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PubMed1999

Health care system and laboratory medicine in Austria: present status and future perspectives.

In the recent past, the role of laboratory medicine has changed from merely supplier of analytical data to supplier of results together with clinical interpretation. In addition, the role of medical laboratories as important partners of health care management by providing data for management functions and decisions is rapidly growing. The article has the purpose of giving an overview of Austria's population, the governmental system and Austrian health politics in context with European health care. The existing health care system with its historical development, to-date status and recent changes due to socio-economic pressure are outlined. Special emphasis is given to the present situation of medical laboratories in Austria. Furthermore, hospital management strategies and some adjustment processes in the authors' clinical-medical laboratory to alleviate the ongoing economic pressure are described. As far as possible, an attempt of forecasting future scenarios is made.

Austria↗
PubMed1985

Coxsackie B, mumps, rubella, and cytomegalovirus specific IgM responses in patients with juvenile-onset insulin-dependent diabetes mellitus in Britain, Austria, and Australia.

Patients from England, Austria, and Australia with recently diagnosed juvenile-onset insulin-dependent diabetes (type 1) mellitus (IDDM) and matched controls were tested for specific IgM responses to Coxsackie B1-5 viruses. 37 of 122 (30%) patients aged less than 15, but only 15 of 204 (6%) controls, were positive (p less than 0.005). Differences in Coxsackie B virus specific IgM responses between patients and controls were statistically significant for patients in England and Austria (p less than 0.005). Coxsackie B virus specific IgM responses were detected in only 3 of 31 patients aged greater than 16. Virus-specific IgM responses were directed against a single serotype, usually Coxsackie B4 or 5, in 23 of 37 (62.5%) children aged less than 15; 10 of 13 (77%) of children aged less than 7 had monotypic responses. Among families of Austrian patients with IDDM, 8 of 79 (10%) siblings had Coxsackie B virus specific IgM responses, 1 of whom subsequently had IDDM, but none of the 80 parents was positive. In contrast, there was no evidence of recent infection by mumps, rubella, or cytomegalovirus (CMV), since mumps-virus specific IgM was present in only 2 of 100 children with IDDM and 5 of 139 controls; no rubella or CMV specific IgM responses were detected in 60 sera from patients with IDDM.

Adolescent↗
PubMed1984

[Epidemiology and phage typing of Salmonella typhimurium in Austria 1980-1982].

From 1980 to 1982 a total of 4541 strains of S. typhimurium of human origin and 745 S. typhimurium of non-human sources were received by the Salmonella Centre. During this period, the percentage of S. typhimurium rose from 33% to 51% (human origin) and from 12% to 33% (non-human origin), respectively. The incidence of infection was 20.0, the regional distribution showed a prominence of the eastern and western parts of Austria with Styria as leading country (46.2). 60% of the isolates of S. typhimurium were associated with illness, which was 10% more than for the other salmonellae; concerning outbreaks as well as single cases, S. typhimurium dominated, whereas the proportion of carriers of S. typhimurium among foodhandlers was small (12% S. typhimurium, 31% other salmonellae). As to the age-specific attack-rate, children younger than 5 years by far predominated with 67.2, with a falling tendency in the other age groups. As far as food is concerned, the increase of S. typhimurium in poultry is particularly striking. According to the phage-typing results, LT 10 was prominent in the years 1980 and 1981, whereas in 1982, LT 66, accounting for 62% out of 2201 tested human isolates dominated among 44 different phage-types as epidemic strain, especially in Styria and eastern Austria. In addition, LT 10 and LT 3 could be found more frequently. Starting from the important role of food in Salmonella associated enteritis, LT 66 leads to chicken as the main source of infection. Apart from LT 66, LT 1, 2, 3 and LT 140 were more frequent in non-human isolates. This infiltration of LT 66 into the Austrian chicken industry could have its origin in imported parent chickens. As mechanism the single replacement of LT 10 by LT 66 is discussed as well as the phage-conversion of LT 10. The other possible chains of infection (other poultry, feeding-staff, man) are regarded as less probable. To prove this thesis investigations on plasmids should be done.

Austria↗
PubMed1987

Epidemiology of borrelia infections in Austria.

From April 1984 to July 1985 873 cases of Borrelia infections were registered at the Hygiene Institute of the University of Vienna. 2609 serum samples of these patients were investigated for antibodies against B. burgdorferi by means of IFA- and ELISA-tests. Erythema chronicum migrans (ECM) was recognized in 60.9% of patients, neurological abnormalities were recorded in 23.4% of which the majority manifested themselves as polyradiculitis and meningopolyneuritis (MPN). Acrodermatitis chronica atrophicans (ACA) was recognized in 11.5%. A small number of patients suffered from Lymphadenosis cutis benigna (LCB), arthritis and cardiac abnormalities. Sixty percent of patients were females and 40% males. Infections were found in all age groups ranging from 2-83 years in females and 1-85 years in males. Tick- or insect-bites prior to the onset of illness were reported by 47.2% and 15.6% of patients, respectively. The main vector is the hard tick Ixodes ricinus. Flying insects from the family tabanidae, i.e. Chrysops caecutiens and Haematopota species, must also be considered as transmitters. Antibodies to B. burgdorferi were found in 22.3%, 93.6% and 100% of sera from patients with ECM, MPN and ACA, respectively. Six of 11 patients with LCB and all with arthritis and cardiac abnormalities showed serologic reactivity. Geographically, Borrelia infections are distributed in all states of Austria. The seasonal distribution of cases show a peak in July and August, but the onset of clinical manifestation could be observed throughout the year. These results present Austria as an area where tick- or insect-borne Borrelia infections are very frequent and endemic in all Austrian states.

Acrodermatitis↗
PubMed2000

Mycobacterium avium subsp. paratuberculosis infection in cattle in Austria, diagnosis with culture, PCR and ELISA.

Serum samples from healthy, infected (n=11) and diseased (n=2) cattle as well as positive (n=17) and negative (n=41) reference sera were tested for antibodies to Mycobacterium avium subsp. paratuberculosis with two ELISA-methods (A-ELISA, Allied Monitors, Fayette, USA; H-ELISA, Institute of Microbiology and Animal Diseases, Veterinary University Hannover). Fecal samples of these animals were examined by PCR and culture. Also field serum samples found to be positive (n=664) or inconclusive (n=1589) by A-ELISA during a survey done on 11028 cattle of 2757 farms at different districts in Austria were retested with H-ELISA (Gasteiner et al., 1999). In both ELISA-methods total agreement between antibody detection and shedding of M. avium subsp. paratuberculosis (PCR, culture) in cases of diseased animals during the testing period was found. In subclinically infected animals H-ELISA showed a better correlation with the results of PCR and fecal culture. Reference serum samples of culturally negative cattle were negative in 98% by H-ELISA and in 82% by A-ELISA, and those of positive animals were positive in 59% by H-ELISA and in 82% by A-ELISA. The 664 A-ELISA positive field serum samples were positive in 20.5%, inconclusive in 32.5% and negative in 47% by H-ELISA. A-ELISA inconclusive sera gave positive reactions by H-ELISA in 5.2%, negative in 74.8% and inconclusive results in 20%. The highest prevalence of antibodies (7.9% by A- and 2.2% by H-ELISA) against M. avium subsp. paratuberculosis were found in cattle at the age of six and seven years. Seropositive animals were found at all tested ages. The A-ELISA gave two to three times more positive reactors than the H-ELISA. Also both tests showed the highest prevalence of reagents among Holstein Friesian (6.2% by A-ELISA, 2.5% by H-ELISA) followed by other cattle breeds. Seropositive cattle were observed in all districts of Austria in 3. 3-7.1% and in 0.5-1.8% of herds according to A- and H-ELISA, respectively.

Animals↗
PubMed2003

Genetic diversity of recent bovine viral diarrhoea viruses from the southeast of Austria (Styria).

To characterise the bovine virus diarrhoea virus (BVDV) isolates circulating in the southeastern region of Austria, namely in the province of Styria, 71 blood samples collected between 1998 and 2000 from persistently infected cattle in 62 herds were subjected to genetic typing. For this, 288bp fragments from the 5' untranslated region (5'-UTR) were amplified by polymerase chain reaction after reverse transcription (RT-PCR). The products were sequenced and used for phylogenetic analysis. Seventy virus isolates were typed as BVDV species 1 (BVDV-1). Only one isolate was typed as BVDV species 2 (BVDV-2), representing the first isolate of this pestivirus genotype found in Austria. In addition, phylogenetic analysis revealed that viruses belonging to five genetic groups within BVDV-1 are circulating in Styria. Most viruses (53) were found in group BVDV-1f, nine viruses in BVDV-1h, four viruses in BVDV-1b, three viruses in BVDV-1d and one virus in BVDV-1g. No virus was found in genetic group BVDV-1a, which is dominant in the UK and widely distributed in USA. Likewise, the BVDV isolates predominating in a neighbouring country, namely Germany, belonged to different genogroups than those circulating in Styria. We conclude that in a particular region and environment certain BVDV-1 genetic groups predominate. New groups, including BVDV-2, can be introduced, e.g. by trade of animals. The low incidence of BVDV-2 in Styria is in concert with the sporadic occurrence of these viruses in other regions of Europe.

5' Untranslated Regions↗
PubMed2003

Small area variation in childhood diabetes mellitus in Austria: links to population density, 1989 to 1999.

We analyzed the associations of environmental factors with the regional distribution of Type 1 diabetes mellitus in Austria. All newly diagnosed cases (n=1449) from 1989 to 1999 were allocated to districts using the postal code. Nitrate content of the water was measured by the Austrian Federal Environmental Agency. Data on infant mortality, population density, and percentage of employment by industry were derived from Statistics Austria. An inverse effect was seen between the proportion of children younger than 15 years of age and the risk ratio (P<.01). Infant mortality, population density, and percentage of persons with employment in industry were not of significant influence. The mean nitrate level was positively associated (P=.07). In regions with a higher percentage of children younger than 15 years of age, fewer children developed diabetes, which is in agreement with the observation that early social mixing is a protective factor. Nitrate levels may have a confounding effect.

Adolescent↗
PubMed2003

Rates of postmortem examination in Austria: the effect of distance between location of death and site of examination.

BACKGROUND AND OBJECTIVE: Despite the importance of autopsies for diagnosing disease and determining cause of death, autopsy rates are decreasing in many countries. Furthermore, autopsy rates are often not distributed randomly between different regions within countries. In this study we analyzed an apparent nonrandom spatial distribution of autopsy rates in Austria for the period 1991-2000. We tested the new hypothesis that the rate of autopsies performed on people who die at home depends on the distance from the residence to the hospital or forensic institute where autopsies are performed. METHODS: Data were extracted from the official mortality records for the years 1991-2000. Only persons who deceased in private residences were included. A logistic regression model was used. RESULTS: Even controlling for variability in sex, age, date of death, and family status, the effect of distance significantly implied lower autopsy rates in the alpine parts of Austria. CONCLUSIONS: This effect of distance may lead to artificially nonrandom mortality patterns in disease maps. As a consequence, the possibility of hypothesizing incorrect health risks to explain nonrandom mortality patterns increases.

Austria↗
PubMed1990

Parasitic infections in HIV patients in Austria: first results of a long-term study.

In the course of a long-term study of parasitic infections among HIV-infected persons in Austria during the period from November 1985 until May 1989, 618 persons infected with HIV (including 270 hospitalized patients, most of them with severe symptoms of AIDS) were examined. 58% of all persons had antibodies against Toxoplasma gondii. The incidence of clinically overt toxoplasmosis was about 20% in the 167 hospitalized persons infected with the parasite. In 29% of 68 patients with suspected pneumocystosis, the infection could be verified. In 9% of 219 patients, Cryptosporidium sp. was found. In two persons, an infection with Strongyloides stercoralis was diagnosed. Except these AIDS-associated opportunistic infections, the incidence of parasitic infections in the Austrian HIV-infected population was found to be low, and, except for Entamoeba histolytica, not significantly exceeding the frequency of parasitic infections in non-HIV-infected Austrians. Compared to data on the frequency of opportunistic infections in AIDS-patients in other developed countries, toxoplasmosis as well as infections with Cryptosporidium sp. seem to be more often diagnosed in Austria, whereas pneumocystosis is slightly less frequently found.

Adult↗
PubMed2003

Screening for West Nile virus infections of susceptible animal species in Austria.

Avian mortality and encephalomyelitis in equines are considered good indicators for West Nile virus (WNV) activity. We retrospectively tested 385 horse sera for WNV antibodies and looked for WNV nucleic acid and/or WNV antigen in paraffin embedded tissues from 12 horses with aetiologically unresolved encephalomyelitis and 102 free-living birds of different species which had been found dead. With the exception of four horses originating from eastern European countries investigated on the occasion of transit through Austria, all horse sera were negative. Nested RT-PCR of the horse tissues yielded no amplification of WNV-RNA. Also, all bird samples, examined by immunohistochemistry, in situ hybridization and nested RT-PCR were negative for WNV. These results indicate that currently WNV cannot be considered a significant pathogen in Austria.

Animals↗
PubMed1998

Trends in HIV seroprevalence, AIDS and prevention policy among intravenous drug users and men who have sex with men, before and after 1990 in Austria.

This study reports for the first time on secular trends in human immunodeficiency virus (HIV) infection and AIDS, and possible associations with prevention policy in Austria. We analysed HIV seroprevalence and AIDS cases among intravenous drug users (IDU) and men who have sex with men (MSM). In this study we found a diminished rate of increase in new cases of AIDS and a decline in HIV seroprevalence among IDU but not among MSM. Among clients visiting HIV counselling and testing centres in Austria between 1987 and 1990, seroprevalence among IDU was estimated at 27.9% as compared to 19.6% between 1990 and 1992 (odds ratio (OR): 0.62; 0.45-0.85). Among MSM corresponding prevalence for these two periods was 12.1% and 10.9%, respectively, which was not a significant decline. In the period 1990 to 1994, the increase in AIDS cases per half-year levelled off for IDU (incidence rate ratio (IRR) :1.00; 0.99-1.01) but to a lesser extent among MSM (IRR: 1.01; 1.01-1.02). The most effective prevention policy intervention was considered to be the national Methadone Maintenance Program (MMTP), started in 1987, and the provision of sterile injection equipment. We observed that in the recent period there was a decline in the frequency of attendance among young (less than 28 years of age) MSM at counselling centres (OR: 1.27; 95 % CI: 1.08-1.49), accompanied by the observation that the rate of seroprevalence among this group did not decline. This is in contrast to young IDU where attendance did not decline but seroprevalence did. Although inference is limited from cross sectional studies, we argue for a reoriented and effectively monitored HIV prevention policy focused on young MSM.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Molecular taxonomy and biodiversity of rock fungal communities in an urban environment (Vienna, Austria).

The diversity of fungal communities on three different historical monuments in the city of Vienna (Austria) was analyzed and compared to the fungal diversity of microfungi on rock in the original quarry located in a rural area (Zogelsdorf, Austria). The fungal strains isolated were characterized by morphology and the complete rock fungal community was identified based on molecular data, that is, by sequencing parts of the small ribosomal subunit (18S) and internal transcribed spacer region 1 (ITS1). The genera Coniothyrium, Epicoccum and Phoma were found to be dominant on monument and rock surfaces. Additionally, black yeasts such as Exophiala species and microcolonial fungi like Sarcinomyces and Coniosporium which hitherto were regarded as typical rock inhabitants in semi-arid environments are frequently found on all rock surfaces in Vienna. The biodiversity of the fungi in the urban environment was much higher than on the same rock type in a rural environment, this difference can be attributed to the elevated organic pollution in the city.

Austria↗
PubMed2002

Connexin 26 mutations in cases of sensorineural deafness in eastern Austria.

Mutations in the connexin 26 (Cx26) gene (GJB2) are associated with autosomal nonsyndromic sensorineural hearing loss. This study describes mutations in the Cx26 gene in cases of familial and sporadic hearing loss (HL) by gene sequencing and identifies the allelic frequency of the most common mutation leading to HL (35delG) in the population of eastern Austria. For this purpose we have developed and applied a molecular beacon based real-time mutation detection assay. Mutation frequencies in the Cx26 gene of individuals from affected families (14 out of 46) and sporadic cases (11 out of 40) were 30.4% and 27.5%, respectively. In addition to known disease related alterations, a novel mutation 262 G-->T (A88S) was also identified. 35delG accounted for almost 77% of all Cx26 mutations detected and displayed an allelic frequency in the normal hearing population of 1.7% (2 out of 120). The high prevalence of the 35delG mutation in eastern Austria would therefore allow screening of individuals and family members with Cx26 dependent deafness by a highly specific and semi-automated method.

Adolescent↗
PubMed2001

Screening for trisomy 21 by fetal nuchal translucency and maternal age: a multicenter project in Germany, Austria and Switzerland.

OBJECTIVE: To examine the effectiveness of screening for trisomy 21 by a combination of maternal age and fetal nuchal translucency thickness at 10-14 weeks of gestation in Germany, Austria and Switzerland. METHODS: This was a multicenter study of screening for trisomy 21 by a combination of maternal age and fetal nuchal translucency thickness at 10-14 weeks of gestation. All the sonographers involved in the study had received The Fetal Medicine Foundation Certificate of Competence in the 10-14-week scan. Fetal nuchal translucency thickness and crown-rump length were measured in 23 805 singleton pregnancies with live fetuses. In each case the risk for trisomy 21 was estimated on the basis of maternal age and fetal nuchal translucency thickness for crown-rump length with the use of The Fetal Medicine Foundation's software. The distribution of estimated risk was determined and the sensitivity and false-positive rate for a risk cut-off of 1 in 300 was calculated. RESULTS: Fetal nuchal translucency thickness was successfully measured in all 23 805 pregnancies and outcome was available in 21 959. The median maternal age was 33 (range 15-49) years and in 7935 (36.1%) the age was 35 years or greater. The median gestation at screening was 12 (10-14) weeks and the median fetal crown-rump length was 61 (range 38-84) mm. The estimated risk for trisomy 21 based on maternal age and fetal nuchal translucency thickness for crown-rump length was 1 in 300 or greater in 13.0% (2800 of 21 475) normal pregnancies, in 87.6% (184 of 210) of those with trisomy 21 and in 87.2% (239 of 274) with other chromosomal defects. CONCLUSIONS: In Germany, Austria and Switzerland the results of screening for chromosomal defects by measurement of fetal nuchal translucency thickness, in centers with appropriately qualified sonographers and using The Fetal Medicine Foundation's software, are similar to those reported in the UK using the same methodology.

Austria↗
PubMed2001

Hospitalization of patients with neurological disorders and estimation of the need of beds and of the related costs in Austria's non-profit hospitals.

In 1997, 273 722 hospitalizations as a result of neurological disorders, including the related operated cases, were reported in Austria's non-profit hospitals (80% of all hospitals). They represent 14.12% of all 1.9 million in-patient treatments. The individual disease groups, e.g. cerebrovascular disorders (59 269 admissions or 3.06%), multiple sclerosis (3920 admissions or 0.2%) and all other groups are detailed. We estimated the cost resulting from these diseases which amounted to 11.88% of all hospital costs. We were also able to estimate that 5549 beds are required for in-patient treatment in the area of neurology, assuming an average duration of treatment of 8 days (Austrian mean value for neurological disorders). This is equivalent to one bed per 1367 inhabitants or 11.31% of all beds for in-patient treatment in non-profit hospitals in Austria. Obviously at present the majority of neurological patients are treated in non-neurological departments. A major increase in resources to neurology is necessary if patients are to receive the benefit of specialized diagnosis and treatment. These further resources not only cover the increase of neurological beds in hospitals but also financial, personal resources and in consequence increased capacity for neurological education, training and research.

Austria↗
PubMed2003

One-year prevalence of migraine in Austria: a nation-wide survey.

This study presents the first nation-wide survey of migraine in Austria. A sample of 997 Austrian > or = 15 years old were interviewed personally (face-to-face) in a random sample in the whole country. Diagnosis of migraine was based on the International Headache Society (IHS) classification. Of the Austrian adult population 10.2% were identified to suffer from IHS migraine, 5.6% from migraine without aura, 2.3% from migraine with aura and 2.3% from borderline migraine. Another 8.5% have possible migraine. Other primary headaches were reported in 30.7%. Sex, age, working status and region were found to be the main demographic influencing factors. Further influences were stress, spinal column problems or weather changes. The most used acute medications were over-the-counter drugs, doctor attendance rate was very low. Working people with migraine dropped out of work 14 days per year, which adds up to 6.8 million working days per year. This remains a substantial economic factor. The findings indicate that migraine sufferers in Austria need to be more informed about their illness and what to do against it, especially encouraging doctor visits.

Adolescent↗
PubMed2003

Occurrence of Salmonella enterica serovar Dublin in Austria.

In Austria, Salmonella enterica serovar Dublin, a bovine-adapted serovar, rarely causes human infections. In the year 2000, Austria was within the European mean with an incidence of 0.1 per million inhabitants. Our data show that the vast majority of all Austrian serovar Dublin infections can be traced to two Tyrolian districts. This concentration of cases can be explained by a particularly traditional aspect of cattle farming in Tyrol, the alpine pasture. There is increased risk of cross-infection due to the communal keeping of animals from various farms. Infected cattle are a source of infection for people, and contagion usually occurs from eating beef and drinking cow's milk. Using pulsed-field gel electrophoresis and automated ribotyping, 3 out of 5 available isolates from human infections could be traced to characteristic Tyrolian S. Dublin clones. Bacteriological screening of herds with a known history of S. Dublin infection would be a start to prevent future contamination of alpine pastures through latently infected cattle excreting potentially infectious feces. Bacteriological screening for fecal carriage before the return of cattle from pastures known to be connected with infections could prevent cross-contamination of large mixed herds.

Adult↗
PubMed2003

[Sensitization to tea tree oil in Germany and Austria. A multicenter study of the German Contact Dermatitis Group].

BACKGROUND AND AIM: Tea tree oil, a distillation product of the Australian tea tree (Melalence alternitolia) is increasingly used as an alternative remedy for various dermatological diseases. Tea tree oil contains several allergenic monoterpenes and sesquiterpenes. In this multicenter study it was evaluated, whether the increasing use of tea tree oil has lead to an increased frequency of sensitization in Germany and Austria which would justify its inclusion into the standard series. PATIENTS AND METHOD: For patch testing a standardized tea tree oil was used, dissolved 5% in diethylphtalate (DEP). Consecutive patients of 11 dermatological departments in Germany and Austria were tested. Readings were taken on day 2 and 3 according to the guidelines of the German Contact Dermatitis Research Group (DKG). RESULTS: 5% tea tree oil was positive in 36/3375 patients (1.1%). Sensitization frequencies showed great regional variations and ranged from 2.3% (Dortmund), 1.7% (Buxtehude), 1.1% (Essen), 0.7% (Graz), to 0% (Berlin, Vienna). 14/36 patients (38.9%) also showed a positive patch test reaction to oil of turpentine. CONCLUSION: Our results show that tea tree oil is an important contact allergen for some centers. It should be tested, if medical history suggests its previous use. Considering the great regional differences in frequencies of sensitization its inclusion into the standard series is not recommended yet.

Adult↗