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[Consequences of international migration for Austria. Population scenarios until 2031].

"The consequences of international immigration on population development and the labour market [in Austria] are assessed on the basis of four scenarios of possible political and economic developments in Europe. In case of massive immigration (net +50,000 per year) the residential population of Austria...will grow to 9.5 million within 40 years.... With a net immigration of +25,000 persons per year the residential population will grow to 8.3 inhabitants.... Without any immigration or with immigration and emigration of equal proportion, the population of Austria will shrink to somewhat above 7.1 million...." (SUMMARY IN ENG)

Austria↗

[Sudden infant death in Austria--status quo and recommendations of the SIDS Consensus Working Group for Improved Registration].

Sudden infant death (SID) is the most common cause of death among infants aged 2 to 12 months in Austria. The complete autopsy required in order to diagnose SID, including the additional investigations, and the comprehensive autopsies needed for epidemiological studies are not common practice because of the different statutory regulations in the provinces and the absence of a uniform federal law in this regard. According to statistics, in the last four years only 83% (1997) to 70% (1999) of the reported SID cases in Austria were autopsied. Our survey in the forensic medicine and pathological institutes of Austria also revealed markedly different practices in regard of the manner in which autopsies are performed and parents are interviewed and followed up. For this reason, the SIDS Consensus Work Group of Austrian centers for the prevention of sudden infant death recommends the following: a) a comprehensive autopsy by a trained specialist to be established as a prerequisite for diagnosing "SIDS"; b) performing autopsies on a centralized basis in those forensic or pathological institutes that have agreed to adhere to protocol-based autopsy standards; c) the introduction of quality control in terms of a regional clinical-pathological conference; and d) standardizing the elements of the interview with parents of SID victims. Implementing these measures and entering the collected information into a data base in which the master data are encoded by the individual institutions, will help to evaluate the role of major epidemiological risk factors that information campaigns are focused upon, namely sleeping in prone position, the role of nicotine, etc. In addition, it will be necessary to formulate federal laws that standardize the divergent provincial regulations.

Austria↗

The strategic approach of managing healthcare data exchange in Austria.

OBJECTIVES: The exchange of electronic medical data between healthcare providers constitutes an integral part of modern medicine, and its importance is growing. Efficient application on a national level requires a uniform approach to the management of healthcare data exchange, avoiding isolated solutions that are expensive and also incompatible. METHODS: In this communication we explain the basic concepts of establishing a nationwide framework to guide healthcare data exchange in Austria. To achieve this goal, a three-step approach was adopted: (i) creating general guidelines to direct electronic medical data exchange; (ii) defining detailed standards for electronic messages; (iii) organizing pilot projects to implement these standards, and further improving the general guidelines based on the results of the pilot projects. RESULTS: We present the MAGDA-LENA framework which guides healthcare data exchange in Austria, and compare it with the US framework HIPAA. We describe several communication scenarios for which concrete message standards were developed in recent years, based on the MAGDA-LENA framework. We further discuss the implementation of these standards in four pilot projects. CONCLUSIONS: The strategic approach of managing healthcare data exchange presented in this paper is expected to have a substantial impact on medical informatics in Austria over the next few years.

Austria↗

[Psychoanalysis and psychotherapy management in Austria].

In a study on the psychotherapeutic provision in Austria the participation of the psychoanalysts was also researched. All over Austria there is a lack of psychotherapists in numbers and regionally. Long term psychotherapy except for a few special institutions are free of charge for the client. In private practice however the patients have to pay heavily. Non-medical psychotherapists are not eligible for refunds by the health insurance system. Almost 4/5 of all psychotherapists belong to a non-medical profession (e.g. psychologists). Only about 1/5 are medical doctors who work as psychotherapists on the basis of a therapeutic training. Psychoanalysts in Austria primarily work as psychoanalytic oriented psychotherapists and to a lesser extent as psychoanalysts.

Austria↗

[Capillaria (Nematoda, Trichuridae) of wild swine (Sus scrofa) in Austria].

Capillaria (Nematoda, Trichuridae) of wild boar in Austria. In a research on Capillaria species with wild boar in Austria 2 species could be found, C. spec. in the stomach and C. garfiai in the tongue. The morphological characteristics of both species were described and represented C. spec. could only be detected in one of 105 stomachs and intestines. C. garfiai, however, could be proved in 77 (= 69%) of 112 examined tongues. C. garfiai which parasitizes in the tongue epithelium causes pathological changes only to a slight degree, so that it is of almost no pathogenic significance. The frequency of infestation with eggs of Capillaria (with a high probability of C. garfiai) was 14.4% of 319 examined samples of faeces. The validity of C. spec. is discussed. Both species were detected at wild boar in Austria for the first time.

Animals↗

[Total cholesterol findings in Austria--an overview of epidemiologic studies].

Hyperlipoproteinaemia is the most important public health risk factor for ischaemic heart disease. This publication gives a review of six Austrian epidemiological studies covering more than 87,000 people in all. The results are not representative for Austria, but give a picture of the epidemiology in Austria. Mean values were calculated age-standardized (age-adjusted when ten-year age groups are registered) to the Austrian population of 1985, for the age group 20 to 79 years. This age range covers 99.77% of the adult male population aged 20 or more, and 95.70% of the women. Mean total cholesterol level for the six studies is 224.2 mg/dl in men and 227.3 mg/dl in women. These results are similar to those of a representative study in the province of Vorarlberg in western Austria (220.0 mg/dl, and 227.4 mg/dl respectively). Variation range is 20.4 mg/dl in men, and 22.5 mg/dl in women; the coefficient of variation is 3.9% in both, men and women.

Adult↗

[Incidence and regional distribution of colorectal cancers in Austria].

Based on data obtained from the official Austrian cancer registry, we evaluated the incidence of, and death rate from cancer of the colon and rectum. The increase in the incidence of colorectal cancer in Austria is comparable to that of other western industrial countries. There is an estimated rise in the annual figures of newly registered patients from 3174 in 1971 to 3981 cases in 1981. Regional distribution within Austria is not homogeneous: the highest risk of disease was observed in Vienna (60 new cases per year per 100000 inhabitants), the lowest in Tyrol with 40 new cases per 100000. The marked east-west slope in the incidence of colorectal cancer in Austria is a good basis for the investigation of pathogenetic factors.

Austria↗

[The status of laparoscopic cholecystectomy in Austria. AMIC--Study Group for Minimally Invasive Surgery].

The complete 1992 register of minimal invasive operations at all surgical departments in Austria has been compiled for the third year running, representing questionnaires returned from 107 departments reporting a total of 11,591 laparoscopic cholecystectomies (LC). Evaluation of the data from the 81 departments with a least 2 years' experience showed an increase of 56.60% in the number of LCs and an overall increase in cholecystectomies of 18.50% in comparison with 1991. Sonography and/or intravenous cholangiography remain the standard procedures for the pre-operative diagnosis of bile-duct concrements, undertaken in 98.05% and 71.70%, respectively, of all cases in 1992. Intra-operative cholangiography has been implemented with increasing frequency (17.56% of all cases in 1992), especially in those departments with longer experience on LC. The conversion rate to open cholecystectomy was 6.09%, and the incidence of secondary cholecystectomy was 1.26%. The mortality rate was 0.11%. Our register now contains the data on 19,872 LCs. Our evaluation of the multicentric data aims at a complete documentation of the frequency of this surgical procedure and the incidence of complications in Austria with a view to establishing guidelines for the indications for LC and planning of this operation, as well as following up current trends in the regional implementation of LC in Austria.

Austria↗

[Analysis of the fluoride content of drinking water in Austria 1993].

This study was undertaken to determine the concentration of fluoride ions in drinking water in Austria. The results show that the fluoride ion concentration is sufficient (0.7-1.0 ppm F-) to prevent caries only in very few parts of Lower Austria, Upper Austria, Salzburg, Tirol, Carinthia, and Styria. Hence, additional fluoridation is necessary to achieve successful prophylaxis of caries.

Austria↗

[Iodine supply and struma in Austria].

Austria is an iodine deficient area as are most parts of Europe. Goiters were always a natural phenomenon. In 1924 goiter prevalence in school children was 45 to 47% and a first attempt was made with iodized salt. This iodized salt (5 mg NaI/kg salt) was not used widely and goiter prevalence remained unchanged for decades. Therefore, in 1963, salt iodized with 10 mg KI/kg was introduced by law in a semi-mandatory way: Non-iodized salt was allowed to be sold only by special request. Consequently, in 1982, 68% of the total salt sold was iodized salt, goiter prevalence dropped to 1.5% in first graders, hypothyroidism in newborns was 1:4,600 and cretinism disappeared. However, in 18 years old females, goiter prevalence was still 13%, and in adults up to 30%. Investigations in various regions of Austria showed that iodine supplementation was insufficient with a mean urinary excretion of 42 to 75 micrograms I/g Cr. Therefore the Austrian Society of Nuclear Medicine (ONG) demanded the raise of the iodine content of salt to 20 mg KI/kg. Finally, in 1990 a new law was issued by the Government following this proposal. In 1992, investigations were done in various regions of Austria demonstrating a normalized iodine excretion of 129 to 177 micrograms I/g Cr. Further prospective and retrospective studies will be done by the ONG.

Adolescent↗

[Incidence and regression of sudden infant death in Austria. Is the change in the SIDS incidence real or virtual?].

After the rise in incidence of the sudden infant death syndrome (SIDS) in the 1980s to a peak of 1.7/1000 live births in Austria in 1988, the SIDS rate more than halved to 0.79/1000 live births in 1994. This trend can be regarded as typical of the epidemiology of SIDS in most Western countries. It is commonly interpreted as a result of preventive measures. However, the decline in incidence of SIDS started several years before systematic preventive activities were undertaken in Austria. Graphical presentation shows that the dynamics of SIDS does not affect the almost linear decline in postneonatal mortality over the past 25 years, as would be expected from the fact that SIDS is the most important cause of death in the postneonatal period. A comparative analysis of trends of postneonatal SIDS and non-SIDS mortality reveals that in Austria the increase of SIDS was accompanied by a rapid fall of non-SIDS mortality, whereas, on the contrary, the decline of SIDS went along with relative increase of non-SIDS mortality. Changing awareness of coroners and forensic pathologists of SIDS, with the resultant changes in frequency and performance of postmortem examinations, and changes in coding practices of causes of death should be taken into consideration as determinants of SIDS incidence before interpreting trends as resulting from public health interventions.

Austria↗

[Collection and utilization of plasma in Austria: on the way to national self-sufficiency].

Self-sufficiency for plasma and plasma products on the basis of voluntary non-remunerated donation is more than guaranteed in Austria. Historically commercial enterprises are co-operating with the non profit sector of the Austrian Red Cross in an ideal way since more than 30 years. Austria needs about 16 millions IE of factor VIII yearly to treat the haemophilia patients as it should be. About 100,000 1 source plasma (FFP) coming from the industry and some 50,000 1 of frozen plasma per year being given for fractionation by the Red Cross Blood Transfusion Services seem to be sufficient for preparing the amount of factor VIII needed. Austria feels furthermore responsible to also fulfill its part as a member of the European Community in order to reach the common European goal of self-sufficiency in due time. As for the term "non remunerated' it is our strong concern that to compensate the plasma donor's time- and work-spending by reinbursement does not mean any sort of "payment'. We agree herewith with the opinion of the "Arbeitskreis Blut' in Germany. To change the successful way of having enough raw material to treat all our haemophilia patients with the necessary amounts of factor VIII by abruptly and artificially pressing for unpaid plasma donations would be a bad decision. By certainly not getting enough plasma by using such an unusual way this idea would not be successful. Austrian Red Cross does not intend to create own plasmapheresis-centres.

Austria↗

The start of clinical nephrology in Austria and developments in the treatment of patients with end stage renal disease over the last decades.

Over the last 50 years nephrology has seen milestone achievements in basic sciences as well as in clinical medicine. This article describes the start of clinical nephrology in Austria in the 1950's and the significant changes over the last decades. With 625 patients/pmp Austria has worldwide one of the highest numbers of patients treated for endstage renal disease. In 1995, 5020 patients were alive on replacement therapy, equally distributed between transplanted and dialyzed patients. An overview over the developments that led to Austria's prominent role in the treatment of end stage renal disease is given.

Austria↗

[Vancomycin resistant enterococci in Austria].

This study reports pheno- and genotypical analysis of 9 isolates of vancomycin-resistant enterococci (VRE) and 5 vancomycin-sensitive enterococci (VSE) in Austria: 5 E, faecium isolates of 4 patients (the sole patients demonstrating VRE at the University Hospital of Innsbruck in 1994 and 1995), 3 glycopeptide-sensitive isolates collected in Innsbruck in February 1996 for epidemiological analysis, and 6 enterococcus isolates from the University Hospitals of Vienna and Graz. The pheno- and genotypical analyses of all glycopeptide highly resistant E. faecium and E. faecalis isolates indicated the presence of VanA type resistance. One E. casseliflavus strain with intrinsic VanC-1 resistance showed a characteristic constitutive low-level resistance to vancomycin and susceptibility to teicoplanin. Genotyping with macro-restriction analysis demonstrated that 3 VRE isolates of the 5 E. faecium specimens were identical; the same applied to 2 VSE isolates. The two patients with VRE had been cared for at the same time in a surgical ICU and likewise, the two patients with VSE were simultaneously treated at a neurological ICU. The genotyping of E. faecalis strains showed that two strains of the three VRE isolates exhibited identical patterns. Epidemiological investigation did not reveal a mode of transmission for this cluster. Two of the 8 patients with VRE died within 60 days after isolation of the bacteria; the doctors in charge did not consider that the enterococci had been the cause of death. The results of our study indicate that oral vancomycin administration to humans is a primary cause of VRE in Austrian hospitals. In Austria approximately 66 kg vancomycin, 20% of it given orally, are administered to patients per year. Approx. 18-20 tons Avotan (active ingredient Avoparcin-10%)/year were used in Austria; as of April 1, 1997 the use of this animal foodstuff supplement is prohibited by the European Commission.

Administration, Oral↗

[Diagnosis and therapy of cervical intraepithelial dysplasia in Austria: a survey].

PURPOSE: To assess the present state of diagnosis, therapy and follow-up of cervical intraepithelial neoplasia (CIN) in Austria. MATERIAL AND METHODS: 100 questionnaires were sent to all departments of Gynecology and Obstetrics in Austria. The anonymous questionnaire consisted of 22 multiple choice questions. It was possible to choose one or more answers by ticking applicable boxes, with the option in individual cases of giving additional information in the form of free text. RESULTS: 55 (55%) departments returned their answered questionnaires, indicating growing consciousness of quality control in medicine. It was found that in the collection of cytologic specimens 67% of the departments used a wooden spatula and cotton swabs. Management of patients with Pap smears indicating low grade squamous intraepithelial lesion (LSIL) and abnormal colposcopy, in 36 (65%) departments consisted of punch biopsy for histological diagnosis. After 3 recurrent Pap smears indicating LSIL, 76% of the hospitals treated such patients by conization, regardless of the histological grade of the lesion. Following inadequate resection of CIN III by conization, operative management of patients was the most commonly used regimen. CONCLUSION: We regard the results of this survey as a basis for the development of further quality management strategies in the prevention, diagnosis and therapy of cervical intraepithelial neoplasia in Austria.

Austria↗

Is public health between East and West? Analysis of wealth, health and mortality in Austria, Central and Eastern European Countries and Croatia relative to the European Union.

AIM: To provide a conceptual framework for health planning activities in the "middle income" transition countries. METHOD: Economic, demographic, and disease-related data in Central and Eastern European (CEE) countries, including Croatia and Austria, were compared to the Europen Union (EU) average. Data were selected from the databases provided by the World Health Organization, Organization for Economic Cooperation and Development, World Bank, United Nations, and the European Bank of Reconstruction and Development. Life expectancy and mortality were extrapolated until the year 2000 by using an exponential growth model for the WHO time series data, starting in 1994. Death rates due to ischemic heart diseases (18%) and cerebrovascular diseases (13%) were selected to show frequent causes of death. RESULTS: Relative to the EU average, the gross domestic product (GDP) share of health expenditures in transition countries was disproportionate to wealth and premature death. The population in CEE-countries was younger and the share of people aged >65 was predicted to remain about 15% below the EU average and Austria. For Croatia, the share of people aged 65 would be on the increase, similar to the share predicted for Austria (slightly above the EU average). Mortality of selected non-communicable, chronic diseases is predicted to increase and remain relatively high. Mortality rates due to infectious diseases have been declining but remained comparatively on a high level. CONCLUSIONS: Coexistence of demographic and epidemiological transition along with high mortality rates due to infectious diseases creates a "double burden". Economic transition has the potential to comprise both the increase in wealth, and life and health expectancy.

Aged↗

[Obesity in Austria: epidemiologic and social medicine aspects].

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.

Adult↗

[Opioid therapy in Austria: results and analysis of a survey].

INTRODUCTION: Many causes are given as the main reason for inadequate pain therapy. The objective of our study was to demonstrate the current position of doctors in general practice all over Austria who prescribe prescriptions. METHODS: A total of 5,359 questionnaires were sent out to general practitioners in all federal states of Austria. These questionnaires contained 21 main questions on subjects relevant to pain therapy. RESULTS: On average, 16% of all general practitioners returned the questionnaires; 89.3% of these are acquainted with the WHO graduated scale, 87% have prescribed strong opioids. Old prejudices such as concerns about the side effects are hardly to be found now. Modern therapy strategies are used. CONCLUSION: Based on the data at hand, pain therapy for patients should be excellent. The reality, however, is somewhat different. The large number of doctors who did not reply makes it enormously difficult to make a statement about the position of pain therapy in Austria.

English Abstract↗