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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).)

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

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).)

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

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

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

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

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.

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

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

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

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

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).)

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

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

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

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

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

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

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

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

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

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.

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.

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

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.

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

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.

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.

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

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

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

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.

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

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.

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

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

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

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