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Study objective The purpose of this study was to determine subjective health-related quality of life (HRQoL) in a sample of the Austrian population over 14 years of age in order to evaluate the effect of socio-demographic variables on HRQoL. Design/Setting HRQoL was determined by means of the quality of life index - German version (QLI-Ge). The influence of socio-demographic variables on HRQoL was assessed by statistical analysis using the Kruskal-Wallis test and an analysis of variance. Participants A random-quota procedure was used to get balanced representation from regions and demographic groups of the Austrian population. The sample consisted of 1049 participants, 493 men and 556 women. Main results Age was found to influence the QLI-Ge total score (index score) and most individual items, with increasing age resulting in a decrease in HRQoL. Differences between the sexes were observed in three dimensions: males scored higher in ‘physical well-being’, ‘psychological well-being’ and ‘occupational functioning’. Marital status impacted most items with married persons showing better values than divorced persons or singles. Profession had only a minor effect on HRQoL, the level of education showed no influence at all. Conclusions The socio-demographic variables age, sex and objective living conditions had a major influence on subjectively rated HRQoL, whereas profession and education were found to play a minor role in this context. It is recommended that in the interpretation of studies assessing HRQoL the above-mentioned objective factors be considered. This will be of particular importance when determining the effect of a pharmacotherapy on HRQoL in patients. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: As the accurate diagnosis and treatment of gestational diabetes mellitus (GDM) is of increasing importance; new diagnostic approaches for the assessment of GDM in early pregnancy were recently suggested. We evaluate the diagnostic power of an 'early' oral glucose tolerance test (OGTT) 75 g and glycosylated fibronectin (glyFn) for GDM screening in a normal cohort., Methods and Analysis: In a prospective cohort study, 748 singleton pregnancies are recruited in 6 centres in Switzerland, Austria and Germany. Women are screened for pre-existing diabetes mellitus and GDM by an 'early' OGTT 75 g and/or the new biomarker, glyFn, at 12-15 weeks of gestation. Different screening strategies are compared to evaluate the impact on detection of GDM by an OGTT 75 g at 24-28 weeks of gestation as recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). A new screening algorithm is created by using multivariable risk estimation based on 'early' OGTT 75 g and/or glyFn results, incorporating maternal risk factors. Recruitment began in May 2014., Ethics and Dissemination: This study received ethical approval from the ethics committees in Basel, Zurich, Vienna, Salzburg and Freiburg. It was registered under http://www.ClinicalTrials.gov (NCT02035059) on 12 January 2014. Data will be presented at international conferences and published in peer-reviewed journals., Trial Registration Number: NCT02035059., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

This paper describes a paradoxical situation in Austria. The vaccination rate against tick-borne encephalitis (TBE) in the general population is 82%, which is the highest worldwide, whereas the vaccination rate against influenza is about 8% and is among the lowest worldwide. A high awareness of TBE among the Austrian population achieved by an annual social marketing programme and the wide use of effective and well-tolerated vaccines have led to a successful containment of that disease. The vaccination coverage increased from 6% in 1980 to 82% in 2013 and exceeds 90% in some high-risk areas. This has led to a steady decline in the number of TBE cases from several hundred cases to 50 to 100 cases per year. The situation in regard to influenza vaccination is the opposite. Although Austria has issued one of the most extensive recommendations for influenza vaccination worldwide, the vaccination rate of the general population is extremely low. The possible reasons for the failure in the implementation of recommendations are ignorance, lack of social marketing and the predominance of a distinct discordance within the health system in general, and the Austrian medical fraternity in particular.

Objective: To investigate trends in mortality and mean age at death from lung cancer (MADLC) compared to mean age at death from all causes (MAD) over the period 1975 - 2007 in Austria. Results are assessed with respect to secular trends in smoking habits., Methods: MAD and MADLC were computed by year and gender as the expected value of a fitted Weibull distribution. Age-period-cohort effects on lung cancer death rates were estimated by hierarchical Poisson models., Results: In females MADLC was on average about 2 years higher than in males and tended to decrease since the mid 1980s, while after the mid 1990s MADLC in males increased such that the difference between men and women shrank to about half a year in 2007. Females dying from lung cancer lost about 6 years of life during the late 1970s but more than 10 years after 2000, while males lost 2 years in the 1970s and 5 years after 2000. Males demonstrated a decreasing risk with increasing year of birth, with the exception of cohorts born during or immediately after the World Wars that showed peak relative risks (RR). Females did not show pronounced birth cohort effect except for a peak RR for cohorts born during and after World War II., Conclusions: MADLC provides additional information about secular trends in addition to incidence data. The declining trend of MADLC in females and in males up to the mid 1990s points to a change of smoking habits with an earlier onset of smoking in both genders. The subsequent increase in males during the last decade may be attributed to an increasing proportion of quitters because smoking cessation delays onset of lung cancer., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Blood pressure (BP) awareness is a main focus of public health efforts. In Austria, an increase of knowledge and perception regarding hypertension was seen after a nationwide educational campaign in 1978, but subsequent surveys documented only short-term impact. We report results of the latest survey in 2009 in comparison to 1978 and 1998., Methods: Balanced for Austrian demographic characteristics 1,005 men and women older than 15 years of age were randomly selected for face-to-face interviews about BP awareness, risk factors, and hazards of hypertension and treatment options including life-style interventions., Results: Overall, 15% identified themselves as hypertensive, which is similar to results from 1978 (14%) but significantly higher than 1998 (12%; P < 0.01). The proportion of hypertensives not undertaking any measure (i.e., pharmacotherapy or life-style changes) significantly decreased since 1998 (5% vs. 10%; P < 0.0001). Thirty-three percent recalled to have measured their BP within the last 3 months, which is comparable to 1998 (34%) but lower than in 1978 (49%) after the nationwide educational BP campaign (P < 0.0001). Alarmingly, an unchanged proportion of 8% reported no BP measurement ever (1978 and 1998: 8%, respectively). Sixty-one percent believed they would be able to clearly identify symptoms of hypertension, while only 19% knew that hypertension might not be noticeable. Heart attack and stroke were considered the most common sequelae of hypertension., Conclusion: Despite a high understanding of the risks of hypertension among the Austrian population, a widespread misconception regarding BP symptoms and infrequent personal checks are worrisome and might also be valid in other Western countries.

Worldwide osteoporosis is underestimated and despite availability of effective and cost effective treatments, these are often not implemented. Apart from a demographically driven increase in disease cases, failure to implement or tardy implementation of preventive measures as well as poor treatment compliance leads to a deterioration of the health economic outcomes. This in turn causes considerable costs to the health care system and to society, through ineffective intake of medication, diminished quality of life and inability to work as well as substantial costs of rehabilitation of patients. Health economic analyses and methods are increasingly used by decision makers to set priorities and evaluate alternative treatment measures about their cost-effectiveness. In order to be able to capture the costs of illness incurred by osteoporosis, different diseases specific models and methods have been developed, such as the reference model of the IOF, an osteoporosis-specific Markov model or internationally comparable intervention thresholds. Health economists estimate that osteoporosis-related costs will double by 2050 in both Europe and the individual countries. For Europe this means an increase from 40 billion Euro in 2000 to almost 80 billion Euro in 2050. In Austria, an aggregation of the different costs of osteoporosis is not possible, due to a lack of comparability and availability of data. The international ICUROS study and the Austrian Osteoporosis Report 2007 are the first steps towards counteracting this situation.

According to epidemiological studies there has been an increase of allergic diseases and corresponding costs. Health economics analyses intend to offer decision guidance towards a more efficient and effective resource distribution, in the conflicting relationship of medicine and economics. In analogy with the "Global Initiative for Asthma (GINA)-study", one arrives at costs of Euro 227.7-455.4 million for the Austrian health system in 2004 for asthma. Direct costs of allergies in general are in part available from health insurance carriers. Between 1998 and 2005 the number of nasal preparations and antiobstructive therapies prescribed rose by 15% and 50% respectively, whilst the costs of these drugs dramatically increased by 96% and 70% respectively. Expenditure on anti-histamines rose by 31% between 2002 and 2004, whereas costs of topical and systemic anti-allergic drugs remained constant. Costs of allergies also include additional costs carried by the individuals affected, which must be added to those covered by the national health insurance carriers. Furthermore, patients with allergies more frequently turn to alternative and complimentary medicine to treat their condition (above all homeopathic remedies, massages and ointments) than people not suffering from allergies. Indirect costs due to allergies are, for instance, those caused by sick leave and loss of productivity. A continual systematic evaluation of available data on allergies in Austria could contribute to more effective implementation of medicines.

The first Austrian Allergy Report is a compilation of all available epidemiological data relating to allergies in Austria. According to this report the cumulative prevalence of allergies in the Viennese population is 27.6% for men and 32.2% for women and the period prevalence in the year before questioning 19.6% and 22.4% respectively. 20.8% of men and 23.1% of women reported about allergies at health examinations. However, an allergy sensitivity to at least one inhalation allergen, verifiable by means of a prick test, is detectable in 50.8% of the general population and in 39.3% of those free from ailments. Analysis of the hospital discharge statistics of all Austrian hospitals shows that around 12,000 people per year were admitted on grounds of an allergy. In accordance with international studies some population sub groups are more often affected than others. Women suffer from allergies somewhat more frequently than men, although the sex difference is reversed among children. Allergies occur in all age groups, with most studies showing that people in their twenties are most frequently affected. People with higher levels of education, in more highly qualified jobs and living in urban areas are more commonly affected by allergies than people from lower socio-economic levels and rural communities. The internationally identified increase in trend can also be identified in Austria with a 2fold, 3.6fold, and 4.6fold increase in the prevalence of hay fever, asthma and atopic eczema respectively, determined from the military health examinations of all recruits for national service between 1986 and 2003/04, although a clear decline in allergy prevalence was registered between 2003/04 and 2005. Health reports like the first Austrian Allergy Report provide the basis for international comparison of basic data. These data also enable the evaluation of the impact of different diseases on the health system as well as the development of public health strategies.

Introduction: Smoking is one of the most important risk factors for the development and progression of atherosclerosis. Smoking cessation is an obligatory element in the management of vascular problems and in patients scheduled for vascular interventions. The aim of this study was to assess the prevalence of patients smoking before and after vascular surgical procedures and to evaluate the requirements for inpatient programs for smoking cessation and nicotine replacement therapy., Methods: 500 patients admitted for vascular interventions were included in this prospective study. Smoking status was evaluated both objectively and subjectively. All patients underwent measurements of exhaled breath carbon monoxide to quantify nicotine dependency and all answered a standardized Fagerström questionnaire both on admission and after surgery to identify current smokers., Results: Of 500 vascular patients included in the study, only 70 (14 %) never had smoked, 243 (49 %) had given up smoking before admission and 161 (32 %) were current smokers. Of the current smokers, 64 (40 %) did not smoke during hospitalization but 97 (60 %) continued to smoke in hospital. Of these 97 patients, 78 (80 %) were men and 19 women; their mean age was 61 +/- 4 years (range 40-84). Four patients had surgery for infrarenal aortic aneurysm, 40 underwent carotid endarterectomy and 53 had peripheral arterial occlusive disease (PAD). There was no difference between abstinent patients and continuing smokers in previous cigarette consumption or Fagerström score, a predictor for long-term smoking behavior. Patients with carotid artery stenosis were significantly more abstinent while hospitalized (P = 0.006); patients with PAD, however, were more likely to continue smoking as inpatients (P = 0.004). Sixty-five percent of continuing smokers stated that they would stop smoking in hospital if counseling and nicotine replacement therapy were provided. With regard to their predominant location of atherosclerosis, patients with PAD were less willing than those with carotid stenosis to abstain from smoking while hospitalized (53 % vs 88 %, respectively; P < 0.001)., Conclusion: A substantial proportion of patients admitted for vascular surgery are smokers. More than half of these continue to smoke in the hospital, an environment where smoking is prohibited by law. Counseling, nicotine replacement therapy and smoking-cessation programs are urgently needed for vascular surgical inpatients.

Purpose: In this cross-sectional study we compared alcohol-dependent smokers and non-alcohol-dependent smokers with respect to intensity of nicotine dependence, craving conditions, sleep disturbances, comorbidity with major depression, reasons for smoking, accompanying somatic diseases and patients' prolonged abstinence from smoking during the 3 years preceding the study., Subjects and Methods: Fifty-one alcohol-dependent smokers and 327 non-alcohol-dependent smokers diagnosed as ICD-10 and DSM-IV-nicotine dependent, were investigated by means of the Fagerström Test for Nicotine Dependence, the Lübeck Craving-Recurrence Risk Questionnaire and the Lesch Alcohol Dependence Typology (both adapted to smoking)., Results: The intensity of nicotine dependence was more enhanced in alcohol-dependent smokers compared to non-alcohol-dependent smokers. Several variables of all factors of craving ("depressive mood", "stimulation", "relaxation", "socially triggered tension") were significantly increased in alcohol-dependent patients (P<0.05). Alcohol-dependent smokers showed depressive symptoms and sleep disturbances, whilst non-alcohol-dependent individuals mainly smoked for stress release and weight control., Discussion: Our study demonstrates that the intensity of nicotine dependence, several conditions of craving for nicotine, sleep disturbances and symptoms of depression appear to be enhanced in alcohol-dependent smokers compared with non-alcohol-dependent smokers. Conclusions. - It is hoped that the factors of craving and reasons for smoking identified in this study will contribute to a better understanding of smoking temptation in alcohol-dependent smokers and non-alcohol-dependent smokers in future.

Today, obesity has already reached endemic proportions in the industrialised nations and will be the major health problem of the century. Worldwide, almost half a billion people are overweight or obese. In Austria, the prevalence of obesity amongst adults is 9.1%, irrespective of gender, but dependent on age, social status, level of education and geographical location. In children and juveniles, the proportion of obesity lies between 4.5% and 7.5% and the trend is increasing. In light of the epidemiological situation and the risks of accompanying and consequential illnesses, it is particularly important that in the future, awareness of the problem is increased, public health strategies are developed, prevention measures targeting specific groups are accelerated and professional therapy is offered to those affected.

Objective: Epidemiological studies have shown that low plasma levels of antioxidant micronutrients, which are commonly found in fruit and vegetables, are associated with increased risk for diseases such as heart disease, cancer, metabolic disorders and the like. The aim of this study was to monitor the dietary habits of a group of healthy, middle-aged, men and women and to assess the effect of supplementation with a natural phytonutrient preparation from fruits and vegetables, on plasma levels of various antioxidant micronutrients and oxidative stress assessed by measuring 8-oxodGuo (8-oxo-7,8-dihydro-2'-deoxyguanosine) in urine., Methods: The study followed a double-blind randomized cross-over design involving 59 healthy men and women (40-60 years of age). The supplement or a placebo was given to two groups for a total period of 14 weeks (crossover week 7). Blood levels of beta-carotene, vitamin C, vitamin E, selenium and folate were measured at 0, 7 and 14 weeks. Fruit and vegetable consumption was monitored by means of a retrospective food frequency questionnaire at week 0, 7 and 14. Urinary 8-oxodGuo was also determined at these time points., Results: Significant increases in blood nutrient levels after active supplementation were observed for beta-carotene, vitamin C, vitamin E, selenium and folate. Ranges measured, after supplementation, often fell into those associated with a reduced risk for disease. Our data suggests that, although generally health conscious, participants still fell short of the recommended five portions of fruit and vegetables per day. No significant group changes were noted for 8-oxodGuo concentration in urine., Conclusion: Supplementation with mixed fruit and vegetable juice concentrates effectively increased plasma levels of important antioxidant nutrients and folate.

Prevention campaigns and new antiretroviral therapies caused a decline in HIV-infections as well as mortality from HIV/AIDS in industrialised countries. Despite this development AIDS is one of the ten mean causes of death worldwide, with 3,1 million deaths in 2002. Hence there is an urgent need for prevention and information campaigns, which ideally should start in early childhood or at school age. It is well known that preventive strategies start at a time when the risk or the possibility of a risky behaviour does not yet exist. A WHO-report in 1993 showed, that sex education often comes too late, as sexual activity of adolescents is already on its way. Persons who are already sexually active can be influenced to have fewer sexual partners and to increase safer sex methods. There is no evidence for causing a higher risk by sex education of adolescents. In Austrian schools numerous experts and organisations cooperate in the sphere of sex education and STD-prevention. School children in Vienna are confronted with this topic by the schools they attend according to the Sex Education-Act of 1970 on a voluntary basis. Various examples of effective teaching models prove intensive efforts and successful interdisciplinary cooperation. This study analyses common risk-reduction-methods and describes the Austrian way of HIV/AIDS/STD prevention in school children, although there is no obligation for sex education in schools, according to the School Teaching-Act of 1986, which leads to better knowledge and subsequent risk behaviour of adolescents in the same geographical area.

Study Objective: To assess period and point prevalence of headache in Austria and the influence of sociodemographic factors and seasonal variations., Design: Data for the prevalence of headache were drawn from the database of seven representative surveys in the SERMO study (Self-Reported Morbidity Study). The aims of the SERMO study are to describe and monitor the characteristics of background morbidity in the Austrian population. The study is based on face-to-face interviews. Headache/migraine was one of 36 disorders the interviewed persons were asked about., Setting: The representative samples of the Austrian general population were selected by the "quota-procedure". Thus each cross sectional sample is representative for the entire Austrian population., Participants: The study population consisted of 7,162 Austrian people over 15 years of age., Results: About one fifth (20.1%) of the Austrian adult population reported having headaches during the year (prevalence 26.4% in women vs. 13.0% in men, p<0.001). Period prevalences varied from 19.6% in August to 23.1% in October 1995. Mean point prevalence in the general population was 5.7% (3.6% in men vs. 7.7% in women, p<0.001). The highest point prevalence (8.0%) was observed among people over 60. Whereas period prevalence showed no trend with age or education, we found increasing point prevalence with age and lower levels of education. In general, significantly more people with self-reported headache suffered from stress (39.1% vs. 33.7%, p<0.001) and chronic diseases (33.6% vs. 23.2%, p<0.001) and took drugs regularly (all kinds of medication: 44.3% vs. 26.8%, p<0.001)., Conclusions: Headache is one of the most commonly experienced symptoms in Austria. The most common concomitant disease in the study population as a whole was hypertension. People with headache had a higher prevalence of hypertension, rheumatic diseases, venous diseases, diabetes and a higher consumption of drugs. Therefore, headache, as one aspect of multimorbidity or a symptom of other diseases, could be an indicator of impaired well-being and poor health.

Objectives: Risk factors for chronic and degenerative diseases, especially overweight and obesity are rarely examined among farmers. Objective of the study was to determine subjective health and health-related lifestyle among Austrian farmers., Methods: The study was performed in 1999/2000 as a nationwide survey by mail among all Austrian farmers, men and women, all insured by the Health Insurance Agency of Farmers., Results: 15.2% of the farmers were obese. 42.9% were overweight. The prevalence of overweight and obesity was high amongst 15-19 year olds, and reached a second peak among the age groups 50-59 and 60-69 years old. Geographically, the highest concentration of overweight and obese farmers was found in the eastern, flat regions of Austria and the lowest concentration in the western, mountainous areas of Austria., Conclusions: Prevalence of overweight and obesity is very high among Austrian farmers, especially when compared to the general population. The results of this study emphasize the need for further work, with respect to the development of prevention strategies to reduce the prevalence of overweight and obesity among Austrian farmers.

Vaccination can only be offered effectively to the general public by the means of social marketing. Experience gained with tick-borne encephalitis (TBE) in Austria will be used to demonstrate the need and importance of this public health tool. After the realisation that only mass vaccination would effect a decrease in the number of TBE cases, a nation-wide TBE vaccination programme was initiated in 1981. Since then there has been a dramatic decrease in the incidence of TBE. The annual TBE-vaccination campaign is by far the most visible of all public health programmes in Austria and has been instrumental in reaching the present vaccination rate of 86% in this country. Outside of Austria TBE is rapidly becoming a growing public health problem in Europe and other parts of the world. In order to effectively contribute toward public health in general and, in specific, to encourage the control of TBE, an international effort was launched with the aim of alleviating this situation. As a first step towards this objective, renowned international experts on TBE created a new body: The International Scientific Working Group on Tick-Borne Encephalitis (ISW-TBE). This Working Group is comprised of internationally recognised scientific experts from endemic and non-endemic regions with extensive personal expertise in the field of TBE and a high level of commitment to improving the knowledge of and response to TBE., (Copyright 2002 Elsevier Science Ltd.)

Although atherosclerosis is today seen as presenting a distinct clinical picture, there are almost no data available about the impact this has on medical practice and about the point at which a patient is considered high-risk. As part of a larger project on the prevention of heart disease and atherosclerosis, "Aktion plus leben", 1,117 physicians were polled in a scientific survey. The study was carried out in some 100 hospitals throughout Austria, above all in departments of internal medicine, but also in neurological departments, and in a number of other units. The results showed that in fact over 90% of those questioned see atherosclerosis as a separate, treatable illness in the context of risk prevention. The most frequent methods of diagnosis were specified as ultrasound and the clarification of symptoms of coronary heart disease. Atherosclerosis prevention is initiated above all in patients with coronary heart disease, myocardial infarction and stroke, but also very frequently in those with diabetes, peripheral vascular occlusive disease, hyperlipidemia and hypertension. Of particular interest to us was the respondents' evaluation of the effect of ramipril, the angiotensin-converting enzyme (ACE) inhibitor used in the HOPE study. The majority of those questioned see a broad range of indications for this ACE inhibitor and ascribe to it a profibrinolytic, antiinflammatory and plaque-stabilising action. Although the survey sought assessment of just one particular medication as a possible treatment option, the study documents the importance of a more inclusive concept of atherosclerosis prevention.

A large number of studies have been focused on patients with severe obstructive sleep apnea syndrome (OSAS) being non-compliant with N-CPAP therapy, but data concerning patients who reject N-CPAP therapy from the very start, without a day of N-CPAP home therapy, do not exist. The purpose of the study was to determine differences, if any, in the quality of life (QoL) between patients rejecting N-CPAP therapy from the start, untreated patients with severe OSAS waiting for N-CPAP titration, and controls. Qol was measured in terms of life satisfaction on the basis of the Munich life quality dimension list (MLDL), an instrument for cognitive assessment of elementary components (physical condition, psyche, social life, everyday life) of QoL. Untreated patients (n = 16) with severe OSAS have a significantly worse QoL in the dimension of psyche (p = 0.00022), social life (p = 0.00582) and everyday life (p = 0.01633) than do rejecters of therapy (n = 19). In the dimension of physical condition, no significant difference was seen (p = 0.47138). Compared with controls (n = 113), rejecters of therapy have a significantly lower QoL score in regard of physical condition (p = 0.00014) but not in terms of psyche, social life and everyday life. We conclude that a good QoL and the absence of the stress of suffering is one reason why patients with severe OSAS reject N-CPAP therapy in spite of physical impairment.

Aim of the study was to investigate attitudes and practice of coronary prevention in offices of general practitioners and internists. 67 Austrian physicians took part in a mail survey focussing on hyperlipidemia. 96.6% of participating physicians recommend dietary intervention at least at total cholesterol levels of 250 mg/dl, 98.0% prescribe lipid-lowering drugs at least at total cholesterol levels of 300 mg/dl. At corresponding levels of total/HDL cholesterol ratios and especially at corresponding levels of LDL-cholesterol the proportion was lower. On average 37.9% of physicians spend up to 5 minutes for patients with hyperlipidemia, 10.3% spend more than 15 minutes. The time frame is similar in overweight patients, and bigger in patients with hypertension and diabetes. Dietary therapy is estimated similarly successful in patients with hyperlipidemia and overweight, but estimated more successful in patients with hypertension and diabetes. Drug therapy of hyperlipidemia is estimated more successful than in overweight and diabetes, and worse compared with hypertension. Main measures for improving prevention are more time and specific postgraduate education. The majority of physicians feel that within the last five years quality has improved both in the outpatient and the inpatient care.

Purpose: To compare the self-reported estimation of sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) and life quality assessed by the Quality of Life Index (QLI)., Background: The PSQI comprised 19 questions and assessed a wide variety of factors relating to sleep quality. The QLI consisted of 10 items for self assessment of different dimensions of life quality., Subjects: A representative Austrian sample (n = 1049) aged above 15 years., Procedure: Interviews in the homes of the participants., Results: 32.1% could be classified as poor sleepers (37% females, 26.5% males). Sleep quality decreased with increasing age, especially in women. Overall quality of life was highest in younger (15-29 years) and lowest in elderly subjects (over 50 years). Life quality decreased with increasing age. Between subjective sleep quality and quality of life a moderate, significant correlation was found (r2= 0.6721)., Conclusions: Complaints about a bad quality of sleep could be used as a screening method in the exploration of patients' quality of life (QoL).

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

The importance of overweight not only for individual health and life expectancy but also for resulting health economics is stressed considering data from Austria. Epidemiology of overweight in Austria shows 8.5% of the population to be morbidly obese (Body Mass Index [BMI] higher than 30) and 14.5% overweight (BMI between 27 and 29.9). Prevalence of overweight in Austria shows a very masked decrease from eastern to the western districts of the country. As in other countries correlation of overweight with cardiovascular risk factors (cholesterol, triglycerides, glucose and systolic blood pressure) was found to be highly significant also in Austrian health screening programs. As far as treatment of overweight and its prevention is concerned not only short term weight loss, but it maintenance is important. Not only a realistic change in feeding behaviour and dieting but also a change in life style including regular physical activity is recommended requiring repeated and long-term controlling by qualified persons of the health profession.

We mostly deal here with socio-medical aspects of vaccinations. Various initiatives are summed up that are intended to optimize the system of immunization by vaccines and to establish certain innovative, and also internationally remarkable approaches. In spite of the undoubted successes of vaccinations in Austria, there still are some major deficits that should be eliminated. The Austrian system of immunization by vaccines has been mainly concentrating on continuously adapting its vaccination schedules. Such modifications are based on current scientific knowledge and thus dynamic in nature whereas the public health system necessarily relies on commonly established and easily adoptable requirements. This discrepancy has brought about a certain degree of uncertainty in some instances.--(See K. Spork, I. Mutz: "Recommendations for Vaccination in Childhood and for Adults".) By further developing immunization programs into a general concept of immunization by vaccines we should be able to put the potential benefits of preventive medical care better into effect than before because such a concept based on clearly defined public health objectives provides strategic and tactical measures and, what is even more important, also includes evaluation.--(See Vutuc, Kunze: "Epidemiology as Background for Vaccinations".) In this connection it has also been necessary to develop various activities in the field of social marketing, examples of which will be mentioned in this issue. There is mainly one recurring source of dispute that must be discussed here, the question of what is immunization of the public at large and what is immunization to be recommended for certain groups (so called risk groups). It has to be principally noted that the idea of risk group immunization has not been too effective in many areas. A typical example for such a project that has to be reconsidered is the active immunization against Central European Encephalitis (CEE) or Tick Bone Encephalitis (TBE).--(See U. Kunze. G. Böhm: "Epidemiology of TBE and Consequences for Further Control Measures Including Vaccination"). Similar considerations also apply to active immunization against influenza or pneumococcal diseases.--(See Süss et al.: "Project 'Vaccinating Hospital Patients' in Upper Austria--Technical Report". Steger, Maczek, Berger. Grubeck-Loebenstein: "Immunizing Against Tetanus in the Elderly: How Long Does Protection Last?") So far, the basic question has been: "Who shall be vaccinated?". Very detailed recommendations have been worked out for that purpose, and some have led to highly complex definitions of which groups should be protected by a particular vaccine. For the future, we will have to reconsider if this question should not be asked the other way round, that is: "Who should not receive a certain vaccination?", based on the hypothesis that this approach may simplify many decision making processes. This would also guarantee optimal information for different target groups in the public health care system but mostly for the general public. Public health care officials and the general public alike have been much concerned with reactions and aversive reactions and side effects. We have to mention that this subject has been the topic of political debates on health, and that single interest groups, even though we must presume in the best of beliefs, have contributed to quite upsetting the public. Without doubt, the Australian health care system still has deficits in organization and substance which to some extent stem from these highly unobjective discussions. It must not be denied, however, that the system of medical care too has not always responded in an optimal way. As a consequence, public health research has been done on background-morbidity which is absolutely essential for scientific discussion. The name of the study, SERMO, is an abbreviation of the term "self-reported-morbidity"; another source for this name is the latin expression "sermo, sermonis".

Venous diseases are common in Western societies, their causes, however, have remained largely unknown. The prevalence of venous diseases in the general population of Austria was assessed, and information on the background morbidity of venous diseases obtained from the data base of the SERMO study (Self-Reported Morbidity Study). The SERMO study consists of 9 representative population surveys conducted between December 1994 and December 1995; the study aimed at describing and monitoring the characteristics of background morbidity in the Austrian population. 5.9% of the sample reported to suffer from venous diseases (vein varicosis, phlebitis, vein thrombosis) in 1995; the point prevalence was 4.1%. The prevalence rate of chronic vascular disorders of the lower extremities was 5.9%. The prevalence of venous diseases is much higher among women than men. Advanced age is as much a risk factor for venous diseases as is low education. This study has shown that persons suffering from venous diseases, especially those advanced in age, suffer more often from concomitant diseases and disorders than others. In addition to clinical and mortality data, self-reported morbidity data provide important information on the health of a general population. Persons above 60 years of age are expected to constitute one third of the entire Austrian population by the year 2030. With this anticipated demographic development in view, the need for long-term prevention plans of chronic venous diseases appears to be of particular importance.

In Austria, microcensus surveys on self-reported morbidity are carried out at regular intervals every ten years, generally by the Federal Statistic Centre. In the following, we describe an epidemiological observational service which could be regarded as an additional public health instrument. This service is termed "health monitor", and the SERMO (self-reported morbidity) study is the scientific project associated with it. The "health monitor" data provide information on the prevalence of various illnesses and impairment, characteristics and variables of background morbidity by repeated short-term representative surveys on self-reported morbidity. The health monitor permits continual observation of the background morbidity of an entire population, while scientific questions pertaining to the SERMO study can be investigated via the health monitor data base. Self-reported morbidity data provide important information about the health of a general population, in addition to clinical and mortality data, and help to make decisions in health policy. By collecting informations (e.g. nearly every month) on background morbidity, "health monitor" and SERMO project could complement other Austrian public health systems to measure the overall health of the population in general.

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

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

In a multicenter study by 243 practicing physicians in Austria 819 severely obese subjects of both sexes without overt disease were encouraged to keep a calorie-restricted diet to reduce weight. After a run-in period of more than two weeks of dieting patients started taking 15 mg dexfenfluramine (Isomeride) twice daily for three month. While their weight was fairly stable during the run-in period progressive weight loss occurred during taking dexfenfluramine due to obvious changes in eating habits and appetite allowing to keep the reducing diet more strictly. Females lost 7.7 +/- 3.9 kg while obese men lost 9.32 +/- 4.6 kg. Laboratory tests obtained before starting dexfenfluramine and after 3 months at termination of medication showed blood glucose, cholesterol, LDL and triglycerides to decrease while HDL-cholesterol increased moderately. Dexfenfluramine was well tolerated by the majority of patients. Side effects such as fatigue, sedation, flatulence or diarrhea occurred in only 7.9% of the probands initially and dropped to 2.1% during the third month of the medication. It is concluded that Dexfenfluramine modifies eating habits and appetite thus making weight reducing diets easier acceptable and resulting in weight loss. It is suggested that Dexfenfluramine has a role in treatment regimes for morbid and refractory obesity.

The typical onset of cigarette smoking is determined on various psychological and social factors. The period of experimental smoking may be followed by habituation. Habituation involves development of skill in inhalation and regulation of nicotine dose, becoming accustomed to the mood-altering and other pharmacologic effects of nicotine, and development of a pattern of conditioned reinforcement from smoking. Many smokers continue to smoke because nicotine helps them to regulate mood. The nicotine intake leads promptly and noticeable to pleasant, desired psychotropic effects. In the event of physical dependence, the occurrence of withdrawal symptoms results in renewed nicotine intake. Psychological and physiological dependence could be very different among smokers and this has important implications on the motivation for smoking cessation. Using the Fagerström Test for Nicotine Dependence (FTND) to assess nicotine dependence in a population 6.000 randomly selected Austrians were interviewed. 42% of men and 27% of women were found to be smokers. 3 groups of smokers differing in dependence can be described: 36.5% are nicotine addicted; 30.2% must be psychosocial dependent because they show nearly no sign of nicotine dependence; and there is a group between, difficult to classify them as more psychological or more nicotine addicted.

In Austria 85 patients (1.10/100,000) were hospitalized with a tick-borne encephalitis (TBE) in 1990, 77 patients (0.98/100,000) in 1991. A relatively low incidence is seen in the younger age groups. The regional distribution follows the distribution of infested areas, with the highest rates in the two provinces Kärnten and Steiermark provinces.

For promoting health the "Fonds Gesundes Osterreich" worked out an "Intervention Programme Against Smoking". In cooperation with different institutions as "Osterreichische Arbeitsgemeinschaft für Volksgesundheit", "Ludwig-Boltzmann Institut für Gesundheitspsychologie der Frau" and "Institute of Social Medicine, University of Vienna" a report on smoking and health, an update on smoking in pregnancy and associated health hazards, report and overview of smoking cessation in Austria and state of the art of smoking cessation therapy were carried out. Based on these projects curricula for physicians, pharmacists, midwives and psychologists were prepared to involve more and more health professionals that smoking cessation treatment will become a generally accepted part of any preventive or therapeutic strategy to control tobacco associated diseases. The target group of the intervention programme is the dissonant smoker, who wants to stop smoking, informing him and providing professional help. Many techniques ranging from self help to sophisticated combined therapeutic approaches including pharmacological interventions are now available to deal with the nicotine addiction problem. For health policy and public health smoking cessation will be one approach within the framework of a comprehensive approach to control the most important modern epidemic, the health damages caused by tobacco consumption.

Hyperlipidemia is the most prevalent coronary risk factor in Austria. Several Austrian expert statements classified total cholesterol levels in adults below 200 mg/dl (5.17 mmol/l) with "normal", levels from 200 to 250 mg/dl (5.17 to 6.47 mmol/l) with "risk", and levels above 250 mg/dl (6.47 mmol/l) with "high risk". Based on different epidemiological studies we estimate that 25% of Austrians have "normal" and 75% elevated total cholesterol levels (50% "risk", respectively 25% "high risk"). Methodological factors prohibit general estimates for HDL-cholesterol and triglycerides based on present data. In a randomized survey among 25- to 64-year old adults in Western Austria, prevalence of low HDL-cholesterol levels below 35 mg/dl (0.91 mmol/l) was 4.0% in men, and 1.3% in women. Prevalence of triglyceride levels above 200 mg/dl (2.29 mmol/l) was 21.5% in men and 8.0% in women.

Unlabelled: Epidemiologic data on sleep disturbances in Austria were collected for the first time in March/April 1993 in a representative inquiry (, Sample: n = 1000, 471 males, 529 females). 26% of the subjects reported sleep disturbances which were mostly chronic (21% had suffered from sleep disturbance for more than one year). The incidence of sleep disturbances increased with age, namely 13% in 14-30 year-old subjects, 22% in 31-50 year-old ones and 41% in subjects over 50. 7% suffered from disturbances in sleep initiation, i.e., they had a sleep latency of over 30 minutes. 19% of them had difficulties in getting to sleep at least once a week. Disturbances in maintaining sleep were reported by 28% of subjects, 56% of them needing longer than one hour to get back to sleep. 30% suffered from daytime sleepiness, 43% of the subjects were impaired by their sleep disturbances in some way, but only 34% had consulted their doctor.

In Austria, in 1990, a total of 3,808 patients with influenza were hospitalized for treatment (49.34/100,000). The age-specific incidence rates show three peaks: < 5 years (132.05/100,000), adolescents (15 to 19-year-olds, 111.5/100,000), old-age groups (85-year-olds, 102.7/100,000). Complications occurred in 1,479 (38.8%) patients, including 846 cases (57.2%) with "other complications" of the respiratory tract, 365 cases (24.7%) of pneumonia, and 268 cases (18.1%) with manifestations affecting other organs. The 3.808 patients spent a total of 34,684 days in hospital. The overall costs of hospital treatment were some 104 million Austrian schillings (approx. 15 million German marks)--per patient on average 26,700 schillings (approx. 3,840 marks); per pneumonia patient 61,200 schillings (approx. 8,743 marks).

The timelag from onset of myocardial infarction to beginning of treatment is significantly correlated with prognosis, especially since introduction of thrombolytic therapy. Based on the last case of 967 Austrian physicians (general practitioners and internists, working in an office or in a hospital) we investigated possible factors delaying the beginning of treatment. On the average it took 111 minutes from onset of symptoms until the patient contacted physicians working in offices. The overall mean from onset of symptoms to hospital admission was 136 minutes. Within the hospital almost no delay was reported. Main factors for delay were repression or suppression and misinterpretation of symptoms. Thus, the biggest potential for an early onset of treatment lies within the patients response to onset of symptoms. Measures improving knowledge about mechanisms of the disease of known or possible coronary heart disease patients are most important. Side-effects, such as over-critical or demanding patients should be avoided. In any case they should not distract from the importance of measures improving patients response.

Benign prostatic hyperplasia (BPH) is one of the most frequent diseases in advanced aged men. The introduction of a new coding system (ICD-VESKA) in 1989 made it possible to analyze the number of hospitalized cases and to calculate the costs of inpatient care. In 1990 10,710 BPH cases were treated within Austrian hospitals. Controlling for multiple entries 9,742 individual patients (269.4 per 100,000) were treated 138,761 days. Case fatality was 0.5% (46 deaths). The number of inpatients comprises only the top 1,3% of morbidity, the total number is estimated with 770,000 patients. Based on the official nursing fees total costs in public affiliated hospitals were AS 250 millions. Including private hospitals total costs increase to AS 306 millions. The inpatient care of BPH represents only a small proportion of the total health and economic burden, which obviously mainly occurs in the outpatient system. Therefore BPH is one of the diseases of which social and economic importance is usually underestimated due to a lack of information.

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

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

251 participants of a representative sample of Austrian physicians (general practitoners, gynecologists, internists) stated their attitudes towards osteoporosis risk factors and methods of prevention. About half of the doctors believe that osteoporosis has less influence on public health than coronary heart disease, stroke or diabetes. Concerning osteoporosis they estimate prevention as most important. For the doctors the most effective preventive strategies, for pre- as well as for postmenopausal women, are physical activity, high calcium intake, and postmenopausal estrogen replacement therapy. Some of the risk factors are very close to the individual lifestyle (e.g. physical activity, nutrition and smoking), 83% of the physicians think that lack of exercise has a great influence on osteoporosis risk, 64% think the same about low calcium intake, 95% about lack of estrogen and 80% about positive family history. Within the physicians as well as the general population osteoporosis awareness is most important concerning growing life expectancy and demographic aspects. Due to this fact it is essential that more than two thirds of the doctors estimate preventive measures as successful.

The incidence of hepatitis A, treated at hospitals in Austria in the year 1990, was 4,3/10(5) (n = 326), of hepatitis B 3,47/10(5). In hepatitis A the highest incidence was observed in children (5-9 years: 14.3/10(5)). Two peaks were observed in hepatitis B; 20-24 years: 5.93/10(5) and 60-64 years: 3.84/10(5). Both disease had the highest incidence in the district of Vorarlberg (hepatitis A 12.4/10(5), hepatitis B 6.86/10(5)), the lowest in the district of Burgenland (0.37/10(5) and no case of hepatitis B).

Population projections of the Austrian Central Statistical Office show a dramatic increase of the proportion of people of 65 years of age and over in Austria until the year 2050. Since this population group is at higher risk to develop dementia, it will be necessary to suitably modify the presently available facilities for social and medical care to meet this increasing demand. Based on official demographic data and epidemiological findings of the "Eurodem"-group (12) our computations show that the number of demented persons, aged 65 or over, will rise from presently 80,000 to over 189,000 in 2050 (1990: 1,023/100,000, 2050: 2,509/100,000 persons of the total population), equivalent to an increase by 140%. By forecasting the number of persons affected, it should be possible to intensify (and in some areas introduce) long-term health planning in respect of aged people, dementia and social, financial and medical care in Austria.