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The rollout of electric vehicles and photovoltaic panels is essential to mitigate climate change. However, they depend on technology-critical elements (TCEs), which can be harmful to human health and whose use is rapidly expanding, while recycling is lacking. While mining has received substantial attention, in-use dissipation in urban areas has so far not been assessed, for example, corrosion and abrasion of vehicle components and weather-related effects affecting thin-film photovoltaic panels. Therefore, the question arises to which extent TCEs dissipate during use and which potential non-occupational human health impacts could occur. We assessed the available information on urban in-use dissipation and human health concerns and conducted exploratory modeling of in-use technology stocks, in- and outflows, and in-use dissipation of neodymium, dysprosium, lanthanum, praseodymium, cerium, gallium, germanium, and tellurium contained in 21 vehicle and renewable energy technologies, for Vienna, Austria. In prospective scenarios, TCE dynamics in a trend-continuation vis à vis official city policy plans and a more ambitious transition scenario were then assessed. We find that electrifying the vehicle fleet without demand-reduction is the main driver of TCE consumption, effectively doubling cumulative end-of-life outflows to 3,073 [2,452-3,966] t and cumulative in-use dissipation to 9.3 [5.2-15.7] t by the year 2060. Sufficiency-based measures could reduce demand and in-use dissipation well below levels with continued trends, thus highlighting the need to combine decarbonization with demand-reducing measures. These results help assess potential future in-use dissipation dynamics and inform discussions about potential public health hazards associated with exposure to TCEs accumulating in the urban environment., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Journal of Industrial Ecology published by Wiley Periodicals LLC on behalf of International Society for Industrial Ecology.)

Telehealth is a valuable tool for reminding transgender-persons to undergo HIV testing, hormone injections, and voice training. Despite increased awareness of the unique health needs of transgender-individuals in recent years, effectively addressing their concerns remains challenging. The COVID-19 pandemic has negatively affected socioeconomic status, mental health, and access to gender-affirming treatment. To better understand how individuals and their specific health issues are addressed in telehealth solutions, we conducted a scoping review using PubMed and Scopus, spanning from 2000 to 2021. We screened eligible articles following the PRISMA checklist, extracted the data, and performed a thematic analysis of 100 reports. For control purposes, we double-checked the ratings during the screening and coding. Our results show that telehealth is primarily used for healthcare access, sexual and reproductive health, and mental health. Since 2020, the overall number of publications has greatly increased, with only nine reports explicitly referring to COVID-19-related challenges. The latter relate exclusively to clinical purposes such as healthcare access. We found that transgender-women were researched more often than transgender-men, particularly in the field of sexual and reproductive health research. Some studies included groups other than transgender-persons, such as parents or clinicians, who might be relevant for advancing telehealth use. The review's findings highlight the need for more research that considers the diversity of transgender-groups and the adapted use of diverse technological tools beyond pandemics and public health crises., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gahbauer and Haluza.)

Over the recent decades, technological advancements have led to a rise in the use of so-called technology-critical elements (TCEs). Environmental monitoring of TCEs forms the base to assess whether this leads to increased anthropogenic release and to public health implications. This study employs an exploratory approach to investigate the distribution of the TCEs Li, Be, V, Ga, Ge, Nb, Sb, Te, Ta, Tl, Bi and the REYs (rare-earth elements including yttrium) in urban aerosol in the city of Vienna, Austria. Leaf samples (n = 292) from 8 plant species and two green facades and water samples (n = 18) from the Wienfluss river were examined using inductively coupled plasma tandem mass spectrometry (ICP-MS/MS). Surface dust contributions were assessed by washing one replicate of each leaf sample and analysing the washing water (n = 146). The impacts of sampling month, plant species and storey level on elemental distribution were assessed by statistical tools and generative deep neural network modelling. Higher TCE levels, including Li, V, Ga, Ge, Tl, Bi, and the REYs, were found in the winter months, likely due to the use of de-icing materials and fossil fuel combustion. A. millefolium and S. heufleriana displayed the highest levels of Li and Ge, respectively. In addition, increased elemental accumulation at lower storeys was observed, including Be, Sb, Bi and the REYs, indicating greater atmospheric dust deposition and recirculation closer to ground level. The results suggest a broad association of TCE levels with urban dust. This study enhances the current understanding of TCE distribution in urban settings and underscores the importance of their inclusion in pollution monitoring. It highlights the complex interplay of human activities, urban infrastructure, and environmental factors, offering valuable insights for managing urban environmental health risks and underlining the need for comprehensive urban ecosystem studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Urban horticulture poses a sustainable form of food production, fosters community engagement and mitigates the impacts of climate change on cities. Yet, it can also be tied to health challenges related to soil contamination. This work builds on a previous study conducted on eleven urban gardens in the city of Vienna, Austria. Following the findings of elevated Pb levels in some soil and plant samples within that project, the present study investigates the elemental composition of soil and plants from two affected gardens 1 year after compost amendment. Inductively coupled plasma mass spectrometry (ICP-MS) analysis of skin, pulp and seeds of tomato fruits revealed minor variations in elemental composition which are unlikely to have an impact on food safety. In turn, a tendency of contaminant accumulation in root tips and leaves of radishes was found. Washing of lettuce led to a significant reduction in the contents of potentially toxic elements such as Be, Al, V, Ni, Ga and Tl, underscoring the significance of washing garden products before consumption. Furthermore, compost amendments led to promising results, with reduced Zn, Cd and Pb levels in radish bulbs. Pb isotope ratios in soil and spinach leaf samples taken in the previous study were assessed by multi-collector (MC-) ICP-MS to trace Pb uptake from soils into food. A direct linkage between the Pb isotopic signatures in soil and those in spinach leaves was observed, underscoring their effectiveness as tracers of Pb sources in the environment., (© 2024. The Author(s).)

Recently, the One Health concept, which recognizes the interconnectedness of environmental, animal, and human health, has gained popularity. To collect data on environmental pollutants potentially harmful to human health over time, researchers often turn to natural organisms known as biomonitors. Honey bees, in particular, prove to be exceptionally valuable biomonitors due to their capacity to accumulate pollutants from the air, soil, and water within a specific radius during their foraging trips. This systematic literature review summarizes the previous application of the bee species Apis mellifera in pollutant monitoring in articles published during the period of 2010-2020. Nineteen studies were included in this systematic literature review. Of these studies, the majority ( n = 15) focused on the detection of heavy metals in honey bees and beehive products, while 4 studies focused on air pollution by polycyclic aromatic hydrocarbons or particulate matter. The matrix most often applied was the whole honey bee. The included studies demonstrated that honey bees and hive products deliver quantitative and qualitative information about specific pollutants. In this regard, the whole honey bee was found to be the most reliable biomonitor. We found that the included studies differed in design and the methods used. Standardized studies could foster a more consistent interpretation of the levels detected in beehive matrices from an environmental health perspective.

COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation (p-value <0.001). Examination of risk factors based on multivariate logistic regression analysis showed that alcohols and alcohols-based materials were associated with skin effects (OR, 1.98; 95%CI, 1.87-2.09), per-chlorine was associated with eye effects (OR, 1.83; 95%CI, 1.74-1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90-2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). The use of sodium hypochlorite and per-chlorine also had a high chance of having respiratory effects. The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics especially when they are used or overused., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Artificial intelligence (AI) has the potential to revolutionize research by automating data analysis, generating new insights, and supporting the discovery of new knowledge. The top 10 contribution areas of AI towards public health were gathered in this exploratory study. We utilized the "text-davinci-003" model of GPT-3, using OpenAI playground default parameters. The model was trained with the largest training dataset any AI had, limited to a cut-off date in 2021. This study aimed to test the ability of GPT-3 to advance public health and to explore the feasibility of using AI as a scientific co-author. We asked the AI asked for structured input, including scientific quotations, and reviewed responses for plausibility. We found that GPT-3 was able to assemble, summarize, and generate plausible text blocks relevant for public health concerns, elucidating valuable areas of application for itself. However, most quotations were purely invented by GPT-3 and thus invalid. Our research showed that AI can contribute to public health research as a team member. According to authorship guidelines, the AI was ultimately not listed as a co-author, as it would be done with a human researcher. We conclude that good scientific practice also needs to be followed for AI contributions, and a broad scientific discourse on AI contributions is needed., Competing Interests: The authors declare no conflicts of interest.

The COVID-19 pandemic has resulted in significant changes in every aspect of our lives. Because of the measures imposed, people were only allowed to leave their homes for certain purposes, and all types of cultural and sports events were canceled. Climbers were greatly affected by these limited options for regular physical activity outside of the home environment. Little is known about the crisis' effects on the climbing community in German-speaking regions. Thus, we surveyed 1028 German-speaking climbers (mean age 34.6 years, SD 10.4; 50.4% females) from December 2020 to February 2021. A cross-sectional online survey collected data on climbing frequency and preferences as well as levels of life satisfaction, using the standardized Short Life Satisfaction Questionnaire for Lockdowns (SLSQL) before and during the crisis. Results showed that due to the pandemic, study subjects climbed less frequently, preferred outdoor locations to climb, and showed decreased life satisfaction scores (21%, (d = 0.87, p < 0.001). In conclusion, these findings highlighted that the COVID-19 pandemic had a negative effect on climbing sports activities and life satisfaction in this study sample. To preserve physical and mental health, indoor and outdoor sport activities should be continued as much as possible with reasonable hygiene concepts in place.

Current climate change aggravates human health hazards posed by heat stress. Forests can locally mitigate this by acting as strong thermal buffers, yet potential mediation by forest ecological characteristics remains underexplored. We report over 14 months of hourly microclimate data from 131 forest plots across four European countries and compare these to open-field controls using physiologically equivalent temperature (PET) to reflect human thermal perception. Forests slightly tempered cold extremes, but the strongest buffering occurred under very hot conditions (PET >35°C), where forests reduced strong to extreme heat stress day occurrence by 84.1%. Mature forests cooled the microclimate by 12.1 to 14.5°C PET under, respectively, strong and extreme heat stress conditions. Even young plantations reduced those conditions by 10°C PET. Forest structure strongly modulated the buffering capacity, which was enhanced by increasing stand density, canopy height and canopy closure. Tree species composition had a more modest yet significant influence: that is, strongly shade-casting, small-leaved evergreen species amplified cooling. Tree diversity had little direct influences, though indirect effects through stand structure remain possible. Forests in general, both young and mature, are thus strong thermal stress reducers, but their cooling potential can be even further amplified, given targeted (urban) forest management that considers these new insights., (© 2022 John Wiley & Sons Ltd.)

Golf is an outdoor sport played worldwide, and golfers of all ages benefit from regular exercise and social contact. The COVID-19 crisis has led to lockdowns, curfews, and closures of golf courses and other indoor and outdoor sports facilities. This study aimed to retrospectively assess how golfers perceived the impact of the crisis on physical activity and life satisfaction. We conducted a cross-sectional online survey among 1,115 golfers (61% men, mean age 55.0 years) in German-speaking countries, mainly Austria and Germany, from March to June 2021. When comparing ratings before and during the COVID-19 period, participants reported exercising more indoors at home independently or with online instructions. Likewise, the popularity of exercising outdoors in publicly accessible open spaces increased overall, especially in rural areas by about 10%. Life satisfaction decreased significantly by 24.2% ( p < 0.001) during the pandemic. From a public health perspective, access to outdoor sports facilities such as golf courses might alleviate the negative psychosocial and health effects of home confinement and restricted access to indoor sports facilities. Further research is recommended to evaluate the longer-term impact of COVID-19-related measures on the physical activity and life satisfaction of golfers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jungwirth, Angerer and Haluza.)

The COVID-19 pandemic has dramatically impacted human lifestyles across the world. Lockdowns and home confinement decreased prior opportunities for everyday physical activity. To retrospectively assess how the Austrian population coped with these aspects of the crisis, we conducted a cross-sectional online survey from March to September 2021 using a structured questionnaire in German. In total, 1214 participants (56.9% females, mean age 37.0 years) living across Austria shared self-reported information on sociodemographic characteristics, indoor and outdoor physical activity, reasons for being outdoors, and life satisfaction before and after the emergence of the virus. As a result, overall indoor physical activity significantly decreased in a before-during COVID-19 crisis comparison, although exercising at home with online instructions increased by about 63%. Exercising outdoors increased overall, specifically in periurban forests and rural areas, both by about 9%. Life satisfaction decreased significantly by 19.7% ( p < 0.001). Outdoor public places and natural environments gained importance due to restrictions affecting access to sport facilities. Further research is needed to evaluate benefits and therapeutic values of outdoor nature for physical and mental health in times of a global pandemic to maintain resilient societies, as it might impact future active living and life satisfaction.

Developed in the pre-internet era in the early 1980s, empirical medical practice, i.e., evidence-based practice (EBP) has become crucial in critical thinking and statistical reasoning at the point-of-care. As little evidence is available so far on how EBP is perceived in the Austrian academic context, we conducted a cross-sectional online survey among a nonrandom purposive sample of employees and students at the Medical University Vienna, Austria (total n = 1247, 59.8% females). The German questionnaire assessed both EBP capability beliefs and EBP use, with the respective indices both yielding good internal consistency. We conducted subgroup comparisons between employees ( n = 638) and students ( n = 609). In line with Bandura's self-efficacy theory, we found a correlation between EBP capability beliefs and EBP use, with higher scores reported in the employee group. The results indicated that the participants did not strictly follow the sequential EBP steps as grounded in the item-response theory. Since its emergence, EBP has struggled to overcome the dominating traditional way of conducting medicine, which is also known as eminence-based medicine, where ad hoc decisions are based upon expert opinions, and nowadays frequently supplemented by quick online searches. Medical staff and supervisors of medical students should be aware of the existing overlaps and synergies of these potentially equivalent factors in clinical care. There is a need for intensifying the public and scientific debate on how to deal with the divergence between EBP theory and EBP practice.

Background and objectives: With the digitalization of modern healthcare delivery, digital media adoption in clinical practice is increasing. Also, healthcare professionals are more and more confronted with patients using smartphone-based health applications (apps). This exploratory study aimed at surveying perceptions on such apps in the context of lung health among a cross section of Austrian practitioners involved in pulmonary care. Materials and Methods: The online questionnaire in German assessed socio-demographic characteristics, telehealth readiness as well as opinions on smoke-free and COPD (chronic obstructive pulmonary disease) apps. We used descriptive statistics to report the finding. Results: We received valid responses from 55 participants (mean age 52.3 years, 69.1% males). Telehealth readiness was medium, indicating existence of certain barriers adversely impacting telehealth use. As for apps targeting smoking cessation and COPD, respondents indicated high relevance for visualization aspects for patients and control/overview features for the treating doctors. Only 40% of participants indicated that they would recommend a COPD app to an older patient. Conclusions: In smoking cessation therapy, doctors commonly adhere to the "5 A's": Ask, Advise, Assess, Assist, and Arrange. We suggest adding "App" as sixth A, assuming that in patient follow-up most of the other A's could also be supported or even replaced by app features in the challenging task to tackle smoking-associated non-communicable diseases.

Digitalized healthcare services offer remote and cost-effective treatment of diabetes patients. Thus, the present online study analyzed the readiness to use telemonitoring among Austrian diabetes patients. We developed and validated a German version of the patient telehealth readiness assessment tool and performed quantitative context analysis of free-text comments on perceived barriers and benefits of telemonitoring. Participants (n = 41, 42.6% females) achieved a medium average readiness level for telemonitoring. The three top benefits were intensified care, shorter travel and waiting times, and better therapy adjustment. The top three barriers were data privacy issues, loss of personal communication and focus on blood sugar, and teledoctor competence. Diabetes patients represent a suitable target group for remote treatment opportunities. However, a shift from traditional face-to-face medical care to exclusive telemonitoring treatment from diagnosis to consultation and treatment requires fundamental new legal framework conditions.

Physicians increasingly use medical applications to facilitate clinical information management. The respective effect on clinical communication and quality of healthcare provision has not been studied in the Austrian context so far. Thus, the current cross-sectional online study analyzed prevalent medical applications use and views on clinical communication competence in everyday medical practice among Austrian physicians (n = 151) and validated the survey tool. More than half of the participants used medical applications in daily clinical practice. The top three benefits of medical applications use were higher quality of healthcare, location-independent health service access, and higher efficiency in healthcare resource allocation. Moreover, study participants felt that communication competence acquired during medical studies inadequately prepared them for daily clinical practices. Medical applications use certainly affects the therapeutic alliance between patients and physician. This study supports the importance of initiating an open, constructive discussion among healthcare stakeholders and developing according to evidence-based guidelines.

The Sun Exposure and Protection Index (SEPI) is a brief instrument for scoring of sun exposure habits and propensity to increase sun protection, previously validated in English and in Swedish, as well as in two different outdoor sun intensity environments (Australia and Northern Europe). The aim of the present study was to study reliability and validity of a German translated version of the SEPI to be used in German-speaking populations. Data was collected at University of Flensburg and at Hamburg University of Applied Sciences from November 2018 to April 2019. Participants (n = 205) filled out the SEPI and also a selection of corresponding questions from the Austrian Vienna UV Questionnaire in German. After three weeks, the participants filled out the SEPI once again in order to assess test-retest stability. Of the 205 participants completing the baseline questionnaire, 135 participants completed it once again after three weeks. Internal consistency, by Cronbach's alpha, for the baseline responses was 0.70 (95% C.I: 0.63-0.76) for SEPI part 1 (sun exposure habits) and 0.72 (95% C.I: 0.66-0.78) for part 2 (propensity to increase sun protection). Test-retest stability was high, with weighted Kappa >0.6 for all items but one, and the instrument correlated well with the previously validated German-language UV Skin Risk Survey Questionnaire. In conclusion, the German version of SEPI can reliably be used for mapping of individual sun exposure patterns.

In today's digitalized world, most parents are Internet-savvy and use online sources for child health information, mainly due to the 24/7 availability of advice. However, parents are often not specifically trained to identify reliable, evidence-based sources of information. In this cross-sectional online survey among a purposive, non-probabilistic sample of Austrian parents ( n = 90, 81.1% females), we assessed aspects of health app use and family policy benefits-related and scenario-based Internet seeking behavior. We found that the surveyed parents showed a high health app use. The participants indicated that they prefer online information seeking to any other option in a scenario describing that their child would be sick at after-work hours, with social media channels being the least preferred source of online information. Mothers and younger parents were more likely to retrieve online information on family policy benefits. With the smartphone in everybody's pocket, parents seemed to rely on mobile and online content when searching for child health information. Pediatricians are best suited to decide what treatment fits the child or their current medical condition, but nowadays they face increasing numbers of pre-informed parents seeking health information online. Provision of targeted parental education and guidance through the online information jungle could effectively empower parents and smooth personal and digital contacts in the delicate doctor-parent-child triangle.

Prior research shows that forests contribute to human health and well-being. In this sense, this cross-sectional case study, adopting the principles of citizen science, assessed the restorative potential of places in the Hallerwald, an Austrian community forest. A convenience sample of adult forest visitors (n = 99, 64% females) completed a survey during a guided 2.5 h forest tour. The German questionnaire assessed the qualities of defined places in the forest. We also investigated changes in mood states, perceived stress, restoration, connectedness, and mindfulness before and after visiting the forest. In cooperation with a local working group, we developed the new Widen One's Mind (WOM) scale, which showed good scale characteristics. All places received high scores in their potential to increase restoration and vitality and to widen one's mind. Positive affect, restoration, connectedness with nature and the forest, and mindfulness increased pre- versus post-visits, whereas negative affect and perceived stress decreased. The findings of this study suggest that in recreational forests, visitors experience beneficial mental effects such as stress reduction in addition to physical exercise. To facilitate regional development goals, we recommend evaluating places in forests regarding the potential effects on the health and well-being as well as citizen participation before initiating extensive remodeling.

With the emergence of an always-on culture and the private smartphones always within reach, professional and recreational contexts overlap. Little empirical knowledge is available on prevailing online habits among healthcare personnel and whether gender matters in this context. To investigate health technology-related preferences, we conducted an online survey among a purposive sample of employees and students at the Medical University of Vienna, Austria. In total, 905 participants (59.0%, 540/905, females) provided self-reported information on use of online services and mobile health applications (apps) as well as respective gender-specific internal and external apperceptions. Mann-Whitney U tests and binary regression analysis assessed respective gender differences. The structured German questionnaire was validated by principal component analysis. The study found a moderate familiarity with health technologies. As for gender differences, prevailing health app use was high among both male and female participants (39, 141/365, and 42%, 229/540, respectively), with apps for tracking activity and nutrition habits most commonly used. Approval for monitoring health and lifestyle parameters, eHealth and telemedicine knowledge levels, and online health information retrieval predicted health app use, whereas gender did not. Socio-demographic attributes including gender influence not only private online habits of users, but might also affect acceptance of health technologies and their professional use in a clinical setting. Thus, addressing the gender dimension already in concept stages of digital devices and services for healthcare and lifestyle could speed up private and public adoption of health technologies., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: As part of the mobile revolution, smartphone-based applications (apps) have become almost indispensable in today's information society. Consequently, the use of medical apps among healthcare professionals has increased heavily over the past years. As little is known on medical app use in day-to-day clinical practice in Austria, the present study aims at closing this knowledge gap by assessing respective prevalence, readiness, and concerns among Austrian practitioners., Methods: We conducted a cross-sectional online survey among a sample of 151 Austrian doctors (mean age 45.0, SD 12.0, 55.0% females). We developed a German study questionnaire on the basis of the Practitioner Telehealth Readiness Assessment Tool (PRAT) to assess medical app use-related readiness and attitudes, and validated it using principal component analysis., Results: In our study, 74% of participants used medical apps on a daily basis, with clarity, ease of use, speed, and support in clinical routine mentioned as most important app features. However, the majority of participants perceived certain barriers to use medical apps. Younger participants used more medical apps, were more likely to use them during work, and yielded higher readiness scores. The most often used medical apps were Diagnosia and Embryotox (both 28.5%)., Conclusions: Nowadays, medical apps serve as an important source of information for many doctors and are especially popular among younger physicians. The omnipresence of smartphones in the smocks of healthcare workers raised awareness for potential shortcomings regarding disruption of traditional face-to-face doctor-patient interaction among all healthcare stakeholders. This study's finding thus highlight the need for initiating a public discussion on legal and social frameworks to successfully integrate mobile apps into everyday clinical.

Technological advances toward consumer-specific expectations require a sustained commitment and coordination across policy- and decision-makers. The present scenario-based study aimed at identifying prevailing perceptions regarding telehealth applications among Austrian healthcare experts. During a two-round online Delphi survey, panelists rated perceived benefits, obstacles, innovativeness, desirability, and estimated implementation date of 10 telehealth scenarios. Panelists (n = 73, 74% males) perceived that the implementation of telehealth scenarios could especially improve patients' knowledge, quality of social healthcare, and living standard. In contrast, the three top-ranked obstacles were costs, technical prerequisites, and data security. Survey participants rated innovativeness of the presented future scenarios as quite high, whereas perceived desirability was moderate. Overall, ratings suggested precautious attitudes toward technological innovations. The survey findings suggest building taskforces and enhancing communication between healthcare stakeholders to proactively shape the future of telehealth in Austria.

Digitalization affects almost every aspect of modern daily life including healthcare delivery. Successful adoption and sustainable integration of information technology-based eHealth and telemedicine concepts in clinical practice depend on constant evaluation of end user needs, proficiencies, and preferences. We therefore assessed how current and future healthcare professionals perceived health technology solutions and whether their perceptions differed. We conducted an online survey among a purposive sample of employees and students at the Medical University of Vienna, Austria. The structured questionnaire collected self-reported practices and beliefs in the context of eHealth and telemedicine among 905 participants (59.0% females), of which 48.4% were employees and 51.6% were students. Participants expressed moderate knowledge of eHealth and telemedicine concepts with higher levels among employees compared to students (both: p<0.05). Compared to employees, students were less convinced that online health information improves patient knowledge (p<0.001), but were more optimistic that telemedicine reduces healthcare costs (p<0.05). Participants doubted that telemedicine services would enhance the doctor-patient relationship and raised concerns regarding data security and privacy issues. Accordingly, quantitative context analysis of free text comments revealed that the four most frequently mentioned themes were related to issues concerning data privacy and security, questions of responsibility, doctor-patient interaction, and reliability of information. This study provides valuable insights into how current and future healthcare professionals differ in their perceptions regarding eHealth and telemedicine. These findings raise awareness of the need to bridge the gap between digital age groups and professional groups, especially in clinical healthcare delivery in a clocked-through, strenuous academic setting as found at a medical university., Competing Interests: The authors have declared that no competing interests exist.

Background: Telemonitoring services could dramatically improve the care of diabetes patients by enhancing their quality of life while decreasing healthcare expenditures. However, the potential for implementing innovative treatment options in the Austrian public and private health system is not known yet. Thus, we analyzed the readiness to use telemonitoring in diabetes care among Austrian practitioners., Methods: We conducted an online survey among a purposive sample of Austrian practitioners (n = 41) using an adapted German version of the practitioner telehealth readiness assessment tool. We assessed three readiness domains for telemonitoring in the context of diabetes care, i.e. core readiness, engagement readiness, and structural readiness, and validated the German tool using principal components analysis., Results: Study subjects perceived themselves as open to innovations and also expressed optimistic attitudes towards telemonitoring in general and offering telemonitoring-based services for their patients. Participants achieved a medium average readiness level for telemonitoring (58.2, 95% CI 53.9-62.5) and were thus in a good position to use telemonitoring, although some arguments may adversely affected its use. The top three perceived benefits of telemonitoring were enhanced quality of treatment, better therapy adjustment, and reduced travel and waiting times for patients. The top three barriers were reduced personal communication, practitioner time expenditure and equally placed poor financial compensation as well as data security and privacy issues., Conclusion: Our data revealed that Austrian practitioners showed a quite moderate readiness to use telemonitoring in diabetes care. To further advance telemonitoring readiness among all pillars of diabetes care in Austria, joint efforts among healthcare stakeholders are required to overcome existing financial, organizational, and technical obstacles.

Aim: To explore how nurses recover from night shift work during periods off duty., Background: Given the large number of affected individuals globally, detrimental health outcomes of night shift work are an important public health issue. Sufficient recovery opportunities are essential to prevent prolonged fatigue associated with demanding tasks and high workload as experienced in nurses working long shifts during the night., Method: Nurses (n = 53, 96% females) who worked in two public nursing homes in Austria completed a 5-day diary to collect data on well-being conceptualized by fatigue, distress and vigour., Results: Nurses experienced worse well-being post night shift days than during rest days. Well-being improved from post night shift day 2 to the following rest day 1 and continued improvement from rest day 1 to rest day 2., Conclusions: Nurses who work at nights are at risk for experiencing prolonged fatigue. Our results suggest that after two consecutive 12-hr night shifts full recovery needs at least three days off work., Implications for Nursing Management: Strategies for maintaining nurses' good health and caring attitudes as well as vigilance for patient safety should include fatigue management plans and optimised schedules for night shift work., (© 2018 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd.)

New technological developments affect almost every sector of our daily lives including the healthcare sector. Successful adoption and sustainable integration of eHealth and telemedicine in Public Health strategies (also known as Public eHealth) depend on knowledge and constant evaluation of consumers' needs, proficiencies, and preferences. We therefore assessed how the general Austrian population perceived innovative Public eHealth solutions. The online survey on 562 Austrian adults (58.9% females) collected self-reported data on current and expected use of smartphone-based health applications (apps) of digital natives (35 years and younger) and digital immigrants (aged 35+). In total, 26.7% (95% CI 23.0-30.4) of participants already used health apps, especially lifestyle-associated apps for monitoring exercise habits and nutritional habits. We found substantial digital age group differences; compared to digital immigrants digital natives were more likely to use mobile devices and health apps. Health apps have the potential to improve community health and prevent lifestyle diseases cost-effectively and efficiently, and thus build an important pillar of Public eHealth. With regard to aging societies, healthcare providers could take advantage of consumer-oriented health apps by assessing individual needs of specific target groups such as elderly people.

Background: Medical device regulations which aim to ensure safety standards do not only apply to hardware devices but also to standalone medical software, e.g. mobile apps., Objectives: To explore the effects of these regulations on the development and distribution of medical standalone software., Methods: We invited a convenience sample of 130 domain experts to participate in an online survey about the impact of current regulations on the development and distribution of medical standalone software., Results: 21 respondents completed the questionnaire. Participants reported slight positive effects on usability, reliability, and data security of their products, whereas the ability to modify already deployed software and customization by end users were negatively impacted. The additional time and costs needed to go through the regulatory process were perceived as the greatest obstacles in developing and distributing medical software., Conclusion: Further research is needed to compare positive effects on software quality with negative impacts on market access and innovation. Strategies for avoiding over-regulation while still ensuring safety standards need to be devised.

Background: Telemonitoring offers new opportunities in the treatment of chronically ill patients and could help to improve their quality of life while reducing healthcare costs., Objectives: The willingness to use telemonitoring is examined for both physicians and patients. From the perspective of the most important stakeholders, advantages and disadvantages as well as barriers for telemonitoring are analysed., Methods: A Telehealth Readiness Assessment was carried out with physicians (n = 41) and patients (n = 47) in a cross-sectional study. A stakeholder survey was conducted by use of interviews (n = 28)., Results: Average readiness for telemonitoring is 58% for physicians, and 65% for patients. Both are thus in a position where there are several arguments which adversely affect the success of telemonitoring. The most important advantage is the intensified care, while the biggest concerns are data protection as well as the loss of personal communication. The greatest barriers are the lack of funding, the weak clinical and economic evidence and the organisation of the Austrian healthcare system., Conclusion: There are still some barriers to overcome, especially financial, political and organisational.

Along with the digital revolution, information and communication technology applications are currently transforming the delivery of health and social care services. This paper investigates prevailing opinions toward future technology-based healthcare solutions among Austrian healthcare professionals. During a biphasic online Delphi survey, panelists rated expected outcomes of two future scenarios describing pervasive health monitoring applications. Experts perceived that the scenarios were highly innovative, but only moderately desirable, and that their implementation could especially improve patients' knowledge, quality of healthcare, and living standard. Contrarily, monetary aspects, technical prerequisites, and data security were identified as key obstacles. We further compared the impact of professional affiliation. Clearly, opinions toward pervasive healthcare differed between the interest groups, medical professionals, patient advocates, and administrative personnel. These data suggest closer collaborations between stakeholder groups to harmonize differences in expectations regarding pervasive health monitoring.

Ubiquitous Internet access currently revolutionizes the way people acquire information by creating a complex, worldwide information network. The impact of Internet use on the doctor-patient relationship is a moving target that varies across sociodemographic strata and nations. To increase scientific knowledge on the patient-Web-physician triangle in Austria, this study reports findings regarding prevailing online health information-seeking behavior and the respective impact on doctor-patient interactions among a nonprobability convenience sample of Internet users. To investigate digital age group-specific influences, we analyzed whether digital natives and digital immigrants differed in their perspectives. The questionnaire-based online survey collected sociodemographic data and online health information-seeking behavior from a sample of 562 respondents (59% females, mean age 37 ± 15 years, 54% digital natives). Most respondents (79%) referred to the Internet to seek health information, making it the most commonly used source for health information, even more prevalent then the doctor. We found similar predictors for using the Internet as a source for health-related information across digital age groups. Thus, the overall generational gap seems to be small among regular Internet users in Austria. However, study participants expressed a rather skeptical attitude toward electronic exchange of health data between health care professionals and patients, as well as toward reliability of online health information. To improve adoption of electronic doctor-patient communication and patient empowerment, public education and awareness programs are required to promote consumer-centered health care provision and patient empowerment.

Objectives: The present paper presents findings from two studies addressing the effects of the employee's intention to have rest breaks on rest-break frequency and the change of well-being during a workday., Background: Rest breaks are effective in avoiding an accumulation of fatigue during work. However, little is known about individual differences in rest-break behavior., Method: In Study 1, the association between rest-break intention and the daily number of rest breaks recorded over 4 consecutive workdays was determined by generalized linear model in a sample of employees ( n = 111, 59% females). In Study 2, professional geriatric nurses ( n = 95 females) who worked over two consecutive 12-hour day shifts recorded well-being (fatigue, distress, effort motivation) at the beginning and the end of their shifts. The effect of rest-break intention on the change of well-being was determined by multilevel modeling., Results: Rest-break intention was positively associated with the frequency of rest breaks (Study 1) and reduced the increase of fatigue and distress over the workday (Study 2)., Conclusion: The results indicate that individual differences account for the number of breaks an employee takes and, as a consequence, for variations in the work-related fatigue and distress., Application: Strengthening rest-break intentions may help to increase rest-break behavior to avoid the buildup of fatigue and distress over a workday.

Purpose: Adequate recovery opportunities are crucial for preventing long-term health effects of acute load reactions in response to stressful work. However, little is known about the time course of recovery from work during non-working days. Thus, the present study assessed recovery from two consecutive 12-hours day shifts during a period of three rest days among nurses., Methods: In total, 48 nurses (89.6% females) working in three public Austrian nursing homes completed 5-day self-reporting diaries prior to a work phase consisting of two consecutive 12-hours day shifts followed by three consecutive rest days. Therefore, morning and evening fatigue, distress, vigor and sleep were self-assessed by standardized questionnaires. We analyzed the data using multivariate analysis of variance for repeated measures., Results: Study participants experienced worse well-being and a greater decline in well-being on working days compared to rest days. Well-being increased from rest day 1 to rest day 2 in fatigue, vigor and distress. Rest day 2 to rest day 3 showed a further improvement in fatigue and vigor., Conclusions: Understanding the concepts of allostatic load, need for recovery and fatigue is essential to develop personalized working schedules. The results suggest that at least three rest days are necessary for full recovery after two consecutive 12-hours day shifts. Thus, adequate time for recovery enables nurses to maintain caring attitudes with patients, thus contributing to patient safety.

Epidemiological evidence suggests an association between low vitamin D status and risk for various outcomes including cardiovascular diseases, cancer, and type 2 diabetes mellitus (T2DM). Analyzing serum 25-hydroxyvitamin D [25(OH)D] is the most established means to evaluate an individual's vitamin D status. However, cutoff values for 25(OH)D insufficiency as well as for optimal 25(OH)D levels are controversial. This systematic review critically summarizes the epidemiological evidence regarding 25(OH)D levels and the risk for colorectal cancer and T2DM. The meta-analytical calculation revealed a pooled relative risk (RR) of 0.62 (CI 0.56-0.70; I² = 14.7%) for colorectal cancer and an RR of 0.66 (CI 0.61-0.73; I² = 38.6%) for T2DM when comparing individuals with the highest category of 25(OH)D with those in the lowest. A dose-response analysis showed an inverse association between 25(OH)D levels and RR for both outcomes up to concentrations of about 55 ng/mL for colorectal cancer and about 65 ng/mL for T2DM. At still higher 25(OH)D levels the RR increases slightly, consistent with a U-shaped association. In conclusion, a higher 25(OH)D status is associated with a lower risk for colorectal cancer and T2DM; however, this advantage is gradually lost as levels increase beyond 50-60 ng/mL.

Ultra-Violet (UV) radiation covers the spectrum of wavelengths from 100 to 400 nm. The potency and biological activity for a variety of endpoints differ by wavelength. For monitoring and communication purposes, different UV action spectra have been developed. These spectra use different weighting functions. The action spectrum for erythemal dose is the most widely used one. This erythemal dose per time or dose-rate has been further simplified into a "UV index". Following this example, in our review we use the term "index" or (plural) "indices" in a more general description for all simplified single-value measures for any biologically effective UV dose, e.g., for human non-melanoma skin cancer and for previtamin D production rate. Ongoing discussion about the existence of an increased melanoma risk due to UV-A exposure underscores the uncertainties inherent in current weighting functions. Thus, we performed an online literature search to review the data basis for these indices, to understand their relevance for an individual, and to assess the applicability of the indices for a range of exposure scenarios. Even for natural (solar) UV, the spectral composition varies spatially and temporally. Artificial UV sources and personal protection introduce further variation to the spectral composition. Many biological effects are proposed for UV radiation. Only few endpoints have been studied sufficiently to estimate a reliable index. Weighting functions for chronic effects and most importantly for cancer endpoints have been developed in animal models, and often for proxy endpoints only. Epidemiological studies on biological effects of UV radiation should not only depend on single-value weighted UV dose estimates (indexes) but should strive for a more detailed description of the individual exposure. A better understanding of the adverse and beneficial effects of UV radiation by wavelength would also improve medical counseling and health communication regarding individual health-supportive behavior., Competing Interests: The authors declare no conflict of interest.

In a recent study, melanoma incidence rates for Austrian inhabitants living at higher altitudes were found to increase by as much as 30% per 100 m altitude. This strong increase cannot simply be explained by the known increase of erythemally-weighted irradiance with altitude, which ranges between 0.5% and 4% per 100 m. We assume that the discrepancy is partially explainable by upwelling UV radiation; e.g., reflected by snow-covered surfaces. Therefore, we present an approach where the human UV exposure is derived by integrating incident radiation over the 3D geometry of a human body, which enables us to take upwelling radiation into account. Calculating upwelling and downwelling radiance with a radiative transfer model for a snow-free valley and for snow-covered mountain terrain (with albedo of 0.6) yields an increase in UV exposure by 10% per 100 m altitude. The results imply that upwelling radiation plays a significant role in the increase of melanoma incidence with altitude., Competing Interests: The authors declare no conflicts of interest.

New technological developments affect almost every sector of our daily lives, including the healthcare sector. We evaluated how connected health applications, subsumed as eHealth and telemedicine, are perceived in relation to socio-demographic characteristics. The current cross-sectional, online survey collected self-reported data from a non-probability convenience sample of 562 Austrian adults (58.9% females). The concept of eHealth and telemedicine was poorly established among the study population. While most participants already used mobile devices, they expressed a quite low desirability of using various telemedicine applications in the future. Study participants perceived that the most important overall benefits for implementing connected health technology were better quality of healthcare, location-independent access to healthcare services, and better quality of life. The respective three top-ranked overall barriers were data security, lack of acceptance by doctors, and lack of technical prerequisites. With regard to aging societies, healthcare providers, and users alike could take advantage of inexpensive, consumer-oriented connected health solutions that address individual needs of specific target groups. The present survey identified issues relevant for successful implementation of ICT-based healthcare solutions, providing a compilation of several areas requiring further in-depth research.

Objective: The aim of this study was to investigate the impact of age on fatigue prevalence and the potential recovery effect of leisure opportunities., Methods: The study was based on the Austrian Health Interview Survey 2006/2007. We investigated data of a subsample of working adults, which consisted of 5018 subjects (51.8% males) aged 35 to 59 years. A logistic regression analysis stratified by gender explored whether age and leisure opportunities predicted prolonged fatigue., Results: Age was not associated with fatigue in females, but older male employees (55 to 59 years) were at a greater risk for fatigue than the reference group (35 to 39 years). Insufficient leisure opportunities increased the odds for fatigue in both genders and all age groups. However, this effect was especially pronounced in male employees aged 55 to 59 years., Conclusions: These results suggest that older male employees may be in need of more leisure opportunities to recover from work.

Recent studies in African contexts have revealed a strong association between spirit possession and severe trauma, with inclusion into a possession cult serving at times a therapeutic function. Research on spirit possession in the Dominican Republic has so far not included quantitative studies of trauma and dissociation. This study evaluated demographic variables, somatoform dissociative symptoms, and potentially traumatizing events in the Dominican Republic with a group of Vodou practitioners that either do or do not experience spirit possession. Inter-group comparisons revealed that in contrast to non-possessed participants (n = 38), those experiencing spirit possession (n = 47) reported greater somatoform dissociation, more problems with sleep, and previous exposure to mortal danger such as assaults, accidents, or diseases. The two groups did not differ significantly in other types of trauma. The best predictor variable for group classification was somatoform dissociation, although those items could also reflect the experience of followers during a possession episode. A factor analysis across variables resulted in three factors: having to take responsibility early on in life and taking on a professional spiritual role; traumatic events and pain; and distress/dissociation. In comparison with the non-possessed individuals, the possessed ones did not seem to overall have a remarkably more severe story of trauma and seemed to derive economic gains from possession practice.

Recreational sunbed use accounts for the main non-solar source of exposure to ultraviolet radiation in fair-skinned Western populations. Indoor tanning is associated with increased risks for acute and chronic dermatological diseases. The current community-based study assessed the one-year prevalence of sunbed use and associated skin health habits among a representative, gender-balanced sample of 1500 Austrian citizens. Overall one-year prevalence of sunbed use was 8.9% (95% confidence interval (CI) 7.5%-10.4%), with slightly higher prevalence in females (9.2%, 95% CI 7.3%-11.2%) compared to males (8.6%, 95% CI 6.7%-10.6%). Factors predicting sunbed use were younger age (by trend decreasing with older age), place of living, smoking, skin type (by trend increasing with darker skin), sun exposure, motives to tan, and use of UV-free tanning products. Despite media campaigns on the harmful effects of excessive sunlight and sunbed exposure, we found a high prevalence of self-reported sunbed use among Austrian citizens. From a Public (Skin) Health perspective, the current research extends the understanding of prevailing leisure time skin health habits in adding data on prevalence of sunbed use in the general Austrian population.