[Show abstract][Hide abstract] ABSTRACT: Objective
To examine the weight-loss success associated with distinct dietary patterns and to determine changes of these dietary patterns during participation in a web-based weight-reduction programme.
Factor analysis was used to identify the dietary patterns of twenty-two food groups that were administered in 14 d dietary protocols at baseline and after 3 months. Successful weight loss (≥5 % of initial weight) and BMI were calculated. Logistic regression analyses were used to assess the rates of weight-loss success from each dietary pattern and changing or remaining in the initial dietary pattern. A generalised linear mixed model was used to estimate the effects of changing or staying in a dietary pattern on change in BMI.
1635) aged 18–81 years.
Users of a web-based weight-reduction programme (2006–2012).
Participants who aligned to a healthful dietary pattern at baseline (OR=1·8; 95 % CI 1·5, 2·3) and after 3 months (OR=1·5; 95 % CI 1·2, 1·9) had a greater chance of successfully losing weight. After adjusting for age, sex, initial dietary pattern and BMI, participants who started with or changed to the healthful dietary pattern had a greater chance of being successful (OR=1·4; 95 % CI 1·1, 1·7) and a higher BMI reduction of 0·30 (95 % CI 0·2, 0·5) kg/m
compared with those who started with or changed to the energy-dense or high-carbohydrate dietary pattern.
A favourable healthful dietary pattern at the beginning and after 3 months was positively associated with anthropometry. However, successful weight loss was feasible in each dietary pattern.
Public Health Nutrition 09/2015; DOI:10.1017/S1368980015002852 · 2.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sehr geehrte Herausgeber, Die Ausbildung von Medizinstudierenden ist einem stetigen Wandel unterworfen. Die Entwicklung und Implementierung neuer Lehr- und Lernmethoden erfolgt im zeitlichen Verlauf jedoch nicht linear sondern ist komplexen Einflüssen unterworfen. Um die Studierenden bestmöglich auf zukünftige Herausforderungen im späteren Berufsfeld vorzubereiten, müssen Medizincurricula flexibel auf gesellschaftliche Anforderungen reagieren.Welche Kompetenzen sollen Absolventinnen und Absolventen eines modernen Medizinstudiums vorweisen? Was ist ein „eine gute Ärztin“, ein „guter Arzt“? Und welche didaktischen Methoden können in der Curriculum Gestaltung eingesetzt werden, damit die gewünschten Outcomes erreicht werden?Die Frage „Sind Sie eine guter Ärztin/ein guter Arzt?“ wird immer öfter von Patientinnen und Patienten, Universitäten, Regierungen, Politikerinnen und Politikern, Sozialversicherungen, Journalistinnen und Journalisten etc. gestellt. Die Antwort auf diese Frage hängt in ...
Wiener Medizinische Wochenschrift 03/2015; 165(5-6):83-85. DOI:10.1007/s10354-015-0349-6
[Show abstract][Hide abstract] ABSTRACT: Prevention and health promotion are gaining importance in modern medical curricula. Aim of this study was to evaluate the self-assessment of knowledge, skills and attitudes of medical students towards health promotion and prevention. In 2012, at the Medical University of Vienna, 27 % of the 633 fourth-year medical students (50.3 % male and 49.7 % female; mean age: 24 years) completed a questionnaire. Results show a high assessment of prevention in most respondents. Knowledge gaps were detected on occupational health and mother-child pass examinations. However, almost all students reported sufficient knowledge on screening and risk assessment of developing cardiovascular diseases. Almost all respondents estimated to be able to identify risky behaviours. Overall, estimation towards prevention of tomorrow's physicians is very positive. However, only 40 % believed to have been adequately trained on preventive medicine so far. Relevant preventive aspects were added to the medical curriculum in 2012-2013 with the new block 'Public Health'.
Wiener Medizinische Wochenschrift 01/2014; 164(7-8). DOI:10.1007/s10354-013-0261-x
[Show abstract][Hide abstract] ABSTRACT: Preventive health check-ups in Austria are offered free of charge to all insured adults (98% of the population) and focus on early detection of chronic diseases, primary prevention, and health counseling. The study aims to explore predictors of compliance with the recommended interval of preventive health check-up performance.
Source of data was the Austrian Health Interview Survey 2006/07 (15,474 subjects). Participation in a preventive health examination during the last three years was used as dependent variable. Socio-demographic and health-related characteristics were used as independent variables in a multivariate logistic regression analysis.
Results show that 41.6% of men and 41.8% of women had attended a preventive health check-up within the last three years. In multivariate analysis, subjects >=40 years, with higher education, higher income or born in Austria were significantly more likely to attend a preventive health check-up. Furthermore, a chronic disease was associated with a higher attendance rate (OR: 1.21; CI: 1.07-1.36 in men; OR: 1.19; CI: 1.06-1.33 in women).
Attendance rates for health check-ups in the general Austrian population are comparatively high but not equally distributed among subgroups. Health check-ups must increase among people at a young age, with a lower socio-economic status, migration background and in good health.
BMC Public Health 12/2013; 13(1):1138. DOI:10.1186/1471-2458-13-1138 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Using a health survey among the rural population of Austria (n=12 484), risk factors for overweight and obesity are analysed. Health awareness turned out as essential mediator, which helps to promote a weight-stabilising life-style. An adverse health behaviour is often due to an unrealistic assessment of a risky overweight condition in connection with a negative attitude to reduce weight. Target groups should be informed about the clearly better health status in normal weight compared with that in overweight and obese people, in order to raise health awareness and motivate people at risk to undergo a modification of their life-style.
Das Gesundheitswesen 06/2013; 76(5). DOI:10.1055/s-0033-1347219 · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
The challenges for health care systems are evident both in terms of costs and of healthy life expectancy. It was the aim of this study to assess the access points towards the different levels of care and predictors for consulting a specialist without having consulted a general practitioner (GP), a common way of access to the Austrian health care system, a system without gatekeeping function.
The database used for this analysis was the Austrian Health Interview Survey 2006-07, with data from 15 474 people. Statistical analyses included descriptive statistics as well as multivariate logistic regression models.
In the 12 months before the survey, 78.8% consulted a GP, 67.4% consulted a specialist, 18.6% visited an outpatient department and 22.8% had a hospital stay at least once. Overall, 15.1% visited a specialist, 8.5% an outpatient department and 8.1% a hospital without consulting a GP concomitantly. One of the main reasons for direct specialist use was a preventive check-up visit. Tertiary education and migration background increased significantly the chance of having been to a specialist without GP contact for both sexes.
The overall access rates for specialists as well as the access rates for specialist without GP consultations were high. The findings point into the direction of a benefit through a structurally supported advocacy role for primary health care professionals. The knowledge gained could contribute to the health policy debate on the importance of coordination and continuity with special respect to demographic factors showing the importance of target-group-specific interventions.
The European Journal of Public Health 01/2013; 23(6). DOI:10.1093/eurpub/ckt008 · 2.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To evaluate self-assessed knowledge about diabetes mellitus, to assess determinants of health knowledge and to evaluate consequences of health knowledge on appraisal about consequences of the disease. DESIGN: Population-based computer-assisted web interview survey, supplemented with a paper-and-pencil survey via post. SETTING: Representative sample of the general Austrian population aged 15 years and older. SUBJECTS: Men (n 1935) and women (n 2065) with and without diabetes mellitus. RESULTS: Some 20·5 % of men and 17·7 % of women with diabetes, and 46·2 % of men and 36·7 % of women without diabetes, rated their knowledge about diabetes mellitus to be 'very bad' or 'rather bad'. Individuals with diabetes and individuals with a family member with diabetes rated their information level more often as 'very good' or 'rather good', with adjusted OR (95 % CI) of 1·7 (1·1, 2·8) and 2·1 (1·6, 2·7), respectively, in men and 2·7 (1·5, 4·8) and 2·7 (2·1, 3·5), respectively, in women. Additional significant influencing factors on diabetes knowledge were age and educational level in both sexes, and city size in men. Independent of personal diabetes status, diabetes knowledge was associated with a lower perception of restrictions on daily life of diabetes patients and with a lower probability of underestimating health consequences of diabetes. CONCLUSIONS: Health knowledge is associated with fewer misconceptions and less underestimation of health consequences in individuals both with and without diabetes mellitus. Thus health information about diabetes is important on the individual level towards disease management as well as on the public health level towards disease prevention.
Public Health Nutrition 08/2012; 16(11):1-8. DOI:10.1017/S1368980012003886 · 2.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine health satisfaction and its predictors in subjects with and without chronic low back pain.
Data for subjects aged 15-64 years were sourced from an Austrian representative population-based nationwide survey including 6,194 men and 6,183 women. Methods: Health satisfaction and its determinants were assessed using the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF).
Prevalence of chronic low back pain was 8.0% (range 7.6-8.3%; 95% confidence interval (CI)) in men and 8.8% (range 8.5-9.2%) in women. The proportion of men, with and without chronic low back pain, who were dissatisfied with their health was 22.5% and 5.7% (p < 0.001), respectively, and in women 28.3% and 5.4% (p < 0.001), respectively. In subjects with chronic low back pain a multi-variate analysis revealed "not needing medical treatment to function in daily life" with odds ratio (OR) (95% CI) of 6.3 (2.6-15.3) and 4.2 (2.1-8.5) as the strongest predictor for health satisfaction in men and women, respectively. In men additionally "satisfaction with one's sex life" and "satisfaction with work capacity", OR: 6.6 (2.9-14.8) and 3.7 (1.5-9.3)were predictors for health satisfaction. In women, however "satisfaction with living conditions" OR: 3.7 (1.7-7.9) was an additional predictor.
Important determinants for health satisfaction are aspects of life such as independence and managing daily activities. These aspects can be influenced by existing therapy options.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 06/2012; 44(8):658-63. DOI:10.2340/16501977-1010 · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lifestyle diseases and cardiovascular complications are dramatically increasing, but little is known about the impact of educational level and health behaviour in men and women in different populations. Therefore, we aimed to investigate the association between educational level (EL) and self-reported chronic diseases and health behaviour in both sexes.
Data were derived from the Austrian Health Interview Surveys 2006/2007, which includes 13 558 persons (50.9% females). The associations between EL and the risk of obesity, hypertension, diabetes, myocardial infarction, stroke and anxiety disorders or depression, nutrition, exercise, and smoking were evaluated. University education served as the reference category (EL4), the lowest educational level was required schooling only (EL0).
Only among women did the risk for diabetes mellitus and hypertension increase with decreasing educational level with the highest rates for EL0 OR [95% CI] adjusted for age, income, family status and lifestyle: 3.7 [1.7-8.0], and 2.5 [1.8-3.5], respectively. Only among the men, however, did the risk for stroke increase with decreasing educational level adjusted OR for EL0: 8.5 [1.7-42.7]. For anthropometric measures and lifestyle factors in both sexes the risk increased with decreasing EL.
EL affects lifestyle, overweight and obesity in both sexes. The apparent sex-specific differences in the association between the prevalence of some chronic disease with EL call for further investigation.
BMC Public Health 05/2012; 12(1):392. DOI:10.1186/1471-2458-12-392 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Arterial hypertension is one of the leading causes of overall mortality and is responsible for a high proportion of deaths due to stroke as well as coronary heart disease. It is defined as a pathological elevation of blood pressure which leads to damage of the cardiovascular system. Cut-off values for hypertension are defined as blood pressure levels higher than 140/90 mmHg (systolic/diastolic). In the pathogenesis of hypertension genetic factors, age and sex play a role, as well as body weight and lifestyle factors, such as nutrition and physical exercise. Lifestyle optimization reduces the risk of developing hypertension and contributes to the treatment in patients with established hypertension. Nutritional factors associated with hypertension are discussed in this article and recommendations regarding diet are made based on the literature. The nutritional factors with the highest impact on blood pressure are reduction of salt intake, a diet rich in potassium, weight management, the DASH (dietary approach to stop hypertension) diet and moderation of alcohol consumption. Salt restriction is essential in the prevention and treatment of hypertension. Based on the literature, in this article recommendations for nutrition and hypertension are given.
[Show abstract][Hide abstract] ABSTRACT: Hypertonie gehört zu den häufigsten Ursachen der Gesamtmortalität und ist zu einem hohen Anteil für Todesfälle durch Schlaganfälle, aber auch durch koronare Herzkrankheit verantwortlich. Die krankhafte Erhöhung des Blutdrucks auf Werte, die zu einer Schädigung des Herz-Kreislauf-Systems führen, bezeichnet man als (arterielle) Hypertonie. Blutdruckwerte ab 140/90 mmHg (systolisch/diastolisch) wurden als hypertensiv definiert. Neben genetischer Prädisposition, Alter und Geschlecht spielen das Körpergewicht und Lebensstilfaktoren wie Bewegung und Ernährung eine wichtige Rolle in der Entstehung der Hypertonie. Lebensstiloptimierung zählt zu den wichtigen Maßnahmen sowohl in der Prävention als auch in der Therapie der Hypertonie. In diesem Artikel werden die Ernährungsfaktoren diskutiert, die mit Hypertonie assoziiert sind. Hinsichtlich der Ernährung haben insbesondere eine Reduktion der Kochsalzzufuhr, eine kaliumreiche Kost, Gewichtsmanagement, die DASH (Dietary Approaches to Stop Hypertension)-Diät, ein Ernährungsmuster, das auf einer obst-, gemüse- und getreidereichen Ernährung mit Milch und Milchprodukten mit niedrigem Fettgehalt basiert, sowie ein, wenn überhaupt, nur moderater Alkoholkonsum einen günstigen Einfluss auf den Blutdruck. Basierend auf der wissenschaftlichen Literatur werden in diesem Artikel Ernährungsempfehlungen bei Hypertonie erstellt.
[Show abstract][Hide abstract] ABSTRACT: Various studies show major regional differences in the prevalence of cardio-vascular disease morbidity and mortality, both in Europe and within European countries. In Austria, these differences are documented by an East-West gradient with declining morbidity and mortality rates when moving from the East to the West of the country. It was the aim of this study to analyse if, and to what extent, socio-demographic and socio-economic determinants, social resources and health behaviour can contribute to the clarification of this East-West gradient by conducting secondary analyses of an existing Austrian health dataset.
The data were analysed using bivariate analyses, as well as univariate and multivariate logistic regression models. These analyses revealed significant East-West gradients for various risk factors, as well as socio-demographic and socio-economic health determinants. There was a gradual decrease of hypertension, diabetes mellitus, obesity, and psycho-social discomfort in both sexes, with the highest prevalences in those Austrian regions with the highest cardio-vascular mortality and a stepwise decrease to the regions with the lowest cardio-vascular mortality. Controlling for educational level significantly raised the odds for diabetes, hypertension and obesity. In the results of the multivariate analyses, factors that significantly and independently predicted diabetes mellitus were geographic location, psycho-social discomfort, lack of physical exercise, and age in both sexes. For women these factors additionally included a low educational level, lack of social support, and being born abroad.
Our study shows a clear gradual decline of cardio-vascular mortality and some of its risk factors from East to West in Austria. Concerning these risk factors, the geographic region and psycho-social discomfort showed the greatest association with diabetes mellitus, hypertension, and obesity. Hence, they contribute to the explanation of the variance in spatial cardio-vascular disease mortality. Yet, a large proportion of this variance remains unexplained. It would be of great importance to public health and preventive measures to take a closer look at spatial differences in cardio-vascular disease morbidity and mortality to better tailor programmes to the regional environments and settings. Our results also call for a greater importance of preventative measures for psycho-social discomfort and increase of social support.
International Journal of Health Geographics 11/2011; 10(1):59. DOI:10.1186/1476-072X-10-59 · 2.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The provision of adequate care for patients with chronic conditions necessitates the knowledge of their perspectives and opinions in order to plan and deliver health services appropriately. The aim of the initiative "Austrian Patients Report" is to collect information on the expectations and requirements of Austrian chronic care patients towards the Austrian health-care system and its actors.
The basis of the "Austrian Patients Report" is an anonymous, structured paper and pencil questionnaire which is adapted to the specific requirements of the chronic condition with the help of patient focus groups. The questionnaire is distributed to the patients via self-help groups, doctor's offices and outpatient centres.
The results clearly indicate that patients expect not only the provision of medical and medicinal care from their doctors, they also value a comprehensive consultation with their doctors, information on different treatment options and a good cooperation between specialists and primary care doctors as highly important. Another important aspect is the respect and understanding of the society concerning the problems which arise from living with a chronic condition.
The "Austrian Patients Report" provides an opportunity to look at aspects of health-care provision from the patient's perspective. The standardisation of the method makes comparisons between patient groups with different chronic conditions possible. This in turn, gives insights into those areas of service provision where improvements need to be made and what is especially important from the patient's view.
Das Gesundheitswesen 03/2011; 74(4):250-6. DOI:10.1055/s-0030-1268449 · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Vaccination is an important public health strategy to prevent adverse health outcomes in the general population and in subjects with chronic diseases. It was the aim of this study to compare data on coverage of recommended vaccinations in men and women with diabetes mellitus and after myocardial infarction (MI) and to analyse trends in three different interview surveys: 1991, 1999 and 2006-07. The data show a rise in influenza vaccination coverage rate in men and women in the general population and in high-risk groups. However, coverage rates in all analysed groups were still strikingly low. Although in soft reported earlier surveys women were vaccinated more often than men, there was a reverse trend observed in the most recent survey. In the survey of 2006-07, men with diabetes or after MI had a higher chance of being vaccinated against influenza when compared to men without these diseases (age adjusted OR: 1.61; 95% CI: 1.29-1.99 and 1.61; 95% CI: 1.21-2.15, respectively). This was, however, not the case in women (OR: 1.10; 95% CI: 0.89-1.35 and 0.87; 95% CI: 0.58-1.33, respectively). Neither men nor women with diabetes mellitus or MI had a significantly higher chance of having pneumococcal vaccination when compared to subjects without these diseases. The observed sex-specific differences demand more research regarding the underlying causes. Strategies to reach higher vaccination coverage in men and women are needed.
Wiener Medizinische Wochenschrift 03/2011; 161(5-6):136-42. DOI:10.1007/s10354-010-0856-4
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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.
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.
American Journal of Hypertension 02/2011; 24(4):408-14. DOI:10.1038/ajh.2010.257 · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many elderly people are affected by cardiovascular diseases (CVD) and the majority of CVD patients are elderly people. For both patient populations, studies have shown that a high body mass index (BMI) is associated with lower mortality when compared to normal weight subjects, a fact commonly known as the "obesity paradox". Whether the correlation between obesity and better survival is based on methodological influences and other non-causal factors alone, or whether there is a causal link between obesity and a better survival in these subjects remains widely unexplored. The interrelation between aging, obesity, CVD, frailty and inflammation is a current issue of intensive research. For the elderly, parameters which include measures of body composition, fat and fat-free mass are of greater importance than BMI. Weight management in elderly people with cardiovascular diseases should aim at improvement and maintenance of physical function and quality of life rather than prevention of medical problems associated with obesity in younger and middle aged patients. Although many studies have shown that weight loss in elderly patients is associated with a poor prognosis, recent data demonstrate that intentional weight reduction in obese elderly people ameliorates the cardiovascular risk profile, reduces chronic inflammation and is correlated with an improved quality of life. An individual approach to weight management that includes the participation of the patient, co-morbidity, functional status, and social support should be aspired.
International journal of cardiology 02/2011; 155(1):56-65. DOI:10.1016/j.ijcard.2011.01.076 · 4.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim was to investigate whether the daily intake of special nutrients, enriched with supplements from natural origins, has any effect on blood parameters.
In this double-blind placebo-controlled clinical trial, 80 healthy subjects (mean age 26.3 years) were statistically assigned to two groups. Group I had to eat two special yoghurt and bread products a day. The other probands represented the control group (II).
Plasma concentrations of blood parameters were measured at the beginning and at the end of the study, and dietary intake was calculated.
In group I, total cholesterol decreased. This was due to a significant drop of low-density lipoprotein-cholesterol from 106.0 to 99.0 mg/dl. A significant reduction of the apolipoprotein B and an increase of vitamin A in group I were also observed.
Regular intake of specially fortified food influences parameters, especially lipids and lipoproteins.
International Journal of Food Sciences and Nutrition 02/2011; 62(1):52-9. DOI:10.3109/09637486.2010.507186 · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Blutdruckkontrolle ist ein Kernpunkt kardiovaskulärer Prävention und trotz der Einfachheit des Screenings mittels Blutdruckmessungen ist die Dunkelziffer der arteriellen Hypertonie nach wie vor sehr hoch. Blutdruckbewusstsein in der Bevölkerung ist damit die Grundlage aller erfolgreichen Präventionsmaßnahmen. Kürzlich publizierten wir Ergebnisse einer repräsentativen Umfrage, in der das Wissen von 1005 Österreichern zu Risikofaktoren und Folgeerkrankungen der Hypertonie, aber auch zum eigenen Blutdruckstatus erfasst wurde. Auffällig war die Diskrepanz zwischen einer hohen Sensibilisierung für allgemeine Risken der Hypertonie und dem Fehlen regelmäßiger persönlicher Kontrollen verbunden mit weit verbreiteter Fehleinschätzung von Hypertoniesymptomen. Nur ca. 1/3 der Bevölkerung gab eine Blutdruckmessung in den vergangenen 3 Monaten an, weitere 30 % innerhalb des vergangenen Jahres, und 8 % hatten noch nie ihren Blutdruck gemessen. Alarmierend ist die Einschätzung von 61 % der Bevölkerung, einen Bluthochdruck sofort oder nach einiger Zeit selbst zu merken, während nur jeder fünfte über die häufige Symptomarmut bzw. -losigkeit der Hypertonie Bescheid wusste. Übergewicht und Stress wurden als die stärksten Risikofaktoren, Herzinfarkt und Schlaganfall als die häufigsten Folgeerkrankungen genannt. Der folgende Beitrag stellt die Ergebnisse im Detail vor und vergleicht sie mit Umfragen der vergangenen 30 Jahre. Weiters werden Resultate in verschiedenen Regionen Österreichs und für spezielle Bevölkerungsgruppen präsentiert.