What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe.

OBJECTIVE: To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity. DESIGN: Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries. SETTING: Twenty-five countries in the European Union and Norway. POPULATION: Women giving birth in participating countries in 2003 and 2004. METHODS: Application of a common collection of data by selecting specific International Classification of Disease codes from the 'Pregnancy, childbirth and the puerperium' chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies. MAIN OUTCOME MEASURES: Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission. RESULTS: In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100,000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women). CONCLUSIONS: Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended.

Survival in a cohort of patients with haemophilia at the haemophilia care center in Vienna, Austria, from 1983 to 2006.

Survival of patients with haemophilia is still a relevant issue of great interest. A survival analysis was conducted among 226 patients with haemophilia A and B (128 severe haemophiliacs), who were treated at the haemophilia care centre in Vienna. Information on mortality in our patient cohort was obtained from the Austrian Central Death Register. Overall, 96 of a total of 226 patients (42.5%) died between 1983 and 2006; 37 patients (38.5%) died due to HIV-infection, 15 due to HCV infection, 15 due to bleeding (15.6%, respectively) and 29 (30.2%) due to various other causes. The mortality of HIV-positive patients was 74.3% (n = 55) and that of HCV-positive patients was 40.4% (n = 55) in the analysed period. The patient mortality rates were compared with those of the general Austrian male population following adjustment for age and calendar period. We found that the cumulative relative survival of all patients was 0.694 (95% CI 0.614-0.767). The cumulative relative survival of patients with severe haemophilia (FVIII or IX level < or =1%) was 0.489 (0.394-0.579), but was normal (0.986; 95% CI 0.858-1.082) for patients with mild or moderate haemophilia (FVIII or IX level 2-50%). The survival rate was lowest in HIV-positive patients (0.287; 95% CI 0.186-0.398), but was also decreased to 0.874 (0.776-0.951) in HIV-negative patients. It can, therefore, be concluded that the survival of patients with severe haemophilia is still decreased compared to those with non-severe haemophilia and the general male population, regardless of HIV-infection.

Time trends of the prevalence of asthma and allergic disease in Austrian children.

After a substantial increase in the prevalence of atopic disease in Europe, recent studies indicate that a plateau has been reached. However, variation across countries and age groups exists. We studied the prevalence and time trends of asthma and allergic disease among schoolchildren in Austria, a country with traditionally low rates of asthma, hay fever, and eczema. As part of the International Study of Asthma and Allergies in Childhood (ISAAC), symptoms and physician diagnoses of asthma and allergic disease of 13,399 Austrian children aged 6-7 yr and 1516 children aged 12-14 yr were surveyed between 1995 and 1997. A similar survey was conducted between 2001 and 2003. Among children aged 6-7 yr, significant increases were seen in the prevalence of physician-diagnosed asthma (+16%; p = 0.013), hay fever (+22%; p < 0.001), and eczema (+37%; p < 0.001) between 1995 and 2003. These changes were paralleled by an increase in the prevalence of symptoms typical for hay fever (itchy eyes and runny nose), but not by an increase in wheeze. Among children aged 12-14 yr, the lifetime prevalence of diagnosed asthma increased by 32%, of hay fever by 19%, and of eczema by 28% (all, p < 0.001). These changes were paralleled by increases in the prevalence of wheezing as documented by both questions before and after a video showing wheezing children but not by symptoms typical for hay fever such as itchy eyes and runny nose. In conclusion, in Austria, contrary to other European countries, the prevalence of asthma and allergic disease increased among schoolchildren. Additional studies are needed to continue monitoring the dynamics of the prevalence of asthma and allergic disease in Austria and to explore trends in their risk factors.

Tar yields of cigarettes and male lung cancer risk.

Of 252 male lung cancer patients, 248 or 98% were cigarette smokers, significantly (P less than .001) more than in the control group (526 = 64% of 839). In relation to the relative risks (RR) of never-smokers, the adjusted (for age, total years smoked, and average number of cigarettes smoked per day) lung cancer RR for smokers who had exclusively smoked cigarettes belonging to group II (15-24 mg tar/cigarette) was 10.4 (P less than .001); for smokers who had exclusively smoked cigarettes belonging to group III (greater than 24 mg tar/cigarette), it was 25.1 (P less than .001). The respective RR of smokers who had mainly smoked cigarettes belonging to group I (less than 15 mg tar/cigarette), group II, or group III were 10.9 (P less than .001), 20.6 (P less than .001), and 36.7 (P less than .001). After the differences in daily consumption were taken into account, the adjusted (for age and total years smoked) lung cancer RR for smokers who had consumed mainly cigarettes belonging to the various groups were the following: group II (11-20 cigarettes/day) compared to group III (11-20 cigarettes/day), RR = 0.6 (P less than .05); group II (greater than 20 cigarettes/day) compared to group III (greater than 20 cigarettes/day), RR = 0.8; group II (greater than 20 cigarettes/day) compared to group III (11-20 cigarettes/day), RR = 1.3 (P less than .001); group II (greater than 20 cigarettes/day) compared to group III (less than 10 cigarettes/day), RR = 7.8 (P less than .001); and group II (11-20 cigarettes/day) compared to group III (less than 10 cigarettes/day), RR = 2.5 (P less than .001).

Rates of postmortem examination in Austria: the effect of distance between location of death and site of examination.

BACKGROUND AND OBJECTIVE: Despite the importance of autopsies for diagnosing disease and determining cause of death, autopsy rates are decreasing in many countries. Furthermore, autopsy rates are often not distributed randomly between different regions within countries. In this study we analyzed an apparent nonrandom spatial distribution of autopsy rates in Austria for the period 1991-2000. We tested the new hypothesis that the rate of autopsies performed on people who die at home depends on the distance from the residence to the hospital or forensic institute where autopsies are performed. METHODS: Data were extracted from the official mortality records for the years 1991-2000. Only persons who deceased in private residences were included. A logistic regression model was used. RESULTS: Even controlling for variability in sex, age, date of death, and family status, the effect of distance significantly implied lower autopsy rates in the alpine parts of Austria. CONCLUSIONS: This effect of distance may lead to artificially nonrandom mortality patterns in disease maps. As a consequence, the possibility of hypothesizing incorrect health risks to explain nonrandom mortality patterns increases.

Prostate cancer in Austria: impact of prostate-specific antigen test on incidence and mortality.

The aim of the study was to assess the impact of prostate-specific antigen (PSA) testing on prostate cancer mortality in Austria. A join-point regression model and permutation tests were used to identify changes in the slope of age-specific trends respectively calculating the annual percentage change (APC). Age-adjusted incidence increased (P < 0.01) between 1983 and 1997 by 79% from 52.2 to 93.6 cases per 100 000 men/year. Incidence in localized/regional stage disease increased in all ages by 143% from 25.7 to 62.4 cases per 100 000 men/year. Incidence in distant disease decreased (P < 0.01) between 1983 and 1997 in all ages by 38% from 9.5 to 5.9 cases per 100 000 men/year. Incidence in unstaged disease increased (P < 0.01) between 1983 and 1997 in all ages by 300% from 4.5 to 18 cases per 100 000 men/year. Age-adjusted mortality increased (P < 0.05) by 13% from 26.8 in 1983 to 30.3 deaths per 100 000 men/year in 1999. No significant changes of trends in mortality rates were detected in the age groups 50-59 years. In the age group 70-79 years the trend changed (P < 0.05) direction in 1991 and in 1994; 1983 through 1991 APC = 3.52 (95% CI 1.37, 5.72), 1991 through 1994 APC = -10.27 (95% CI -26.20, 9.1) and 1994 through 1999 APC = -0.25 (95% CI -4.55, 4.24). PSA testing increased incidence but no impact on mortality in the target population can be observed so far.

The burden of cancer in Austria.

The aim of this study was to assess the overall progress against cancer in Austria by analysing changes in age-adjusted mortality rates from 1970 to 1996. For the years 1970 to 1996, age-adjusted rates for all malignant neoplasms and for selected sites were calculated for men and women, according to year, age and sex. The number of cancer deaths were obtained from the Austrian Central Statistical Office--age-adjusted mortality rates of all malignant neoplasms decreased in men between 1971 and 1996 by 13% (from 289.1 to 251.4 deaths per 100,000), and in women between 1970 and 1996 by 19.1% (from 276.6 to 223.7 deaths per 100,000). Among older people (> or = 55 years) the mortality decreased by 13% in men and by 17% in women; among younger people (< 55 years) by 12% and 30%, respectively. The decrease in total cancer mortality is promoted by three tumour sites (the leading causes of cancer deaths in 1970). In both sexes, the decrease of stomach cancer mortality had the major impact, followed by colorectal cancer in women and by lung cancer in men. The observed changes in mortality are primarily related to changing incidence and early detection, rather than improvements in treatment. Unfortunately, there is evidence that prevention is losing ground in Austria. The implementation of the well-established knowledge of cancer prevention and the strengthening of preventative research is urgently needed.

Genetic polymorphisms of CYP1A1 and GSTM1 and lung cancer risk.

Susceptibility to lung cancer may, in part, be determined by interindividual differences in the cytochrome P450-catalysed bioactivation and the glutathione S-transferase-catalysed detoxification of procarcinogens. Therefore a lung cancer case-control study was set up to investigate the association of three polymorphisms of the CYP1A1 gene (CYP1A1*2A, CYP1A1*2B, CYP1A1*4) and GSTM1*0 genotype with lung cancer risk in Austrian Caucasians. Genomic DNA was isolated from the peripheral blood lymphocytes of 134 male lung cancer patients and 134 age-matched controls with nonmalignant conditions and PCR-based analyses were performed. There was no significant difference in risk between cases and controls, either for the CYP1A1*2A (OR=1.09, 95%CI=0.46-2.58), CYP1A1*2B (OR=1.09, 95%CL=0.46-2.58) or for the CYP1A1*4 polymorphism (OR=0.49, 95%CL=0.20-1.16). The prevalence of the GSTM1*0 genotype in the lung cancer group (47.8%) was comparable to that found in the control group (49.3%) and also had no effect on lung cancer risk (OR=0.94, 95%CL=0.54-1.57). Further, in a subgroup of male ever-smokers (n=126), no significant influence on the relative risk was found for these polymorphisms. Our results suggest that these investigated polymorphisms can not be considered as genetic susceptibility markers for lung cancer within the Austrian Caucasian population.

Mortality trends of lung cancer in Austria and the Czech Republic.

This paper concerns itself with possible reasons for differences in lung cancer (ICD9-162) mortality rates in Austria and the Czech Republic. Lung cancer mortality in Austrian men reached its peak in 1973 and decreased gradually after a plateau by 23% since then, while the Czech mortality rate in men was constantly increasing till 1986 and then started to decline by 21% till 1998. As far as women in both countries are concerned, the risk of dying from lung cancer has risen dramatically for the last 20 years. In Czech men the mortality rate between 1970-1998 was significantly higher than in Austrian men while in women the death rates were closely similar. Differences cannot be explained by different smoking habits. In the past occupational exposure to cancerogenic agents in the Czech Republic was certainly one of the futile factors for the different lung cancer mortality rates. However, nowadays, Austria and the Czech Republic have to cope with similar problems particularly with an increasing number of children and adolescents (especially females) starting smoking very early. Activities to prevent children and adolescents from starting or stopping to smoke will be the only way to control lung cancer epidemic in the 21st century.

[Incidence of Haemophilus influenza meningitis in Austria]. / Inzidenz der Hämophilus influenza-Meningitis in Osterreich.

The incidence of Haemophilus influenza meningitis was analysed for the first time in Austria. In 1990 a total of 55 cases occurred, representing an incidence of 0.71/10(5). Most of the patients were children aged less than 5 years (n = 42, 76.4%). The incidence in the age group 0-4 years was 9.48/10(5), in each of the other 5-year age groups the incidence was lower than 1/10(5).

[Haemophilus influenzae meningitis in Austria: 1990-1992 incidence]. / Haemophilus influenzae-Meningitis in Osterreich: Inzidenz 1990-1992.

The incidence of Haemophilus influenzae meningitis in children aged less than 5 years in Austria was 9.5/10(5) (n = 42) in the year 1990, 12.4/10(5) (n = 56) in 1991 and 10.4/10(5) (n = 48) in 1992. In each of the other 5-year age groups the incidence was lower than 1/10(5). In 1992 Hib vaccine was registered and recommended for children below 5 years of age. So far no impact of immunisation has been observed on the incidence of meningitis. A new strategy must be found to improve the implementation of immunisation.

Prevalence of self-reported screening mammography and impact on breast cancer mortality in Austria.

Mammography for breast cancer screening has been available in Austria free of charge since 1974 and has been explicitly recommended for mass screening since 1980. The type of screening is opportunistic. Evaluation has to rely on population-based data (mortality, stage distribution, screening prevalence). In a representative cross-sectional study (women aged 40-79 years, n = 566, conducted in 1995) 58% reported at least one screening mammography; the lowest prevalence was found in the age group 70-74 years: 39.3%, the highest in the age group 50-54 years: 71.4%. 23.1% reported at least 2 mammograms within an interval of less than 2 years; lowest prevalence 70-74 years: 10.7%, highest 50-54 years: 35.7%. Age-standardized mortality rate has stabilized since 1985. Since 1980 age-specific rates have increased significantly in all age groups > 54 years, but a decreasing tendency in most groups has been noted since around 1990. The incidence rates of stage II or worse tumors have increased significantly since 1982, except in the age groups 40-44 and 55-59 years; however, during the past 3 to 6 years the absolute rates of incidence of advanced tumors has decreased in alle age groups. The reduction of advanced cancers at diagnosis, followed by a reduction of mortality rates is plausible related to screening prevalence. More uniform decreasing trends should be expected in the years to come. If not, discontinuation of the current opportunistic form of screening without monitoring and evaluation, financed by public money, has to be discussed.

Development of birth weight in Austria from 1970-1995.

We analysed the development of birth weight of all Austrian live births in the period 1970-1995. The relationship between birth weight and the variables maternal age, length and sex of the newborn and year of birth is described by means of a linear regression model. Over the 26 years an increase of up to 60 g was observed in the mean birth weight. This positive trend may partly be due to the extensive use of the maternity care program ("mother-and-child Passport") introduced in 1974. Maternity payment was made to the mother it she underwent at least five examinations within the antenatal care program. This payment was reduced from 15,000 AS in 1996 to 2000 AS as from January 1st 1997, a measure which may lead to a reduction in the use of this maternity care program, with consequent negative implications for the morbidity of both mother and child and for the positive trend of birth weight development over the past decades.

[Epidemiologic development of AIDS in Austria]. / Die epidemiologische Entwicklung von AIDS in Osterreich.

AIDS statistics as released by the Austrian Health Authorities refer to the notification date of the disease, but not the time of diagnosis which is essential for descriptive analysis. We present for the first time data on the exact time of diagnosis of, and death from AIDS. Between 1981 and 1992 altogether 899 AIDS cases were registered (747 men, 152 women), of whom 547 persons have already died (462 men, 85 women). At present there are 352 patients with AIDS in Austria (285 men, 67 women). The incidence, prevalence, and mortality rates of AIDS in Austria, both in absolute and relative (per 100,000 men/women 1990) figures are presented in a table.

Prevalence of self-reported cervical cancer screening and impact on cervical cancer mortality in Austria.

Pap smear screening was introduced in Austria in the late 1960's and was recommended annually for all women older than 20 years ever since. This is an opportunistic screening. The evaluation has to rely on population based data (mortality, stage distribution, screening prevalence). In a representative cross-sectional study (women aged 20-69 years, n = 933, conducted in 1995), 76% reported at least one Pap screening during their life; the highest prevalence (88%) was reported by women aged 50-59 years, the lowest prevalence (65%) by women aged 60-69 years. Forty-eight per cent of all women reported that they had undergone screening at least 4 times (40-49 years: 57%, 20-29 years: 34%). Between 1980 and 1996, mortality due to cancer of the uterus, part unspecified (ICD-9: 179), decreased by 54% (P = 0.0001) and that of cancer of the cervix (ICD-9: 180) by 44% (P = 0.0001). Since 1980, age-specific incidence rates of invasive disease decreased (P = 0.0001) in all 10-year age groups (20-29 years: -59%, 30-39 years: -48%, 40-49 years: -34%, 50-59 years: -62%, 60-69 years: -59%). The incidence of preinvasive disease increased significantly (P = 0.001) in the age groups 20-29 years by 30% and 30-39 years by 45%, respectively. No significant changes are observed in other age groups. Opportunistic screening has reduced mortality from cervical cancer and particularly limited the increase among younger women, but the high proportion of cancer deaths from uterine cancer, in part unspecified, obscures the actual trend. We estimate that the true mortality from cervical cancer has been nearly halved between 1980 and 1996. Most of this reduction must be attributed to the screening activities in the 1970's and we expect a further decrease as a result of the expanded screening activities in the 1980's.

Hybrid capture based human papillomavirus typing in cervical screening compared to cytology and histology.

INTRODUCTION: Cervical cancer is frequently associated with infection from various types of human papillomavirus (HPV) with high a oncogenic potential (high-risk types). Commercial systems for HPV typing are available, but the question as to when HPV typing should be performed has not yet been solved. OBJECTIVES: To assess the value of HPV typing in a clinical setting in a population with opportunistic screening. STUDY DESIGN: Cytology, histology and HPV status of 593 patients from a high-risk collective were evaluated retrospectively. For HPV typing, the hybrid capture (HC) system was used. RESULTS: Infection with high-risk types of HPV was associated with more severe cervical lesions. Women with PAP III or PAP IIID who were infected with high-risk HPV were at increased risk for high-grade cervical lesions (CIN III+) (p = 0.006). Conization influenced HPV status: of 63 patients who were HPV high-risk positive before conization, 4 remained positive afterwards. CONCLUSION: HC appears to be a useful system to triage women with PAP III or IIID and to detect patients with residual HPV infection after conization. However, because of high costs and no significant increase in the sensitivity of cytology, the use of HPV typing in routine cervical screening cannot be recommended in countries with opportunistic annual cytological screening.

Indoor factors and their association to respiratory symptoms suggestive of asthma in Austrian children aged 6-9 years.

The ISAAC (International Study of Asthma and Allergy in Childhood) was founded in 1990 in order to maximise the value of epidemiological research into asthma and allergic diseases, to describe the prevalence of asthma and allergic disease in children living in different locations, to make comparisons within and between countries, to provide a framework for further etiological research and to find prevention strategies. We analysed a sub-sample of a population-based study (1995 to 1997) in Upper Austria. The aim of our study was to investigate the influence of indoor risk factors on wheezing in children 6-9 years old. Our calculations were based on the results of a questionnaire answered by parents about their children's indoor environment at home. Smoking of the mother during pregnancy and/or during breastfeeding (OR 1.28; 95% CI 1.08-1.48), smoking of the mother at the present time (OR 1.25; 95% CI 1.12-1.41), a bird (OR 1.40; 95% CI 1.06-1.85) or rabbit (OR 1.37; 95% CI 1.03-1.82) as a domestic pet, synthetic bedding (OR 1.33; 95% CI 1.18-1.49) and dampness or mould at home (OR 1.43; 95% CI 1.24-1.65) are associated with a significantly increased risk of childhood wheezing in the last 12 months. Other variables such as "smoking of the father", "cooking with gas", "gas central heating" and other "pets" do not achieve statistical significance.

[Cellular immunodeficiency (including AIDS): incidence and length of stay of hospitalized cases in Austria in 1990]. / Zellulärer Immundefekt (inklusive AIDS): Inzidenz und Aufenthaltsdauer stationär behandelter Fälle in Osterreich im Jahr 1990.

The incidence of cellular immunodeficiency (including AIDS), treated at hospitals in Austria in the year 1990, was 3.8 per 100,000 (n = 294, males 6.3 per 100,000, females 1.5 per 100,000). On the average every patient with this diagnosis was admitted to the hospital 3.6 times per year. The average hospitalization time was 7.5 days, summing up to a mean of 27.3 days of stay per case per year. A total of 8031 days was necessary for the hospital care of these patients, costing AS 86873 for care per person in 1990 (AS 3,180 per day in the hospital). In relation to the grand total of approximately 1.8 million admissions to Austrian hospitals, patients with the diagnosis "cellular immunodeficiency (including AIDS)" cover only 0.06% of all admission and 0.03% of patient days per year respectively.

[Vaccination status and sociodemographic variables in Viennese public school students]. / Impfstatus und soziodemographische Variablen bei Wiener Volksschülern.

A representative sample of 585 children, attending 2nd grade elementary school in Vienna, was examined. Vaccination certificates were collected, the parents' attitudes towards recommended vaccinations and data on sociodemographic variables were obtained by questionnaire. Compared to 95.9% of the less educated only 90.4% of the higher educated parents are interested that their children receive all vaccinations recommended (p < 0.01). When the dominant country equals "Austria", parents are more reluctant (p < 0.05) to have their children vaccinated (80.4%), compared to others (former Yugoslavia 92%, Turkey 90.9%, other countries 93.1%). A complete immunization against Diphtheria, Tetanus and Poliomyelitis (DT/OPV) was observed in 65.3% of the children. DT/OPV and additionally Mumps and Measles (MM) in 54% and DT/OPV + MM and Pertussis in 43.8% respectively. The immunization coverage is significantly higher (p < 0.01) in children with the dominant country = Austria (DT/OPV 70.7%, DT/OPV + MM 61.8%, DT/OPV + MM + Pertus sis 51.1%) compared to children from former Yugoslavia (DT/OPV 56.3%, DT/OPV + MM 34.5%, DT/OPV + MM + Pertussis 24.1%), Turkey (DT/OPV 54.5%, DT/OPV + MM 40.9%, DT/OPV + MM + Pertussis 33.3%), and "other countries" (DT/OPV 41.4%, DT/OPV + MM 34.5%, DT/OPV + MM + Pertussis 24.1%).

[Prevalence of smoking habits of Upper Austria students of the 7th and 8th grade and effect of smoking habits of family and peers]. / Prävalenz der Rauchgewohnheiten von oberösterreichischen Schülern der 7. und 8. Schulstufe und Einfluss der Rauchgewohnheiten von Familie und Peers.

The aim of the study was to explore the prevalence of different smoking habits in a population of Austrian pupils, 12 to 15 years old, and the relationship of familial and peer group smoking customs with these habits. In 1997 a population-based survey (International Study of Asthma and Allergies in Childhood, ISAAC) was conducted of all 7th and 8th grade school children of a district of Upper Austria. Information on the smoking habits of the adolescents, the family members, and of the peer as well as smoking habits of the teacher, gender, and age of the children was collected. The overall-prevalence of having ever smoked in this population is 57.8%. The percentage of eversmokers among the 12-year-olds is 50%. This amount increases to 63.8% among the 14- to 15-year-olds. The odds ratios for smoking daily is highest among those whose best friend smokes (OR: 70.63, CI: 9.19, 542.40). The risk of daily smoking increases also if the siblings of the juvenile (OR: 4.71, CI: 1.15, 19.35) or the mother (OR: 4.95, CI: 1.67, 14.70) smoke. If the father smokes the risk to smoke monthly is increased (OR: 2.09, CI: 1.28, 3.40). These results point to the fact that smoking prevention programes should take into account the influence of peers and family of the adolescents.