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This position paper deals with an expert consensus on diagnosis and management of eosinophilic esophagitis and esophageal food impaction issued by the Austrian Eosinophilic Esophagitis Network, a working group under the patronage of the Austrian Society of Gastroenterology and Hepatology (ÖGGH). In need of a standardized approach on the management of EoE, recommendations were made based on international guidelines and landmark studies., (© 2024. The Author(s).)

Ulcerative colitis (UC) is one of the main forms of inflammatory bowel disease (IBD). Despite the widening range of drug treatment options, primary nonresponse, secondary loss of response as well as adverse events call for additional treatment alternatives.Tofacitinib is an oral small-molecule drug of the class of Janus kinase inhibitors which, in the European Union, was approved for the treatment of moderate to severe active UC in August 2018. This position paper, drawn up by the IBD Working Group of the Austrian Society of Gastroenterology and Hepatology, summarizes the mechanism of action, clinical development, marketing authorization status, efficacy and safety of tofacitinib. Also, by providing a synopsis of available data from both pivotal and post-marketing studies, clinical aspects of specific interest are highlighted and discussed.The available body of evidence indicates that tofacitinib is an additional effective medication for the treatment of UC that exhibits a good safety profile. This position paper aims at optimizing the safe and effective use of tofacitinib in daily clinical practice., (© 2022. The Author(s).)

Survival in cancer is continuously improving due to evolving oncological treatment. Therefore, cardiovascular short-term and long-term side effects gain crucial importance for overall outcome. Cardiotoxicity not only presents as heart failure, but also as treatment-resistant hypertension, acute coronary ischemia with plaque rupture or vasospasm, thromboembolism, arrhythmia, pulmonary hypertension, diastolic dysfunction, acute myocarditis and others. Recent recommendations have proposed baseline cardiac risk assessment and surveillance strategies. Major challenges are the availability of monitoring and imaging resources, including echocardiography with speckle tracking longitudinal strain (GLS), serum biomarkers such as natriuretic peptides (NT-proBNP) and highly sensitive cardiac troponins. This Austrian consensus encompasses cardiotoxicity occurrence in frequent antiproliferative cancer drugs, radiotherapy, immune checkpoint inhibitors and cardiac follow-up considerations in cancer survivors in the context of the Austrian healthcare setting. It is important to optimize cardiovascular risk factors and pre-existing cardiac diseases without delaying oncological treatment. If left ventricular ejection fraction (LVEF) deteriorates during cancer treatment (from >10% to <50%), or myocardial strain decreases (>15% change in GLS), early initiation of cardioprotective therapies (angiotensin-converting enzyme inhibitors, angiotensin or beta receptor blockers) is recommended, and LVEF should be reassessed before discontinuation. Lower LVEF cut-offs were recently shown to be feasible in breast cancer patients to enable optimal anticancer treatment. Interdisciplinary cardio-oncology cooperation is pivotal for optimal management of cancer patients., (© 2022. The Author(s).)

The enormous progress made in recent years in the field of information and communication technology and also in sensor and computer technology has affected numerous fields of medicine and is capable of inducing even radical changes in diagnostic and therapeutic processes. This is particularly true for cardiology, where, for example, telemetric monitoring of cardiac and circulatory functions has been in use for many years. Nevertheless, broad application of newer telemedical processes has not yet been achieved to the extent one would expect from the encouraging results of numerous clinical studies in this field and the state of the art of the underlying technology. In the present paper, the Working Group on Rhythmology of the Austrian Cardiological Society aims to provoke a critical discussion of the digital change in cardiology and to make recommendations for the implementation of those telemedical processes that have been shown to exert positive effects on a wide variety of medical and economic parameters. The greatest benefit of telecardiological applications is certainly to be found in the long-term care of patients with chronic cardiovascular diseases. Accordingly, follow-up care of patients with cardiological rhythm implants, management of chronic heart failure and secondary prevention following an acute cardiac event during rehabilitation are currently the most important fields of application. Telemedicine is intended to enable high-quality and cost-efficient care for an increasing number of patients, whose care poses one of the greatest challenges to our healthcare system. Not least of all, telemedicine should make a decisive contribution to improving the quality of life of this segment of the population by favorably influencing mortality, morbidity and hospitalization as well as the patient's contribution to treatment.

This study estimates factors of importance for the carbon dioxide equivalent (CO 2 e) emissions generated by travellers flying for different reasons based on representative Austrian micro data for the period 2014-2016. The annual average number of flights taken by adults vary between 0.1 (visiting friends) and 0.8 (going on holiday), and the amount of CO 2 e emissions generated by each return flight is approximately 1100 kg. This leads to a total of 6 million tonnes CO 2 e emissions per year. Results of the Pseudo Poisson Maximum Likelihood estimations reveal that the amount of CO 2 e emissions created is related to socio-demographic, locational and seasonal factors, although mainly for the largest group of travellers: the holiday makers. In this group, individuals with university degrees, young persons (16-24 years) and capital city residents generate the largest amounts of emissions, as opposed to persons with children and large households. Residents of the capital region each quarter cause 64 kg more CO 2 e emissions than inhabitants of rural areas, persons with university degrees create 74 kg larger emissions than those without degrees and young adults instigate 90 kg more emissions than middle-aged persons. CO 2 e emissions of holiday flights are highest in the first quarter of the year. The importance of education is also pronounced for CO 2 e emissions related to business travel, as is gender.

Božidar Špišić was a pioneer of Croatian orthopedics. In 1908 he founded the first private orthopedic clinic in the entire South Slav region. During the First World War he organized and headed the first orthopedic hospital for the rehabilitation and resocialization of wounded soldiers. In the interwar period, Špišić was tasked with establishing the orthopedic clinic within the auspices of the School of Medicine, University of Zagreb. This effort in shaping and developing orthopedics in Croatia would not have been possible without his participation in a wide network of internationally renowned orthopedists. After graduating from the University of Graz in 1904, Špišić spent the next 4 years specializing in orthopedics with Hans Spitzy, Arnold Wittek, Fritz Lange and, most importantly, Adolf Lorenz. In this paper, we have reconstructed the transfer of knowledge and experiences between these prominent Austrian and German orthopedists and Božidar Špišić. We have paid special attention to the identification of those elements in Špišić's work that can be traced back to his mentor, teacher and lifelong colleague Adolf Lorenz, such as his treatment for congenital hip dislocation. We believe that the analysis of professional networks can shed additional light on the historiography of orthopedics, given that these influences did not manifest solely through the acquisition of specialized clinical knowledge but also through a profound influence on the core tenets of orthopedics as a discipline-its institutional organization and overall conservative approach., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Renal sympathetic denervation (RDN) is an interventional supplement to medical treatment in patients with arterial hypertension. While the first sham-controlled trial, SYMPLICITY HTN‑3 was neutral, with improved procedural details, patient selection and follow-up, recent randomized sham-controlled trials of second-generation devices show a consistent blood pressure lowering effect of RDN, as compared to sham controls. These new data and the recent U.S. Food and Drug Administration (FDA) premarket approval of two RDN devices are the basis for the present recommendations update.This joint position paper from the Austrian Society of Hypertension, together with the Austrian Society of Nephrology and the Working Group of Interventional Cardiology from the Austrian Society of Cardiology includes an overview about the available evidence on RDN and gives specific recommendations for the work-up, patient selection, pretreatment, procedural management and follow-up in patients undergoing RDN in Austria. Specifically, RDN may be used in clinical routine care, together with lifestyle measures and antihypertensive drugs, in patients with resistant hypertension (i.e. uncontrolled blood pressure on 3 antihypertensive drugs) and in those with uncontrolled hypertension, after adequate work-up, if institutional, patient-related and procedural conditions are fulfilled., (© 2024. The Author(s).)

Mercury in wood is an important pool of this heavy metal in forest ecosystems because of its relatively high proportion in the biomass compared to other pools. This paper describes the successful application of a modified methodology for stem disk sampling based on wood particles from stem disks from Donawitz (Styria, Austria; pig iron production), from Brixlegg (Tyrol; former copper and silver mining, copper ore processing and copper recycling), and from Gmunden (Upper Austria; cement production). The maximum mercury concentration in the stem disks from Donawitz (Hinterberg: 20.5 ppb, St. Peter: 9.3 ppb) was recorded in the early 1970s. Several maxima were obtained from the stem disks from Brixlegg: the first was in 1813 (149.9 ppb), potentially even earlier, a second (37.6 ppb) in the late nineteenth century until the late 1920s, and a third local maximum in the 1970s (9.1 ppb), followed by a tendency to decline until the present. A stem disk from Gmunden in Upper Austria showed values of mercury concentrations indicating no increases compared to literature about background sites (≤ 3.2 ppb). This method revealed trends in mercury concentrations in tree rings originating from several different mercury emission sources in Austria coinciding with information about industrial history (where available) together with a justifiable effort. We therefore recommend it for further investigations on mercury concentrations in tree rings and their changes over time., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The paper reports the results of an exploratory online survey among German, Austrian, and Swiss hospital chaplains (n = 158, response rate 17%) to identify the ethical conflicts they encounter in their work. Respondents indicated that questions surrounding end-of-life care are predominant among the conflicts faced. Chaplains get involved with these conflicts most often through the patients themselves or through nursing staff. Most encounters occur during pastoral care visits rather than in structured forms of ethics consultation such as clinical ethics committees. The results add to the ongoing discussion of chaplains as agents in ethics consultation within healthcare systems as well as their specific role and contribution., (© 2022. The Author(s).)

Background: When a country introduces different COVID-19 control measures over time, it is important to identify the specific measure that was effective and therefore responsible for "flattening the curve". This information helps policymakers find the right decision and saves the economy by avoiding severe yet ineffective measures., Objective: This paper aims to fill the literature gap by investigating two regions that introduced two or three consecutive measures during the second COVID-19 wave, namely Austria and Victoria., Method: We calculated the first derivative (acceleration) of the filtered daily case data and identified the date of the start and end of the acceleration's major downturn (effective phase) relative to the date when the control measures were introduced (Austria: soft/hard lockdowns; Victoria: stages 3/4 lockdowns, mask order)., Results: In Austria, the effective phase started 5 days after the introduction of the soft lockdown and ended at the start of the hard lockdown. In Victoria, the effective phase started 19 days after the introduction of the stage 3 lockdown, 5 days after the introduction of the mask order, and ended 6 days after the start of the stage 4 lockdown., Conclusion: Considering that the effect of control measures is expected the earliest one serial interval after their introduction, the control measure responsible for "flattening the curve" was the soft lockdown in Austria and the mask mandate in Victoria. The severe lockdowns in both regions were ineffective., (© 2022. The Author(s).)

In the past 12 months a plethora of relevant novel data for the treatment of metastatic HER2 positive breast cancer were published. To bring this new evidence into a clinical perspective, a group of Austrian breast cancer specialists updated their previously published treatment algorithm for those patients. For this consensus paper a total of eight scenarios were developed in which treatment strategies appropriate for specific patient profiles were evaluated. Consensus was established by detailed discussions of each scenario and by reaching full consensus., (© 2022. The Author(s).)

This paper assesses the multiplexing efficiency of environmental taxes in ensuring environmental, energy, and economic security which is an integral part of sustainability in six European countries that are leaders in the Environmental Performance Index. This study aims to confirm the hypothesis that environmental taxes and payments could simultaneously affect changes in important environmental, energy, and economic security as well as sustainability parameters. Not all the previously selected taxes, which affect the parameters of all three areas of environmental, energy, and economic sustainability and security can ensure their simultaneous growth. Calculations made for the period 1994-2019 showed that in the system of environmental taxation of Denmark, five environmental taxes and fees provide an increase in the integrated level of environmental, economic, and energy security and sustainability; in Belgium, two environmental taxes are characterized by multiplex efficiency; in France, seven environmental taxes and payments; in Austria, four; in Finland, one; and in the UK, four. The paper's findings could create the basis for improving environmental taxation systems in the countries to increase comprehensive national security growth and ensure sustainable development path of the countries., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Egg freezing has led to heated debates in healthcare policy and bioethics. A crucial issue in this context concerns the distinction between "medical" and "social" egg freezing (MEF and SEF)-contrasting objections to bio-medicalization with claims for oversimplification. Yet such categorization remains a criterion for regulation. This paper aims to explore the "regulatory boundary-work" around the "medical"-"social" distinction in different egg freezing regulations. Based on systematic documents' analysis we present a cross-national comparison of the way the "medical"-"social" differentiation finds expression in regulatory frameworks in Austria, Germany, Israel, and the Netherlands. Findings are organized along two emerging themes: (1) the definition of MEF and its distinctiveness-highlighting regulatory differences in the clarity of the definition and in the medical indications used for creating it (less clear in Austria and Germany, detailed in Israel and the Netherlands); and (2) hierarchy of medical over social motivations reflected in usage and funding regulations. Blurred demarcation lines between "medical" and "social" are further discussed as representing a paradoxical inclusion of SEF while offering new insights into the complexity and normativity of this distinction. Finally, we draw conclusions for policymaking and the bioethical debate, also concerning the related cryopolitical aspects., (© 2021. The Author(s).)

This paper presents a first quantitative analysis of language in media reports of neonaticide and a comparative examination of language use within the reports. One thousand twenty-seven Austrian print media reports from 2004 to 2014 were retrieved; after exclusion, 331 were analysed using the Linguistic Inquiry and Word Count (LIWC) software. After a preliminary analysis, a comparative analysis was carried out between reports on the Graz case and all other cases. The preliminary analysis revealed that a majority of media reports were related to one repeat neonaticide case (Graz) despite not being clinically different from other cases identified for the same period. The comparative linguistic analysis shows some statistically significant differences relating to the domains of emotional words (less words of anxiety, sadness) and family and in the category of insight and certainty (more words). The unexpected media attention on the Graz case and the ensuing verdict, which was in contradiction with the Austrian infanticide act, might have been influenced by the way language was used by journalists and the media. The authors suggest guidelines on sensitive media reporting are required., (© 2021. The Author(s).)

This position statement is an update to the 2011 consensus statement of the Austrian Society of Cardiology (ÖKG) and the Austrian Society of Cardiac Surgery (ÖGTHG) for transfemoral transcatheter aortic valve implantation.Due to a number of recently published studies, broadening of indications and recommendations of medical societies and our own national developments, the ÖKG and the ÖGHTG wish to combine the 2017 ESC/EACTS guidelines for the management of valvular heart disease with a national position paper and to focus on certain details for the application in Austria. Thus, this position statement serves as a supplement and further interpretation of the international guidelines., (© 2021. Springer-Verlag GmbH, AT part of Springer Nature.)

In Austria, data on vaccine hesitancy is scarce. Available studies suggest around 1-11% of parents refuse vaccination, while many more are hesitant and consider refraining from some but not all of the recommended vaccinations. However, the key drivers for vaccine hesitancy in Austria are largely unknown. To learn more about vaccination coverage, attitude towards and knowledge around immunization as well as views on mandatory vaccination, we conducted a survey in a rural Austrian lay population including adults and children. Two paper-based questionnaires, one for adults 16 years or older and one for children aged 6-15 years, were developed, then sent to all houses of a rural community in Austria as well as handed out at the local primary and middle school, respectively. Self-reported coverage rates of children and adults were found to be low. Within the surveyed population 3% of children had never been or do not get vaccinated. More than half (57%) of the survey participants had a positive attitude towards vaccines, 21% were without reserves, 16% were found skeptical and 5% had a generally negative attitude. Knowledge about immunization in general was poor. Younger adults and people with secondary education appear to be most skeptical and negative towards vaccination. Children's attitudes were closely linked to those of their parents. The major concern around vaccination in adults was fear of side effects. In adults, 54.2% support mandatory vaccination for Health Care Workers and 20.7% are against it. 39% of adults and 37% of children wanted more information on vaccination, preferably provided by physicians. Knowledge about disease prevention by vaccination should be improved and children could also benefit from an early age-appropriate vaccine education to strengthen health literacy. Physicians are the most trusted source of health information. Medical doctors should be aware of their very important role in transmitting trusted health information. This should include an up-to-date education in communicable disease prevention and immunization during their whole medical career. Furthermore, the curricula of health-care workers may need to be improved and harmonized concerning prevention and vaccination., (© 2020. The Author(s).)

The paper is an English translation of Heinrich Obersteiner's lecture on the significance of the granular layer of the cerebellum, rendered from the original German text that was published under the title Über die Bedeutung der Körnerschichte des Kleinhirns in the Jahrbücher für Psychiatrie und Neurologie (the official organ of the Society for Psychiatry and Neurology in Vienna), volume 30, pages 192-200, 1909, communicated on 21 September 1909 before the Session on Neurology and Psychiatry at the 81st meeting of the Society of German Natural Scientists and Physicians held in Salzburg, Austria.

The issue of sustainable management of biosolids (excess sludge) from wastewater treatment is an important issue in the entire developed world. Residual sludge disposal costs and environmental impact may be significant, and reducing such costs, as well as the energy consumption for dewatering and drying, is a key issue for safe and sustainable sludge disposal, considering the recent ban of some disposal options, such as landfilling, in many European countries. An alternative to thermal technologies is solar drying (not to be confused with bio-drying, very close to the concept of composting). Solar greenhouse drying technology is characterized by reduced land requirements compared with traditional outdoor drying beds, as well as by low-energy requirements compared with other thermal drying methods. Process operation is cost-efficient, with close to no maintenance, and observed specific evaporation rates up to threefold higher than conventional drying beds. Many applications of this technology exist in Poland, Germany and Austria: more than 10,000 t of wet sludge per year is treated in this way in Germany alone and almost as many (9000 t/year) in Poland. This paper examines current biosolids treatment technologies applicable to small wastewater treatment plants (2000-9999 population equivalents served) and opportunities for possible solids reuse in Poland in view of sustainable circular economy schemes. In particular, a purely solar-driven greenhouse facility for sewage sludge drying was investigated under different conditions (season, temperature, environmental humidity) and possible improvements for its efficiency evaluated. Sludge processed by solar drying could have different final disposal pathways, according to season, in accordance with the prescriptions of the new National Waste Management Plan of Poland.

Background: Addressing the growing burden of mental diseases is a public health priority. Nevertheless, many countries lack reliable estimates of the proportion of the population affected, which are crucial for health and social policy planning. This study aimed to collect existing evidence on the prevalence of mental diseases in Austria., Methods: A systematic review was conducted using MeSH, EMTREE and free-text terms in seven bibliographic databases. In addition, the references of included papers and relevant Austria-specific websites were searched. Articles published after 1996 pertaining to the Austrian adult population and presenting prevalence data for mental diseases were included in the analysis., Results: A total of 2612 records were identified in the database search, 19 of which were included in the analysis, 13 were community-based studies and 6 examined institutionalized populations. Sample sizes ranged from 200 to 15,474. The evidence was centered around depression (n = 6, 32%), eating disorders (n = 4, 21%) and alcohol dependence (n = 3, 16%). While most studies (n = 10, 53%) used questionnaires and scales to identify mental diseases, seven studies used structured clinical interviews, and two studies examined use of psychotropic drugs. Due to the diversity of methodologies, no statistical pooling of prevalence estimates was possible., Conclusion: Information on the prevalence of mental diseases in Austria is limited and comparability between studies is restricted. A variety of diagnostic instruments, targeted populations and investigated diseases contribute to discrepancies in the prevalence rates. A systematic, large-scale study on the prevalence of mental diseases in Austria is needed for comprehensive and robust epidemiological evidence.

Background: Nowadays, an increasing number of patients expect their physician to provide a measureable and, therefore, comparable treatment effect that quantifies success or failure of the applied therapy. Unfortunately, different knee classification schemes applied to the same patient may provide diverging results. Therefore, the objective of this paper was to present recommendations to clinicians for a meaningful outcome assessment of their patients., Methods: Out of 39 knee evaluation systems available in the literature, we performed an elimination process based on the criteria (1) widespread use, (2) available reference values and (3) publication of at least one validation study., Results: Six clinical scores were detected which met the inclusion criteria. Owing to authors' recommendations and personal opinion the International Knee Documentation Committee (IKDC) Score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were identified to be the most suitable outcome measures that enable patients a realistic assessment of their treatment effect compared with individuals in similar life situations., Conclusion: To our opinion the IKDC should be applied to athletic patients suffering from post-traumatic knee symptoms who are younger than 50 years. For non-athletes aged 50 years and older the WOMAC is considered suitable whereas the KOOS is recommended to all other patients with knee disorders.

Increased activity of the sympathetic nervous system plays a major role in the pathophysiology of primary arterial hypertension. Interventional renal sympathetic denervation (RSD) is a novel percutaneous treatment, decreasing sympathetic activity and consecutively blood pressure by ablating sympathetic nervous fibers located in the adventitia of the renal arteries. The procedure has been tested in several clinical trials in patients with resistant hypertension (defined as systolic office blood pressure > 160 mmHg-in diabetic patients > 150 mmHg-treated with ³ 3 antihypertensive drugs) and caused a meaningful blood pressure reduction, lasting for at least 3 years. So far, no major adverse events have been identified; however, data on the long-term consequences are lacking. The present position paper of the Austrian Society of Hypertension is aiming to assist in choosing possible indications for RSD in clinical routine, based on the available evidence in 2012.

Background: Despite a recent decline in smoking behavior in many European countries, lung cancer rates remain high, especially in Central and Eastern Europe. This paper aims to describe trends in smoking behavior and lung cancer incidence and mortality, including histopathological classification of lung cancer, in a Central European country: Austria., Methods: Using data from the Austrian Central Cancer Registry, we calculated age-standardized incidence, histopathology-specific incidence, and age-standardized and birth cohort-specific mortality rates for all lung cancer cases in Austria. Using national survey data, we estimated prevalence of smoking in the Austrian population. Our analysis covers the time period from 1970 to 2009., Results: In 2009, lung cancer incidence rates were 41.3/100,000 and 18.5/100,000 and mortality rates were 36.3/100,000 and 14.5/100,000, for males and females, respectively. Male lung cancer rates declined but increased steadily in females over the past three decades. In 2009, the most common histological type is adenocarcinoma, which reflects a shift from predominantly squamous cell carcinoma and large cell carcinoma in the mid 1980s. In 2009, 27 % of men and 19 % of women were smokers, which represent a rise of smoking rates in women, especially in younger women, and a decline in the men., Conclusions: While in Austrian men the lung cancer rates, in accordance with their decreasing prevalence of smoking, declined over the past 30 years, the increasing smoking prevalence and lung cancer rates in women remain a public health concern. Antismoking laws and public health initiatives to curtail smoking habits are needed in Austria, especially targeting younger women.

This paper examines regional changes in the prevalence of overweight (BMI ≥ 25 kg/m²) and obesity (BMI ≥ 30 kg/m²) among Austrian adults (aged ≥ 20 years) during a 35-year period, taking into account the social inequality with regard to obesity. Self-reported data from five cross-sectional nationally representative surveys (n = 178,818) conducted between 1973 and 2007 were analysed. The prevalence of overweight was higher in men than women (2007: 46.3 vs. 31.2 %;p < 0.001) and similar in all Austrian regions. There was a clear east-west gradient for obesity among both sexes, with the highest rates in Eastern Austria (in 2007, women: 18.1 %, men: 16.1 %;p < 0.001) and the lowest in Western Austria (in 2007, women: 12.6 %, men: 11.7 %;p < 0.001). Logistic regression analyses have shown a general decrease of overweight per year among women (OR = 0.991, 95 % CI 0.990-0.993) and men (OR = 0.999, 95 % CI 0.998-1.000), while the obesity prevalence has risen during the study period in every region (women: OR = 1.003, 95 % CI 1.001-1.005; men: OR = 1.011, 95 % CI 1.009-1.013), with the highest increase among women in Central Austria and men in Western Austria. Social inequalities for obesity showed a tendency to increase in the Western and Eastern region. Our results showed a significant regional difference for obesity prevalence during the entire study period. Obesity is a frequent health problem among Austrian adults residing in the Eastern region.

Objective: This paper tries to evaluate the connections between the Viennese Anatomical School and the Croatian Anatomist Jelena Krmpotic-Nemanic., Materials and Methods: 17 papers written by Professor Jelena Krmpotic-Nemanic in the last decade of her life were chosen for analyses. According to their themes they could be divided into three groups: ones which evaluate the anatomical terminology, ones which research the development of anatomical structures, and ones which describe the anatomical variations. Mentioned papers were analysed through their topics, methods of research and cited references., Results: Analyses of the mentioned papers revealed the indirect link between the Viennese Anatomical School and the Professor Jelena Krmpotic-Nemanic, through her mentor Professor Drago Perovic, regarding the themes and the methods of her anatomical researches. It has also showed her preference for Austrian and German anatomical textbooks and atlases, primarily ones published in Vienna and Jena, rather than English and American ones. Finally, her direct connections with the Viennese Institute for the History of Medicine and the Viennese Josephinum Wax Models Museum were emphasized., Discussion and Conclusion: Mentioned indirect and direct influences of the Viennese Anatomical School on the work of Professor Jelena Krmpotic-Nemanic were critically appraised.

The aim of this paper was to assess the prevalence of morning headaches in the Austrian general population and to analyse their relationship to daytime functioning and quality of sleep. In a nationwide survey, we recruited 1000 adults (478 men, 522 women, age over 14 years). For this study, we selected all subjects with self-reported morning headaches as well as controls matched for age, sex, size of hometown, level of education and marital status. Forty-eight persons reported morning headaches making a prevalence of 5% in the Austrian general population. Compared to controls, subjects with morning headaches reported more often daytime sleepiness (50% vs. 18.8%, p = 0.003), difficulties in staying awake (47.9% vs. 18.8%, p = 0.005) and falling asleep involuntarily (29.2% vs. 8.3%, p = 0.019). Moreover, they reported a longer sleep onset latency (26.5 ± 27.5 vs. 13.5 ± 13.5 min, p = 0.005), and more often sleep disturbances (58.3% vs. 14.6%, p < 0.001), tossing and turning around during the night (50.0% vs. 8.0%, p < 0.001), problems with sleep maintenance (64.6% vs. 22.9%, p < 0.001) and the symptom of restless legs (20.8% vs. 2.1%, p = 0.01). In addition, subjects with morning headaches felt less often refreshed in the morning (18% vs. 51%, p < 0.001) and reported regular use of medication more often (64.6% vs. 29.2%, p = 0.001) than controls. After correction for multiple testing, the differences in sleep maintenance, sleep disturbances and regular use of medication remained statistically significant. In conclusion, this is the first Austrian population-based controlled study to show that morning headaches afflict one out of 20 persons and are related to self-reported sleep problems.

The aim of this paper is to give an overview of research on fatigue in older adults, with a focus on fatigue as an early indicator of the aging process. Fatigue is a strong predictor of functional limitations, disability, mortality, and other adverse outcomes in young-old and old-old populations, between men and women, and in different geographic localities. Several biological, physiological and social explanations are proposed: fatigue may be seen not only as a self-reported indicator of frailty, defined as a physiologic state of increased vulnerability to stressors, which results from decreased physiologic reserves and even dysregulation of multiple physiologic systems, but also this state may be accelerated because of the cumulative impact of social, mental and biological factors throughout life.

Objective: Medicine is a discipline where there are still pronounced gender imbalances. Whereas worldwide about 50% of beginners in medical schools are female, only few of them reach leading positions. Our aim was to analyze how this situation is reflected in a peer-reviewed general medical-scientific journal., Methods: We screened all papers submitted to the Wiener klinische Wochenschrift - The Middle European Journal of Medicine between January 2001 and September 2009, analyzing the percentage of female first authors of submitted papers and accepted papers, the contribution of female authors depending on the type of article and medical specialty, and the percentage of invited female peer reviewers as well as the quality of their reviews., Major Results: During the period studied, a total of 2507 manuscripts were submitted to Wiener klinische Wochenschrift. 26% of these papers had female first authors, and this proportion increased continuously from 16% in 2001 to 32% in 2007, whereafter it remained constant. The proportion of papers submitted by female first authors was dependent on the medical subspecialty (e.g. 48% female first authors of pediatric papers, 12% female first authors of cardiology papers). There was no difference in the acceptance rate of papers by male and female first authors; however, a somewhat higher rate of papers with female first authors was subject to rapid rejection (21% vs. 16%). Papers with female first authors more often named a different corresponding author than papers with male first authors, and in most of these cases the corresponding author was a man. More than 40% of all submitted original papers, 24% of the review articles, but only 10% of the editorials had female first authors. During the years studied only 5-11% of reviewers were women, despite that the quality of their reviews was generally better than those by men. Among the 21 members of the editorial board only one is a woman., Conclusion: Between 2001 and 2007 the percentage of manuscripts submitted to Wiener klinische Wochenschrift by female authors constantly increased and is now around 30%, reaching almost 50% in some specialties such as pediatrics. Nevertheless, there remains a massive gender imbalance in Wiener klinische Wochenschrift: review papers or invited editorials are only rarely authored by female researchers, a very low percentage of peer reviewers is female - although the quality of their reviews is generally better - and only one member of the editorial board is female. Even though this is mostly a reflection of the general situation in academic medicine, medical journals can and must take action and contribute to the elimination of these gender inequalities.

An outbreak of hepatitis A affecting 21 residents of an Austrian city occurred from the end of November 2007 until mid-January 2008. A case series investigation suggested the consumption of food purchased from supermarket X as the common link. A food handler employed in the delicatessen department of that supermarket had been serologically diagnosed with hepatitis A on 28th November 2007. During the infectious period of approximately 3 weeks, he worked on 11 days. Interviews with the other cluster cases revealed that the hepatitis A virus (HAV)-infected food handler did not practice appropriate hand hygiene. The investigation revealed no other possible source of infection. We hypothesize that the food of the delicatessen department contaminated by the HAV-infected food handler during his infectious period was the source of the outbreak. The district public health authority recommended the reinforcement of hygiene precautions, i.e., access to viricidal hand disinfectant and the use of disposable gloves and single-use paper towels, in the involved supermarket. The federal ministry of health recommended HAV vaccination for all food handlers in food production and gastronomy companies; this recommendation was included in the Austrian national vaccination plan 2008, even though the vaccination of food handlers is costly and its cost-effectiveness is not proven. Appropriate and regular hand hygiene, particularly after toilet visits, is the most effective measure for preventing HAV transmission.

Adequate treatment of gastrointestinal stromal tumors (GISTs) is linked to an interdisciplinary treatment approach. Austrian representatives of medical oncology, surgery, pathology, radiology and gastroenterology have issued this consensus manuscript within the context of currently available and published literature. The paper contains guidelines and recommendations for diagnosis, therapy and follow-up of GIST patients in Austria.

Background: The ABS International group conducted a survey to estimate the prevalence and characteristics of country-specific hospital antibiotic management programs. This paper summarizes the results for Austria., Methods: The survey was conducted in April and May 2007. A questionnaire with various items related to hospital antibiotic management was sent to 160 Austrian hospitals., Main Findings: Of 160 questionnaires sent, 80 were returned and evaluable. The mean total score for all items and all hospitals was 3.29 (median: 3.42; range 1.35-4.74). The larger the hospital the higher were the reported scores concerning diagnostics, antibiotic-related organization and antibiotic-consumption control, but the lower the scores for antibiotic-related personnel development and antibiotic-related relationships to relevant environments. The maturity figure for large hospitals (>500 beds) was 3.57, for medium hospitals 3.34, and for small hospitals (<200 beds) 3.01., Conclusions: The self-reported results of our questionnaire-based survey clearly show that there is still need for improvement. In all five categories surveyed, Austrian hospitals scored their antibiotic maturity lower than the international averages. The establishment of an antibiotic officer enables the development of antibiotic stewardship tools such as antibiotic lists. Such tools can be seen as quality indicators.

Objectives: The goal of this paper is to describe the hospital-based epidemiology of severe TBI in Austria., Patients and Methods: Data sets from 492 patients included in the study by 5 Austrian hospitals were available. Age and gender distribution, education, occupation, location of trauma, mechanism of injury, alcohol use, type and severity of injury, associated injuries, length of intensive care unit stay, and intensive care unit outcome were evaluated for each of the 5 centers., Results: The sample represents roughly 13% of all cases with severe TBI which were treated in Austrian hospitals during the study period. Mean age was 48 +/- 21 years, and most patients were male (72%). The most important trauma locations were roads (50%), home (24%), outdoors (10%), and workplace (7%). Transportrelated trauma was the most important mechanism (44%) followed by falls < 3 m (30%), falls > 3 m (11%), and sports injuries (5%). Detailed analysis of transport-related trauma showed that car accidents (45%) were most common, followed by pedestrian (20%), motorbike (19%), and bicycle (16%) accidents. Significant differences between the centers were found for most of the variables analyzed. The severe traumatic brain injury was associated with spinal cord injury in 10%, and with severe multiple trauma in 38% of cases. Intensive care mortality was 31.7%. There were no significant correlations between mechanisms of injury and severity of trauma, nor between mechanisms and ICU outcome., Conclusions: Epidemiology of severe traumatic brain injuries in Austria is not much different from other industrialized countries. Traffic accidents are responsible for the majority of traumas, stressing the importance of road injury prevention. Attention should also be paid to the specific risks of older people and to prevent injuries at home.

Objectives: The goal of this paper is to describe the ICU management of severe traumatic brain injury (TBI) in Austria., Patients and Methods: Data sets from 415 patients included by 5 Austrian hospitals were available. The analysis focused on complications and outcomes of intensive care, monitoring of intracranial pressure (ICP), efficacy of interventions to control ICP, management of hemodynamics and cerebral perfusion pressure (CPP), ventilation, and effects of hyperglycaemia., Results: Overall ICU mortality was 30.8%; 90-day mortality was 35.7%. Final outcome was favorable in 33%, unfavorable in 51%, and in 16% the final outcome was unknown. An ICP monitoring device was used in 64%; most patients received intraparenchymal sensors (77%). Events associated with mortality > 50% were CPP < 50 mm Hg for > 12 hours/day, ICP > 25 mm Hg for > 12 hours/day, and MAP < 70 mm Hg for > 18 hours/day. The use of ICP monitoring was associated with significantly reduced ICU mortality. Interventions that may have improved the outcome included the use of barbiturates (short-term), hypertonic saline, moderate hyperventilation (33 < pCO2 < 37; p < 0.001 vs. aggressive hyper-and normoventilation), and normothermia. Hyperglycaemia was associated with poor outcome., Conclusions: Our study showed that ICU management of patients with severe TBI mostly follows international guidelines, and that outcome was comparable to or even better than that reported by other authors. Low CPP was associated with poor outcome, and was more often due to low MAP than to elevated ICP. The use of barbiturates and hypertonic saline was more common than expected. CPP should be maintained > 50 mm Hg, the use of catecholamines, fluid loading, barbiturates (short-term), moderate hyperventilation, hypertonic saline, and insulin may improve outcome after severe TBI.

Objectives: The goals of the Austrian Severe Traumatic Brain Injury Study were to investigate the current management of patients with severe traumatic brain injury in Austria and to assess the effects of introducing guidelines for the management of severe traumatic brain injury upon the outcome of these patients. The purpose of this paper is to give a detailed description of the goals, methods, and overall results of the study, and to provide an introduction to a series of papers where the results of the study will be presented and discussed., Study Design: The study included patients with severe traumatic brain injury from five centers in Austria. Data on accident, pre-hospital treatment, hospital treatment, and patient status were collected prospectively. Patient data was entered daily for the first 10 days in hospital and then up to a year after discharge from intensive care. All data was entered into an internet-based database. The data was evaluated to describe epidemiology, pre-hospital treatment, medical management, and surgical management; the evaluation also assessed the effects of guideline-based management on traumatic brain injury patients., Results: The data set comprises a total of 492 patient records from the 5 participating hospitals; this data was collected over a 3-year period. Data quality is considered good; the number of missing data items is low. ICU mortality was 31.6%. Final outcome: 23% of the patients had a good recovery, 10% had moderate disabilities, 8% had severe disabilities, 6% were persistent vegetative, and 38% died. Final outcome was unknown in 16% of patients., Conclusions: This study proved that an internet-based database may be a valuable tool for prospective multicenter studies if many variables have to be collected for a high number of patients. The results of our study provide enough evidence to initiate further research on many aspects of the management of traumatic brain injury patients.

Objectives: The goal of this paper is to describe prehospital status and treatment of patients with severe TBI in Austria., Patients and Methods: Data sets from 396 patients with severe TBI (Glasgow Coma Scale score < 9) included by 5 Austrian hospitals were available. The analysis focused on incidence and/or degree of severity of typical clinical signs, frequency of use of different management options, and association with outcomes for both. ICU mortality, 90-day mortality, final outcome (favorable = good recovery or moderate disability; unfavorable = severe disability, vegetative state, or death) after 6 or 12 months, and ratio of observed (90-day) to predicted mortality (O/E ratio) are reported for the selected parameters. Chi2 -test, t-test, Fisher's exact test, and logistic regression were used to identify significant (p < 0.05) differences for association with survival and favorable outcome (both coded as 1)., Results: The majority of patients were male (72%), mean age was 49 +/- 21 years, mean injury severity score (ISS) was 27 +/- 17, mean first GCS score was 5.6 +/- 2.9, and expected hospital survival was 63 +/- 30%. ICU mortality was 32%, 90-day mortality was 37%, and final outcome was favorable in 35%, unfavorable in 53%, unknown in 12%. We found that age > 60 years, ISS > 50 points, GCS score < 4, bilateral changes in pupil size and reactivity, respiratory rate < 10/min, systolic blood pressure (SBP) < 90 mm Hg, and heart rate < 60/min were associated with significantly higher ICU and 90-day mortality rates, and lower rates of favorable outcome. With regard to prognostic value the GCS motor response score is identical to the full GCS score. Administration of > 1000 ml of fluid and helicopter transport were associated with better outcomes than expected, while endotracheal intubation in the field had neither a positive nor a negative effect on outcomes. Administration of no or < 500 ml of fluids was associated with worse outcomes than expected. Outcomes were better than expected in the few patients (5%) who received hypertonic saline., Conclusions: Age, ISS, and initial neuro status are the factors most closely associated with outcome. Hypotension must be avoided. Fluids should be given to restore and/or maintain SBP > 110 mm Hg. Helicopter transport should be arranged for more seriously injured patients.

Objectives: The aim of this paper was to analyze the impact of economic growth measured by real gross domestic product (GDP) on the incidence of occupational injuries in Austria., Methods: The relationship between GDP and the occupational injury rate of the wage-earning population between 1955 and 2004 was analyzed using an error correction model. The sample size increased from 1.568,371 persons in 1955 to 2.656,952 in 2004. Occupational injuries were divided into fatal and non-fatal injuries., Results: Occupational injuries (fatal and non-fatal) decreased from 8.59% to 4.08%: non-fatal injuries decreased from 8.56% to 4.07%; fatal injuries decreased from 0.03% to 0.01%. Austrian GDP increased from EUR 37.7 billion to EUR 202.8 billion (base year 1995). Statistical analysis clearly shows that a growing economy is associated with declining injury rates (fatal and non-fatal). Two mechanisms are discussed. Firstly, rising GDP is accompanied by greater investment in safer technologies and occupational safety measures. Secondly, booming economies are associated with a reduced risk of unemployment, which is already known to be a risk factor for occupational injuries., Conclusions: Economic development appears to have an impact on the incidence of occupational injuries in Austria. Health policy should emphasize the necessity for safety at work particularly in phases of economic slowdown.

Background: Many studies have shown that mortality increases with decreasing level of education. This paper aims to identify those causes of death that contribute most to educational mortality differentials in Austria, and to reveal those causes of death for which the relative differentials are higher-than-average., Methods: Individual-level 1991 census and death registry records for the entire Austrian population were linked for a follow-up period of one year. Mortality differentials were measured using the regression-based Relative Index of Inequality (RII)., Results: Causes of death contributing most to educational mortality disparities among men were lung cancer (13%), digestive diseases (13%), ischemic heart disease (12%) and the category 'other circulatory diseases' (11%); among females, corresponding conditions were all circulatory diseases combined (58%) and 'other neoplasms' (14%). Compared to all-cause mortality differential among men (RII = 0.72), larger relative disparities were observed for alcohol-associated deaths (RII = 1.71), followed by digestive and respiratory diseases (RII = 1.21 and 1.07, respectively), stomach and lung cancer (RII = 1.04 and 1.08, respectively), injuries (RII = 1.15) and suicides (RII = 0.97). Among females, disparities that were considerably larger than for all-cause mortality (RII = 0.46) were identified for diabetes (RII = 1.35), injuries (RII = 1.12), cerebrovascular disease (RII = 0.94), respiratory diseases (RII = 0.84) and ischemic heart disease (RII = 0.75). For causes of death combined that are amenable to medical intervention, the differentials were surprisingly large (RII(males) = 0.57; RII(females) = 0.48), given that Austria has a comprehensive, social health-care system., Conclusion: Efforts to reduce high death rates among the less-educated for identified diseases that contribute largely to overall mortality disparity could increase average life expectancy and improve the general health status of the Austrian population.

Recent technical developments in genetic testing has led to a situation where the DNA in previously stored tissue samples can be extracted and used for genetic analysis. This raises the question of how to decide whether a specific use of such samples should be allowed. Using the genetic testing of ancient DNA in general, and the DNA of the pharaoh Tutankhamen in particular as examples this paper analyses the question. It investigates whether ethical frameworks based on proxy consent, cultural affiliation, ownership, or the privacy rights of the dead are appropriate and justifiable in this context. The conclusion is that frameworks based on proxy consent, cultural affiliation, and ownership are not very useful.

The impact factor (Institute for Scientific Information, ISI, Philadelphia, PA, USA) is a widespread used and acknowledged source for judging the quality of a researcher. In addition the "Science Citation Index (SCI)" [Institute for Scientific Information (ISI)] provides the scientific community with a citations database indicating the number of cited references in indexed articles. For several reasons, the SCI seems to be more relevant. To evaluate the quality of the journal "Wiener klinische Wochenschrift", we assessed how often contributors to this journal have been cited during the last decade and which contributions have ranked as top papers. Moreover, with the aim of a more objective type of scientific evaluation, we have employed a new score, the "Citation Per Time Score (CPT-Score--the SCI divided by the number of years of observation, starting one year after publication). We have evaluated the total SCI for the years 1990 to 1994 and for the years 1995 to 1999. The number of total citations between the appearance of an article and the year 2000 was analyzed. The highest ranked publication of the whole decade (1990-2000) was a paper by G. Stanek with 40 citations. Furthermore, we have evaluated the "Top Ten Papers" of the journal. Interestingly, a steady increase of the total citation index of the journal "Wiener klinische Wochenschrift" over the last decade could be demonstrated. This study clearly shows that the citation rate of an article is not determined by the impact factor of the journal but rather the quality of the contribution. Moreover, the citation analysis of papers published in the last ten years in the "Wiener klinische Wochenschrift" shows a satisfactory citation rate for articles published in this journal. It is therefore definitely attractive to submit an article to a journal such as the "Wiener klinische Wochenschrift".

Introduction and Purpose: Marked activation of natural foci of tularemia in the known endemic area of Central Europe, comprising the borderland of Slovakia, Austria and the Czech Republic, led to an epidemic outbreak in western Slovakia and an increase in the number of human tularemia cases in the adjoining regions of northeastern Austria and southern Moravia from 1995 to 1997. The aim of this paper was to present the results of a longitudinal study on the prevalence of infection with Francisella tularensis in small mammals and ticks in six localities of western Slovakia and northeastern Austria from 1991 to 1997, and to draw attention to the importance of systematic surveillance of natural foci for epidemiologic prognoses and for taking preventive measures., Methods: In Slovakia, three localities of the Záhorie lowland were monitored for 3 to 6 years (1991 to 1996) for the presence of F. tularensis in small terrestrial mammals. In Austria, small mammals and ticks from three localities were investigated for 1 to 3 years (1994 to 1997). Spleens of live-trapped animals (at 1- to 2-month intervals) and ticks collected by flagging (in 6- to 8-week intervals) were examined by inoculation of pools into white mice, or individually by cultivation., Results: In four localities under investigation (three localities in western Slovakia and one in Austria), a nearly simultaneous flare-up of tularemia epizootics was recorded in the autumn of 1994. The highest mean prevalence of infection in small mammals was 3.9% in the last quarter of the year, which along with isolations of F. tularensis from Dermacentor reticulatus ticks collected from vegetation in the locality of Austria (1.3% positivity), indicated the high epizootic activity of foci. F. tularensis was isolated from five rodent species--Apodemus flavicollis, A. sylvaticus, Clethrionomys glareolus, Microtus arvalis and Sorex araneus. From 1995 to 1996, the persistent activity of the focus was repeatedly confirmed by isolations of F. tularensis from D. reticulatus ticks. In 1995 a natural focus of tularemia was detected in a further locality of Austria, where the agent was isolated from D. reticulatus. The increased epizootic activity of foci in the endemic region of Central Europe indicated a higher risk of acquiring tularemia for humans and was, in fact, followed by an epidemic outbreak in western Slovakia as well as by a large number of cases in Austria and the Czech Republic., Conclusion: Our findings clearly demonstrate that long-term surveillance of natural foci in endemic regions provides useful information on the activation of tularemia foci before the onset of epidemic outbreaks, thus permitting timely epidemiologic prognoses and the institution of preventive measures.

Inadequate pain management of cancer patients remains a striking problem despite impressive scientific progress in the knowledge of the pathophysiology, pathogenesis and therapy of pain. Our paper focuses on three topics: 1. physician-related barriers, 2. patient-related barriers, and 3. society- and tradition-related barriers as well as government regulations. It is imperative to overcome these barriers, especially since legal regulations for pain management were embodied into statutory regulations in Austria two years ago.

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

We report about our experience with the patient data management system (PDMS) Hewlett Packard CareVue 9000 at two neonatal ICUs. We describe our PDMS configuration (hard- and software), local adjustments and enhancements such as knowledge based systems for calculating the parenteral nutrition of newborn infants (VIE-PNN), for advising medication (VIE-Nmed), and for managing mechanical ventilation (VIE-VENT), and the results of a structured interview with our staff members about the acceptance of the system. Despite some criticism nearly all collaborators liked the system, especially because of its time saving automated documentation of vital data and mechanical ventilation parameters. More than 2/3 preferred the computer assisted documentation to charting by hand, only 1/41 would have liked to return to paper documentation. All staff members possessed excellent (15/39) or good (24/39) knowledge of the system. Main points of critique were the system's therapy planning facilities (medication administration records), the restrictive facilities for documenting patient care and the yet unsolved problems of data evaluation and export. PDM systems have to be constantly adapted to the user's needs and to the changing clinical environment. Living with the system asks for an intensive dialog with the system and its functionalities, for creativity and well defined ideas about the future system development.

Register and Multicenter Study for Testicular Tumours Bonn was founded in September 1976. Until August 1981, from 46 institutions participating in Austria and the Federal Republic of Germany the data from a total of 1508 patients with testicular tumours have been collected and evaluated. This paper gives an overview on the data available at the moment, and especially informations on the age distribution (children 3.6%, men over 50 years 6.3%), predisposing factors (maldescensus testis 8%, atrophy 6%), masking factors (hydrocele 7%, trauma 7%) and duration of anamnesis (average 136 days).