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In many cases sarcoidosis is a multisystemic disease that requires interdisciplinary medical cooperation in the diagnostics, treatment and medical care during follow-up. Due to the often chronic course, it is of utmost importance to include patients with their priorities and wishes at an early stage and extensively in disease management and to establish a shared decision making whenever possible. In the process of writing this joint position paper, the expert group on interstitial and orphan lung diseases of the Austrian Society for Pulmonology and the working group on rheumatological lung disorders of the Austrian Society for Rheumatology and Rehabilitation sought to include patient advocacy groups as well as experts for rare organ manifestations of sarcoidosis. This position paper is not only meant to reflect current scientific and clinical standards but should also focus the national expertise and by networking and exchange to be a first step to strengthen cooperation between stakeholders to ultimately improve care for patients with sarcoidosis., (© 2024. The Author(s).)

People living with diabetes mellitus can be supported in the daily management by diabetes technology with automated insulin delivery (AID) systems to reduce the risk of hypoglycemia and improve glycemic control as well as the quality of life. Due to barriers in the availability of AID-systems, the use and development of open-source AID-systems have internationally increased. This technology provides a necessary alternative to commercially available products, especially when approved systems are inaccessible or insufficiently adapted to the specific needs of the users. Open-source technology is characterized by worldwide free availability of codes on the internet, is not officially approved and therefore the use is on the individual's own responsibility. In the clinical practice a lack of expertise with open-source AID technology and concerns about legal consequences, lead to conflict situations for health-care professionals (HCP), sometimes resulting in the refusal of care of people living with diabetes mellitus. This position paper provides an overview of the available evidence and practical guidance for HCP to minimize uncertainties and barriers. People living with diabetes mellitus must continue to be supported in education and diabetes management, independent of the chosen diabetes technology including open-source technology. Check-ups of the metabolic control, acute and chronic complications and screening for diabetes-related diseases are necessary and should be regularly carried out, regardless of the chosen AID-system and by a multidisciplinary team with appropriate expertise., (© 2024. The Author(s).)

Public safety (prevention of accidents) is the primary objective in assessing fitness to drive a motor vehicle. However, general access to mobility should not be restricted if there is no particular risk to public safety. For people with diabetes mellitus, the Führerscheingesetz (Driving Licence Legislation) and the Führerscheingesetz-Gesundheitsverordnung (Driving Licence Legislation Health enactment) regulate important aspects of driving safety in connection with acute and chronic complications of the disease. Critical complications that may be relevant to road safety include severe hypoglycemia, pronounced hyperglycemia and hypoglycemia perception disorder as well as severe retinopathy and neuropathy, endstage renal disease and certain cardiovascular manifestations. If there is a suspicion of the presence of one of these complications, a detailed evaluation is required.In addition, the individual antihyperglycemic medication should be checked for existing potential for hypoglycemia. Sulfonylureas, glinides and insulin belong to this group and are therefore associated with the requirement of a 5-year limitation of the driver's license. Other antihyperglycemic drugs without potential for hypoglycemia such as Metformin, SGLT‑2 inhibitors (Sodium-dependent-glucose-transporter‑2 inhibitors, gliflozins), DPP-4-inhibitors (Dipeptidyl-Peptidase inhibitors, gliptins), and GLP‑1 analogues (GLP‑1 rezeptor agonists) are not associated with such a time limitation.The relevant laws which regulate driving safety give room for interpretation, so that specific topics on driving safety for people with diabetes mellitus are elaborated from a medical and traffic-relevant point of view. This position paper is intended to support people involved in this challenging matter., (© 2023. The Author(s).)

Epidemiological investigations have shown that approximately 2-3% of all Austrians have diabetes mellitus with renal involvement, leaving 250,000 people in Austria affected. The risk of occurrence and progression of this disease can be attenuated by lifestyle interventions as well as optimization of blood pressure, blood glucose control and special drug classes. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society of Nephrology for the diagnostic and treatment strategies of diabetic kidney disease., (© 2023. The Author(s).)

Recent epidemiological investigations have shown that approximately 2-3% of all Austrians suffer from diabetes with renal involvement, i. e. 250,000 people in Austria are affected. The risk of occurrence and progression of this disease can be ameliorated by life style interventions as well as optimization of blood pressure, blood glucose levels and special drug classes. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society for Nephrology for the diagnostics and treatment strategies of diabetic kidney disease.

The use of ECMO to stabilize critically ill patients with severely depressed cardiac function and hemodynamics increased in the last years due to broader availability, better performance and easier implantation of the devices. The present guidelines of the Austrian Society of Cardiology focus on the use of ECMO in adult non-operated patients with cardiac diseases. Not only indications and contraindications are highlighted, but also the equally important issues of monitoring, complication management, measures during implantation and operation, and weaning of the devices are treated in detail. Thereby the present guidelines aim to optimize the use of ECMO in the individual centers, and aim to help current non-ECMO centers in developing a local ECMO-program or to contact ECMO-centers for discussion of individual patients.

Exocrine pancreatic insufficiency in diabetic patients is frequent. Studies based on fecal elastase-1 measurement give prevalence rates of about 50 % in type 1 and 33 % in type 2 diabetic patients. Nevertheless, not all patients report typical symptoms like diarrhea, steatorrhea and weight loss. For indirect testing the determination of fecal elastase-1 has the highest sensitivity and specificity. This test should be performed at least in all symptomatic patients. For differential diagnosis celiac disease (with a prevalence of about 3-5 % of type 1 diabetic patients), autonomic neuropathy, but also diseases like irritable colon and gastrointestinal tumors have to be taken into account. Patients with symptoms and a fecal elastase-1 < 100 µg/g should be treated with pancreas enzymes in adequate daily doses administered at main meals. Treatment improves symptoms significantly, supply with fat soluble vitamins is normalised, risk for osteoporosis is reduced. An improvement of glucose metabolism is but not seen in all studies. A pancreatogenic diabetes, also termed as type 3c diabetes, has not primarily to be treated with insulin, often-at least initially-treatment with oral antidiabetic drugs is possible and sufficient.

The challenges posed by the COVID-19 pandemic face different institutional structures and traditions of action in the European health systems. This article uses the example of the public health services in Sweden, France and Austria to address the question of the similarities and differences in the measures taken to combat the pandemic (status: November 2020).Among the countries presented in this article, Austria is the least affected by the pandemic and France is the most affected. In all analysed health systems there is a tension between national and regional responsibilities. France's healthcare system is particularly centralized, while Sweden's is strongly regional and municipal. Governments in the nation states are striving to obtain pandemic containment powers independent of parliamentary decisions. Sweden differs from Austria and France in that its pandemic containment strategy is based primarily on recommendations and appeals rather than directives and bans. The sequences of action during the pandemic and, apart from Sweden, the instruments used to contain the pandemic are similar. The course of the pandemic and the measures taken in Austria and France show clear parallels with those in Germany. The protection of particularly vulnerable groups has not been sufficiently successful in all countries and remains a challenge to be met.

This position statement reflects the perspective of the Austrian Diabetes Association concerning the perioperative management of people with diabetes mellitus based on the available scientific evidence. The paper covers necessary preoperative examinations from an internal/diabetological point of view as well as the perioperative metabolic control by means of oral antihyperglycemic and/or insulin therapy., (© 2023. The Author(s).)

This position statement reflects the opinion of the Austrian Diabetes Association concerning the perioperative management of patients with diabetes mellitus based on the available scientific evidence. The paper covers necessary preoperative examinations from an internal/diabetological point of view as well as the perioperative metabolic control by means of oral antidiabetics and/or insulin therapy.

This paper was created by the Austrian Society of Pneumology (Working group Ventilation and Intensive Care) to summarize the specific characteristics of mechanical ventilation in patients presenting with chronic obstructive pulmonary disease (COPD). The main differences in pathophysiology and mechanical ventilation are shown, including acute respiratory failure and out-of-hospital mechanical ventilation.

Objective: The aim of this study was to analyze the possible reasons for acute admission to a department for geriatric psychiatry. The reasons for hospitalization, the psychiatric and somatic comorbidities of the patients over 65 years old with schizophrenia, schizoaffective disorder and delusional disorder were examined to identify patterns and risk profiles., Material and Methods: A retrospective analysis was carried out using paper and electronic patient records of a department of acute care for geriatric psychiatry and psychotherapy. During the assessment period 206 successive patients over 65 years old were included in the study. The patient cohort included 64 patients with schizophrenia according to the international classification of diseases 10 (ICD-10, category F20), 78 patients with persistent delusional disorder (ICD-10, F22) and 64 patients with schizoaffective disorder (ICD-10, F25)., Results: The reason for admission for one third of the patients in all three groups was aggressive behavior, whereas delusions and hallucinations were more frequent in the groups of F20 and F22 patients than in patients with schizoaffective disorders (F25). Somatic comorbidities were seen significantly more often in the group of F22 patients than in the other two groups., Conclusion: Acute admission was essentially due to acute psychiatric symptoms. Additional somatic comorbidities and psychosocial influencing factors played only a minor role in this study. The patients examined in this study constituted a special group within the acute treatment of inpatient psychiatry because they showed distinctive psychopathological productive symptoms but were relatively healthy from a somatic point of view. Patients with the diagnosis of schizophrenia (F20) or schizoaffective disorder (F25) were significantly different from patients classified into the group of delusional disorders (F22).

This guideline which is endorsed by the Austrian Society of Haemophilia, the Austrian Society of Paediatrics, and the Austrian Society of Haematology & Medical Oncology is intended to give a clear and practical guidance for diagnosing and treating haemophilia in Austria. In the treatment of haemophilia there are few controlled interventional trials, and recommendations usually have a rather low level of evidence.The main basis for this paper are the new international guidelines by the World Federation of Hemophilia, published in 2013. These were adapted according to the local situation and experience.Covered topics are diagnostics, control visits, pharmacological treatment options, prophylaxis and treatment in children and adults, possible problems arising in haemophilia carriers and special aspects like home therapy, options for venous catheters, management of various traumas, bleedings and interventions, including dental procedures, and last not least inhibitors and their treatment.

Background: Gout is the most common inflammatory arthropathy in the Western world. This is mainly due to the high socioeconomic status, sufficient even superfluous nutrition, overweight and alcohol consumption. Despite adequate medication, information and advice on nutrition and lifestyle are one of the cornerstones in the management of these patients., Objective: The aim was to provide recommendations on nutrition and lifestyle in cases of gout and hyperuricemia by a group of rheumatologists, based on a review of the most recent literature., Materials and Methods: The study group for osteoarthritis and crystal arthropathies of the Austrian Society for Rheumatology and Rehabilitation (ÖGR) carried out a literature search on this topic. The selected papers were listed according to the level of evidence., Results: Based on this literature search nine recommendations were generated and modified via a Delphi approach: four red "don'ts" concerning nutrition and beverages to be avoided, three green "do's" concerning favorable food as well as two blue general lifestyle recommendations. The format of the recommendations is a two-page leaflet with the list of recommendations, level of evidence, strength of recommendation and literature citations on the front page and a colored icon presentation of food and beverages in a circle, matching the colors of the written recommendations, on the reverse., Conclusion: For the first time in Austria, nine recommendations on nutrition, beverages and lifestyle for patients with gout and hyperuricemia were defined for everyday practice, as education material for patients and updated information for physicians.

This position statement reflects the opinion of the Austrian Diabetes Association concerning the perioperative management of patients with diabetes mellitus based on the available scientific evidence. The paper covers necessary preoperative examinations from an internal/diabetological point of view as well as the perioperative metabolic control by means of oral antidiabetics and/or insulin therapy.

Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is a twofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders frequently associated with diabetes mellitus are disturbed eating behaviour, anxiety disorders, schizophrenia and borderline disease. The coincidence of mental disorders and diabetes mellitus has unfavourable influences on metabolic control and micro- and macroangiopathic late complications. Improvement of therapeutic outcome is a challenge in the modern health system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce morbidity and mortality in this patient group.

The Austrian guideline for prevention and early detection of breast and ovarian cancer in high risk patients--particularly in women from hereditary breast and ovarian cancer families--were established with particular consideration of the most recent position paper of the European Society of Breast Cancer Specialists (EUSOMA) by the authors mentioned above. The guideline is aimed at facilitating and standardizing the care and early detection strategies in women with an elevated life time risk for breast and ovarian cancer.

Nowadays, clinical and evidence based guidelines are considered one of the major efforts to improve patient care in medical practices as well as hospital settings. In the literature, clinical guidelines have been defined as "systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances", which promote both clinically effective standards and cost-effective care. Despite controversial discussion about the clinical impact of guidelines, they may provide workable recommendations that may thus be important for improving the individual patient's care. Adverse drug reactions (drug allergies, drug hypersensitivities) often represent a major hazard for the affected patient, and a definite diagnosis is important for further drug therapies in most cases. In this context, any diagnostic procedure must be preceded by an individual risk-benefit assessment. Drug provocation testing is regarded as the gold standard, but this kind of testing should be performed in accordance with established criteria and, in the vast majority of cases, in a hospital setting. In this paper we present a clinical guideline for drug provocation testing in Austria.

Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. GA2LEN (Global Allergy and Asthma European Network), an FP6 Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle allergy as a whole. GA2LEN benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA2LEN the world leader in the field. Besides these activities, research has been jointly made and the first papers are being published. GA2LEN achievements in general can be grouped as those for a durable infrastructure built up during the project phase those which are project-related work based on these novel infrastructures, and the development and implementations of guidelines. The major achievements of GA2LEN are reported in this paper.

Objectives: The costs of twelve selected neurological, neuro-surgical and psychiatric disorders in Austria in the year 2004 will be presented. The present paper is part of the "Cost of Disorders of the Brain in Europe" study., Methods: The data for the present calculations are based on systematic reviews of epidemiological and health-economic studies. For all European countries identical methods were applied. All economic data were transformed to Euros for Austria in the year 2004 ("Purchasing Power Parity adjusted")., Results: The highest costs per case per disorder were caused by brain tumors (49,800 Euro) and multiple sclerosis (30,500 Euro). One-year-prevalence estimates (Austrian population 8.1 million) were highest for anxiety disorders (848,000 cases), followed by migraine (537,000 cases) and affective disorders (479,000 cases). The total costs (i.e. for all cases of a specific disorder in Austria) were highest for affective disorders and addiction (alcohol and illegal drugs). The total cost of all included disorders (addiction, affective disorders, anxiety disorders, brain tumours, dementia, epilepsy, migraine, multiple sclerosis, Parkinson's disease, psychotic disorders, stroke and brain trauma) was estimated at 8.8 billion Euros for Austria in the year 2004. Direct health care cost amounted to Euros 3.2 billion (37% of total cost), direct non-medical cost totalled Euros 1.5 billion (17%), and indirect cost Euros 4.1 billion (47%)., Discussion: Even when considering that such estimates based on international studies have methodological limitations, the total cost of the twelve included disorders is considerable. The total cost of these twelve disorders constitutes 4% of the gross national product of Austria. Taken together, these disorders cost each Austrian citizen Euros 1 090 per year.

The observation that the topic "older women in traffic" does not hold a prominent position within existing literature in this field is the starting-point of this paper. Apart from a mere numerical deficiency of respective contributions, we assume in addition the existence of a conceptual weakness in the scientific discourse. Therefore we try to develop a general concept of mobility along age-relevant and gender-related dimensions, present afterwards-as an empirical supplement-some selected examples from focus group and in-depth interviews, and finally outline a proposition for a concept of mobility of older women (and men), which is intended to provide some practical reference for operationalization in empirical research. The frame of this concept is constituted by the assumption that outdoor mobility is rooted in social structures and their change, as they are represented in a certain historical time, and simultaneously, by purposeful action of the individuals involved, from which these structures finally emanate.

Before a telemedical application can be implemented in practice, various technical, organisational, and legal questions have to be solved. The answers to these questions are, however, in most cases not very obvious. Telemedicine guidelines which could provide a path to follow currently exist only for selected medical fields and are frequently customized for particular medical and technical scenarios. The use of existing telemedicine guidelines in Austrian health care is further complicated by the fact that most of them are based on foreign legal systems. This paper therefore aims to develop general telemedicine guidelines which are appropriate for all application areas of telemedicine in Austrian health care. From nine existing telemedicine guidelines for individual medical fields, two generally applicable guidelines were derived. The corresponding abstraction process was based on a categorization of telemedical applications, which is oriented on the communication partners involved. The derived, general guidelines address seven typical problem domains in the practical application of a telemedical application. As opposed to the existing guidelines, they (1) are independent of special medical fields and are therefore appropriate for all application areas of telemedicine -- also in medical fields where no specific guidelines have existed before; (2) are adapted to the Austrian legal system; (3) provide additional insight for medical fields where specific guidelines have already existed, as they can benefit from recommendations of other medical fields where equivalent telemedical applications are employed.

In older textbooks the use of peritoneal dialysis (PD) in patients with liver cirrhosis and/or ascites was contraindicated. Only a small number of papers have focused on this problem and they mainly consist of case reports and retrospective studies of small numbers of patients. In addition, most nephrologists' experience of performing PD in patients with liver diseases is rather limited. Nevertheless, for these patients PD offers a wide range of advantages, such as a simplified ascites management, since repeated abdominal punctures become unnecessary. Furthermore, because of continuous peritoneal ultrafiltration, hemodynamic tolerance during PD is significantly better than in hemodialysis and results in a markedly lower frequency of hypotensive episodes. The risk of nosocomial infection with hepatitis B or C viruses can also be reduced by treating these patients with home PD. Although some authors suggest that PD patients with liver cirrhosis have an especially increased risk of Gram-negative peritonitis, currently available data show controversial results. There is also little information in the literature on the impact of increased peritoneal protein loss on malnutrition and outcome of these patients. Nevertheless, recent studies have shown that protein loss into the peritoneal cavity in PD patients with liver cirrhosis is high only initially, stabilizing at a lower level in the further course of treatment. In conclusion, in patients with end-stage renal disease suffering from liver cirrhosis and/or ascites, PD can be considered as a good or adequate treatment option.

Toxocara canis and T. cati are not only ubiquitously distributed parasites of dogs, foxes and cats, but may also infest humans, causing a great variety of symptoms and sometimes also severe diseases: the visceral larva migrans syndrome, the ocular larva migrans syndrome, covert toxocarosis, common toxocarosis, neurological toxocarosis, and some other clinical pictures (asthma bronchiale, epilepsy, rheumatoid arthritis) are considered to be induced by Toxocara species. Both Toxocara species are also widely distributed in Austrian dog, fox and cat populations; seroepidemiological studies carried out in Austria revealed seroprevalence rates of 3.7% among the normal human population and up to 44% among persons particularly exposed to those parasites (i.e. veterinarians, farmers). Although many Toxocara infestations do not cause severe clinical manifestations, a few dozens of toxocarosis patients have been registered every year during the last years; in reality, however, we have to assume that several hundreds of patients suffer from toxocarosis. This paper tries to give a synoptic overview of the nosology of this (still) largely almost unknown helminthozoonosis, moreover it summarizes the most important epidemiologic parameters, and presents the diagnostic and therapeutic possibilities available today.

Objective: Orthostatic intolerance (OI) is a syndrome which is characterised by headache, concentration difficulties, palpitation of the heart, dizziness associated with postural tachycardia and plasma norepinephrine concentrations that are disportionately high in upright posture. OI hitherto can only be diagnosed by a tilt table examination with high expenditure. In this paper we examine the reliability and validity of a questionnaire as a screening instrument for OI., Methods: We studied 138 young males (mean age 21.6 years) from the military service. After a medical check and filling in the questionnaire, the participants underwent a tilt table test. The questionnaire consisted of 10 items registering presence and frequency of typical OI-symptoms., Results: 104 probands showed a normal tilt table test. OI was diagnosed in 14 probands, orthostatic hypotension (OH) in 6 and postural orthostatic tachycardia syndrome (POTS) in 14. The participants with OI scored significantly higher in the questionnaire than the normal subjects: The mean score of the OI group was 22.6, the normal participants had a mean score of 3.9. Participants with POTS had a mean score of 13.5 and subjects with OH had a mean score of 17.0., Conclusions: We were able to establish a short questionnaire as a reliable and valid screening instrument for OI. Usage of this questionnaire can simplify enormously the diagnostic management of patients with suspected OI.

The 7th annual meeting of the memory clinics of Germany, Switzerland and Austria in March 2002 in Göttingen, Germany was an optimal opportunity to make an inventory about the state of the art in diagnostic and therapy of dementia and mild cognitive impairment in German-speaking memory clinics. Several problems were discussed including difficulties in 1) diagnosis of patients with aphasia or foreign patients, 2) handling of demented patients without a caregiver, 3) psychological support for patients, who have been diagnosed in a very early stage, 4) misunderstandings between general practitioners, neurologists and psychiatrists in private practice on the one hand and the memory clinics on the other hand, 5) recommendations for prevention of dementia, 6) recommendations concerning dementia and car driving and 7) questions of genetic counselling. The following paper is a summary of the results of a workshop in Göttingen and gives practical recommendations based on the experiences of the memory clinics.

Compared to health services in other countries in the world, the Austrian health care system works relatively well. At the moment it is shaped and dominated by various structures, decision makers and financial backers, which means that it does not work as well as it could under ideal circumstances. The government now wants to develop a national health care plan which, in a concerted action by all those involved in the health service, shall guarantee superior medical care while at the same time taking into account economic aspects. This paper takes a critical look at the idea of an Austrian health care plan from a clinical point of view.

Breast cancer is the most frequent type of cancer in women. The therapeutic approaches to breast cancer have developed rapidly over the past 20 years, due to the increasing knowledge about the biology of breast cancer. Therefore it was possible to increase response rates as well as the duration of response and survival in neoadjuvant, adjuvant, and palliative treatment. This paper gives a review of the current breast cancer trials. Effective new cytotoxic chemotherapy and hormonal therapy agents, as well as the identification of specific molecular abnormalities (HER2/neu) led to the development of targeted therapeutic interventions in the neoadjuvant, adjuvant, and palliative treatment of breast cancer. Increased understanding of the biology of breast cancer led to the development of rational therapeutic interventions, which are currently under active clinical development.

It was tried to show the most essential results of a approximately 45 years' research activity on the field of iodine balneology from the Paracelsus Institute and--since 1993--from the Paracelsus-Gesellschaft Bad Hall. The papers were concerned with: basical studies about the chemistry of the iodine waters, generation of special analytic methods and techniques for iodine determinations and for investigations of the iodine metabolism, generation of new therapeutical iodine applications (for example: eye iontophoresis, electro-aerosol; preparation of the iodine water for a mineral water indoor swimming-bath and for special therapy solutions), investigation of the (favourable) iodine effects on the cardiac and circulation system, on blood rheology, thyroid function, lipid metabolism and on the antioxidant defence mechanisms (with special consequences for arteriosclerosis, diabetes mellitus and cataract), also on visual function and eye diseases (retina, color perception, contrast sensitiveness, cataract, dry eye) and respiratory diseases. Comparative studies on patients and on experimental animals as well as model experiments (e.g. on connective tissue: in vitro studies; tissue cultures) have been used to objectify many empirically observed cure effects. Possible side-effects of a cure with iodine brine (e.g. iodism) were mentioned.

Geriatric Assessment is a structured interdisciplinary process for the diagnosis of the functional status and potential for rehabilitation of geriatric inpatients. This paper describes the possibilities and scope of the Vienna Model of Geriatric Assessment oriented in terms of practicability and focused implementation of resources. By using this multidimensional proceeding the rehabilitation-quotient of patients has increased more than 39%. From this point of view Geriatric Assessment in a geriatric hospital is a practical instrument to prevent hospitalization, to increase survival at home, and to improve functional status in elderly patients.

Further education in practical, clinical and scientific-theoretical gerontology is of great importance either for the global care of the elderly or to increase the knowledge concerning the problems of aging. In this paper we try to evaluate critically activities referring to this, to furthermore develop in international comparison strategies to improve the situation. We present objectives of the Austrian health politics and we more precisely depict the actual implementation as to university and non-university education events.

The objective of this study was to perform a citation analysis of the frequency of the various languages used in the bibliographical references of the original articles published in the Wiener klinische Wochenschrift during the past 75 years (1920-1995). The languages of publication were recorded of 14,667 references from 800 original papers, at the rate of 50 articles per year at intervals of five years. The percentage of references in German remained constant until 1946, but has been decreasing progressively since that time: 87% in 1920, 84% in 1946, 51% in 1970, and 20% in 1995. The percentage of references in English, on the other hand, has continued to increase, especially since 1946: 3% in 1920, 9% in 1946, 41% in 1970, and 79% in 1995. Even though the importance of English started to increase as from 1946, it did not supplant German as the main language of medicine in Austria until 1980 (thirty years later than usually accepted up to now).

Primary osteoporosis is common, with significant sociomedical consequences. This paper studies the prevalence of risk factors and risk behavior for osteoporosis in women of four different occupational groups: housewives, blue collar workers, white collar workers/civil servants and farmers. We analyzed risk factors and risk behavior associated with osteoporosis in the scientific literature. The sample comprises 9,939 women. The data set is based on a health survey conducted in 79 selected rural communities of Styria (Austria) between 1989 and 1993. Sociodemographic data, lifestyle, health complaints, chronic conditions and utilization of preventive and treatment services were surveyed by means of standardized personal interviews. The results show that the women of the four occupational groups were subjected to very different stresses. White collar workers/civil servants had the lowest risk with regard to osteoporosis. Our results suggest that efficient intervention programs to prevent osteoporosis need to specifically focus on the different social life styles of women.

In January 1896 experiments were made around the world with cathode-tubes to test Röntgen's paper "a new kind of rays". Mostly hands without pathological variations were X-rayed. At the same time in Vienna the clinical applications of X-rays were investigated. Two patients were successfully operated on after X-ray-examination. Remarkable for that time was an X-ray of an arteriogram of the arm of a dead person. It was made on 17th January 1896. The experiments with Lenard's cathode-tube were important for the discovery of X-rays. His experimentation was the inspiration for Röntgen's discovery of X-rays.

Between 1989 and 1991 16 Austrian pediatric institutions published 232 scientific papers with a total impact-factor of 200,406 in internationally recognized journals. Seventy-three percent of them came from only three institutions, the University departments of pediatrics in Graz and Vienna and the St. Anna Children's Hospital (77, 63 and 30 publications, respectively). The impact-factor (IF) of these publications ranged from 7.591 to 0.010. The average IF was 0.864 and the median IF 0.430 per paper. Whereas 70 papers (30%) were published in journals with an IF over 1, only one third appeared in pediatric journals.

This paper gives guidelines for medical doctors in which cases of atopic dermatitis an attestation--according to austrian law--can be given to get an elevated family subvention. Following points have to be taken into consideration: correct diagnosis of atopic dermatitis, severity of disease (more than 10% of body surface), duration of disease (more than 6 months), correct treatment with acknowledged methods, necessity of diet and psychotherapy, combination with other atopic diseases. In the rule only in infancy and for preschool aged children the attestation can be given.

A survey was performed in 1989 by the Institute of Social Medicine and the Austrian Workers Compensation Board(AUVA) to investigated the alcohol problem in 277 factories in which the workers were exposed to hot and dusty atmospheres. As a result of the findings, a further study was undertaken by the same research team to investigate one possible solution to the problem of alcohol consumption at work in a paper-producing factory, predominantly under hot and dusty conditions. The study was well prepared by many activities in the field of health promotion. In this trial, an electrolyte drink especially suited for heat-burdened work places, was introduced for three months as alternative drink to alcohol. Before and after this period the employees answered a questionnaire regarding their alcohol consumption and any changes in consumption habits. One of the main results of the study was the significant increase in electrolyte drink consumption and decrease in wine consumption although that of beer remained practically unchanged. The offered electrolyte drink was accepted as alternative drink by many workers and represents a practical example of health promotion at the place of work. This study should encourage other factories and businesses to experiment with electrolyte drinks especially suited to their particular conditions in an attempt to overcome the problem of alcohol consumption during working hours.

This paper addresses the problems which have arisen in connection with the improved intensive care of neonates and the possibility of prenatal diagnosis and therapy. Medical problems consist of difficulties in determining the indications. Ethical problems result from the right of decision of the pregnant woman, of her family and of the society beyond the normal physician-patient relationship and there are expert and legal questions, too. A more public evaluation of the patient material may lead to solution of the problems. Ethical and legal principles can be derived from these basic considerations. No new morals and ethics must evolve even if damage to the fetus or malformations can now be recognized antenatally instead of only postnatally as before. Malformations incompatible with life are indications for termination if the pregnant woman so desires. Every other type of malformation is something which the pregnant woman, her family and society must come to terms with. Prenatal medicine is able to soften the consequent burdens for the family and society.

The paper starts with reflections on the rôle of biometry in clinical research. Factors which might influence the efficacy of biostatistical consulting of clinicians are dealt with. Primarily, advantages and disadvantages of various behavioral patterns between the medical investigator and the biometrician are discussed. The recruitment and training of new biometricians, organizational structures and material foundations of clinical biometry are regarded as further factors influencing a constructive working practice. The paper ends with considerations on the future of the discipline.

Albert Mueller-Deham played a role of great importance in the history of American and general geriatrics. He was born in 1881 in Vienna where he studied medicine. After graduation he was an intern, and later assistant professor at the First University Department of Medicine in Vienna. Among his teachers were such famous names as von Nothnagel, von Noorden und Wenckebach. In 1925 he was appointed chief of the medical department in the large, renowned "Versorgungsheim Lainz" in Vienna and became director of the geriatric research unit established by his initiative. With many scientific papers and his most important work, the textbook on geriatrics "Internal Medicine in Old Age" (in three languages) he became one of the pioneers of modern geriatrics. His main interest laid in the importance of the pathology of old age and its connection with clinical diseases. In 1938 he emigrated to the United States for politico-racial reasons and worked as attending physician at the Goldwater Memorial Hospital in New York. There he had the chance to continue his scientific work and pass on his vast experience to colleagues and students until his retirement from clinical practice in 1951. His new interests were philosophy and art, resulting in a book entitled "Human Relations and Power". Mueller-Deham died at the age of 90 in Santa Barbara, California. Albert Mueller-Deham deserves an important place in the history of medicine for recognizing, as one of the first in Austria, the characteristic features of diseases in old age as opposed to younger age groups. His clinical observations in the light of subsequent post-mortem analyses laid the foundation of modern geriatric medicine.

Although the anaesthetizing effect of cocaine had been known for a long time, it was only in 1884 that Karl Koller first carried out animal experiments, followed by clinical testing in humans of the anaesthetic effect of cocaine on the eye. Freud had shortly before directed the attention of Viennese doctors to the alkaloid cocaine in a paper. Upon Freud's suggestion Königstein tested the effect of cocaine therapeutically, whilst Koller independently conceived the use of cocaine as a local anaesthetic for eye operations. Jelinek introduced cocaine into laryngology and Wölfler into surgery, as further applications for the use of this local anaesthetic.

Over a three-year period (1985 to 1987), the number of fetal malformations was entered into Styrian Malformation Register (SMR). The data were compared with those of the Austrian Ministry of Health. The SMR collected 137 cases of urinary tract malformations, but only six appeared in the Health Ministry statistics. This discrepancy resulted from the different data collection methods. Presently only a small percentage of fetal abnormalities is officially registered. Using the example of urinary tract malformations this paper shows the value of prenatal ultrasound screening. Such infants must be treated soon after delivery to avoid progression of parenchymal damage. Ultrasound examinations should not be restricted to pregnant women at defined risk. Registration of all prenatally diagnosed--or missed--malformations is a quality-control measurement and improves prenatal diagnosis.

This paper analyzes the birth and death certificate data of infants who died from the Sudden Infant Death Syndrome (SIDS) before their first birthday. It investigates possible causes of differences in regional mortality and of the significant increase in the number of cases between 1980 and 1987. Moreover, the authors try to assess whether the number of SIDS cases registered by the Austrian Central Statistical Office is plausible. Between 1980 and 1987 the number of SIDS cases increased from 38 (= 2.9% of all infant mortality cases) to 141 (= 16.6%). Moreover, there are significant regional differences in SIDS mortality, varying between 0.3 per thousand in Upper Austria and 2.2 per thousand in Salzburg. Possible causes for these mortality differences are discussed (misclassifications, regional differences in the level of infant mortality). Finally, the authors look at the reliability of the official Austrian SIDS statistics and conclude that the officially announced number of SIDS cases may not give an accurate picture of the situation but is still the best estimate available.

The contribution of Albert Wiedmann (1901 to 1970) towards the development of the Viennese Dermatological School are evaluated. The following main points of interest can be focused out of a large number of scientific papers; investigations in the field of venerology, innervation and nutrition of the skin (concept of the "neuro-hormonal cells"), phlebology and the relationship between dermatological disorders and internal medical diseases. His outstanding abilities as a researcher, tutor and physician were matched by his great talents for organisation and qualities of leadership as chief of the 2nd Department of Dermatology, University of Vienna, 1946 to 1970.

Interest in the implementation of long-term clinical studies has grown considerably in Austria in recent years, partly encouraged by studies of this nature performed in West Germany, Great Britain and the United States. However, such studies have to be based on biometric standards that must be adhered to in the planning, implementation and reporting phases of long-term studies if they are to be regarded as authoritative and to find international acceptance. The present paper deals with such standards, based on the current level of methodological development as well as the authors' experience gathered over many years of participation in such projects. Special emphasis is placed on planning, random sampling and analysis, randomization, documentation, organization, termination of studies, reporting, multicentre investigations and cooperation between doctors and statisticians. The authors present several alternatives with and without the use of computers, attempt to explain to clinicians the role of the biostatistician in the supervision of long-term studies and offer their services to those interested in their cooperation.

The individual physical efficiency was ascertained according to a method developed by RUTENFRANZ, where the criterion was taken as being the particular performance which resulted in a pulse rate of 170 beats per minute. This was termed the p.w.c. 170 (physical working capacity), and was measured on a bicycle ergometer, with increasing loading of 1, 2, and 3 watt per kilogram of body weight. During this loading the E.C.G. was watched telemetrically on an oscilloscope, and recorded each minute. The p.w.c. 170 was ascertained both graphically and arithmetically from the respective pulse rate in the 6th minute of each load level. Initially, twenty healthy children were tested, so as to arrive at normal values. The average reading for these children was about 5% below the normal values given by RUTENFRANZ. Subsequently, fifty five obese children were examined, so as to clarify the question as to whether there was a linear correlation between overweight and physical efficiency. Indeed, it was possible to establish a regression equation according to which each 10% of overweight lead to a decrease of physical efficiency of 5.8%. The results of further examinations will be reported in the next paper.

This paper presents clinical data elucidating the natural history of gall stone disease, based on observations carried out on a secluded alpine population treated conservatively for generations. Special circumstances corroborating a statistical evaluation are outlined. Pertinent parameters supporting this study are anatomical findings at operation following the introduction of established surgical procedures into the region, with particular attention to age grouping within the collectives of patients. A total of 130 patients, operated on for gall stones for the first time in their lives, were evaluated, 18 patients undergoing incidental cholecystectomy for asymptomatic gall stones were excluded from this series. Of the remaining collective presenting with clinical symptoms of cholelithiasis, 54% were admitted for complications of the disease, i.e. 15% for acute cholecystitis and 39% for choledocholithiasis (including jaundice in 27%). We conclude that the natural history of gall stone disease in this region implicates the incidence of the above-mentioned inherent complications unless cured electively by early cholecystectomy.