independent variables. RESULTS: The multivariate multilevel analysis reveals a significant association between the HDI and the number of days recorded for sickness absence. In countries with a higher HDI, people report a lower number of days with sickness absence. Higher psychosocial job demands are associated with poorer health. There are significant cross-level interaction effects between psychosocial job demands and the HDI for these associations. Psychosocial job demands are stronger associated with sickness absence and presenteeism in high-HDI than in low-HDI countries. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH: We argue that Public Health Actions that are connected to work characteristics need to take into consideration the level of HDI of the countries. In low- and high-HDI countries, different actions could be necessary to reach the needs of the working population.

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.

Nutrition and health: different forms of diet and their relationship with various health parameters among Austrian adults.

Population-based studies report a beneficial health effect and a lower mortality rate for diets rich in fruits and vegetables. Therefore, the aim of our study was to analyze differences between various forms of diet and health-related variables. The sample for this study was taken from the Austrian Health Interview Survey 2006/07 (N = 15,474). Multivariate analyses of variance adjusted by sex, age, and socioeconomic status (SES) were conducted to examine health-related behavior, health, and quality of life depending on different forms of diet. Additionally, differences in the SES and body mass index (BMI) were analyzed. Our results show that a vegetarian diet is associated with a better health-related behavior, a lower BMI, and a higher SES. Subjects eating a carnivorous diet less rich in meat self-report poorer health, a higher number of chronic conditions, an enhanced vascular risk, as well as lower quality of life. In conclusion, our results have shown that consuming a diet rich in fruits and vegetables is associated with better health and health-related behavior. Therefore, public health programs are needed for reducing the health risks associated with a carnivorous diet.

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.

Female and male victims of violence in an urban emergency room--prevalence, sociodemographic characteristics, alcohol intake, and injury patterns.

BACKGROUND: Violence as well as alcohol-attributable injuries is a dominant public health issue worldwide. Victims, being injured, frequently visit emergency rooms (ER). METHODS: We interviewed all the patients seeking help in an urban emergency room reporting being victims of violent behavior over a period of 3 months (from November 2011 to January 2012). RESULTS: Our results showed that 1 out of 23 patients seeking help in our ER was due to forcible means. A total of 15 % of all victims reported domestic violence (75 % women) and others (90 % men) reported brawl as the reason for seeking help. Overall, 80 % of the victims were younger than 40 years. In case of domestic violence, two-third (only women) reported that they were hurt by their intimate partner. At total of 50 % were treated for head wounds and 35 % had injuries of their extremities. One-third of the patients were alcoholized. The victims of brawls mainly suffer from head injuries (69 %). Half of this patient group was under the influence of alcohol. CONCLUSIONS: To conclude, victims of violence seek for help in emergency rooms daily. Alcohol consumption is the main factor for violent behavior. Public health programs to prevent alcohol related violence and therefore, alcohol-attributable injuries have to be implemented. Addressing the need to enhance the awareness of the health professionals has to be an imperative.

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.

Healthcare for migrants and for marginalized individuals: The Marienambulanz in Graz, Austria.

The Marienambulanz in Graz, which was founded in 1999, is an outpatient clinic aiming to provide free medical services for marginalized groups. Medical and socioeconomic data of patients at the outpatient clinic have been collected electronically since 2003. The purpose of this study was to find out which persons were treated at the Marienambulanz in the last seven years (2003-2009) and to find out the most frequent reasons for attending the Marienambulanz. We analysed existing medical data descriptively in order to find out the four most frequent reasons for going to the outpatient clinic, the nationality of the patients and whether or not the patients had insurance coverage. Since 2003, 3,652 patients (2,342 men and 1,310 women) have been treated at the Marienambulanz. The majority of patients came either for an initial medical examination, for medication or for further thorough examinations including advice about general health and - if necessary - for childcare. Interestingly, more than 60% of the patients were insured. The Marienambulanz provides medical assistance for uninsured persons and for marginalized insured persons who do not make use of the regular health care system. It can be argued that the regular Austrian health care system fails to provide health care for marginalized groups. The Marienambulanz in Graz, as a low-threshold institution, serves the purpose of bridging the gap to the regular health care system for marginalized groups.

The impact of socio-economic status on pain and the perception of disability due to pain.

Pain is a major burden for society and a great challenge for public health. The aim of this study was to evaluate the association of socio-economic status (SES) with pain, and assess if there were socio-economic differences in the impairment due to pain, even when the same level of pain was reported. Data were sourced from the Austrian Health Interview Survey 2006-2007, a population based nation-wide survey with 15,474 respondents. SES, based on education, income and profession was inversely and gradually associated with the prevalence of severe pain, with the number of indicated painful body sites, the intensity of pain, and with the subjective level of feeling disabled through pain. In a stepwise logistic regression model, adjusted for age, gender, diseases, number of painful body sites and intensity of pain, people with lower SES gradually reported greater disability through pain. Even at the same intensity of pain and the same number of painful body sites, people in the lowest as compared to the highest socio-economic class were twice to three times more likely to feel disabled through pain. Adjusted odds ratios for the lowest group of SES was 2.80 (95% CI, 1.93-4.06) in terms of education, 1.83 (95% CI, 1.40-2.41) in terms of income and 2.05 (95% CI, 1.32-3.19) in terms of profession. This unexplained socio-economic gradient contributes to the confirmation of the social component in a bio-psycho-social model of pain.