Austrian Health Research Articles

Moderate Altitude Residence Reduces Male Colorectal and Female Breast Cancer Mortality More Than Incidence: Therapeutic Implications?

Simple SummaryLiving at moderate altitudes has been reported to be associated with health benefits, including reduced mortality from male colorectal and female breast cancer. The aim of this study was to evaluate altitude-dependent incidence rates and to compare them with mortality rates of those cancers. We further explored whether altitude-associated differences in lifestyle behaviour exist. Analyses including all incidence cases and deaths over a 10-year observation period of an Alpine country (Austria) revealed that the age-standardized incidence and mortality rates of male colorectal cancer decreased by 24.0% and 44.2%, and that of female breast cancer by 6.5% and 26.2%, from the lowest (<251 m) to the highest (1000–2000) altitude level. The population-based survey indicated higher physical activity levels and lower body mass index for both sexes living at a moderate altitude compared to those living below 251 m. These observations may, in certain cases, support decision making when changing residence.Background: Living at moderate altitude may be associated with health benefits, including reduced mortality from male colorectal and female breast cancer. We aimed to determine altitude-dependent incidence and mortality rates of those cancers and put them in the context of altitude-associated lifestyle differences. Methods: Incidence cases and deaths of male colorectal cancer (n = 17,712 and 7462) and female breast cancer (n = 33,803 and 9147) from altitude categories between 250 to about 2000 m were extracted from official Austrian registries across 10 years (2008–2017). Altitude-associated differences in health determinants were derived from the Austrian Health Interview Survey (2014). Results: The age-standardized incidence and mortality rates of male colorectal cancer decreased by 24.0% and 44.2%, and that of female breast cancer by 6.5% and 26.2%, respectively, from the lowest to the highest altitude level. Higher physical activity levels and lower body mass index for both sexes living at higher altitudes were found. Conclusions: Living at a moderate altitude was associated with a reduced incidence and (more pronounced) mortality from colorectal and breast cancer. Our results suggest a complex interaction between specific climate conditions and lifestyle behaviours. These observations may, in certain cases, support decision making when changing residence.

Adjuvant anti-PD-1 antibody treatment in stageIII/IV melanoma: real-world experience and health economic considerations.

Anti-programmed death 1 (PD-1) antibodies have evolved as a new standard of care in the adjuvant treatment of completely resected melanoma. Real-world data on treatment efficacy and safety as well as cost-effectiveness are still limited. Treatment outcomes were retrospectively analyzed in a continuous patient cohort receiving adjuvant nivolumab (91 patients) or pembrolizumab (9 patients). Based on the obtained clinical data, a semi-Markov model was developed to evaluate cost-effectiveness. After a median follow-up of 11.5 months, disease recurrence was observed in 39 patients (39%). The site of first recurrence was locoregional in 17, distant in 19, and combined locoregional and distant in three patients. Twelve-month estimates for recurrence- and distant-metastasis-free survival were 64.8% and 77.4%, respectively. Sixteen patients experienced grade3 or 4 treatment-related adverse events, while 22 patients discontinued treatment due to adverse events. The base-case Markov model yielded an incremental cost-effectiveness ratio of 13,330€ per quality-adjusted life year for adjuvant anti-PD-1 antibody treatment compared to a simulated observation cohort. Real-world outcomes of adjuvant anti-PD-1 antibody therapy in completely resected melanoma appear comparable to clinical trial data. Moreover, our data suggests this treatment strategy to be cost-effective according to Austrian health economic standards.

Sex, Gender, and Cardiovascular Health in Canadian and Austrian Populations

BackgroundEvidence differentiating the effect of biological sex from psychosociocultural factors (gender) in different societies and its relation to cardiovascular diseases is scarce. We explored the association between sex, gender, and cardiovascular health (CVH) among Canadian (CAN) and Austrian (AT) populations. MethodsThe Canadian Community Health Survey (CCHS) (n = 63,522; 55% female) and Austrian Health Interview Survey (AT-HIS) (n = 15,771; 56% female) were analyzed in a cross-sectional survey design. The CANHEART/ATHEART index, a measure of ideal CVH composed of 6 cardiometabolic risk factors (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes, and hypertension; range 0-6; higher scores reflecting better CVH) was calculated for both databases. A composite measure of psychosociocultural gender was computed for each country (range 0-1, higher score identifying characteristics traditionally ascribed to women). ResultsMedian CANHEART 4 (interquartile range 3-5) and CAN gender scores 0.55 (0.49-0.60) were similar to median ATHEART 4 (3-5) and AT gender scores 0.55 (0.46-0.64). Although higher gender scores (CCHS: β = −1.33, 95% confidence interval [CI] −1.44 to −1.22; AT-HIS: β = −1.08, 95% CI −1.26 to −0.89)) were associated with worse CVH, female sex (CCHS: β = 0.35, 95% CI (0.33-0.37); AT-HIS: β = 0.60, 95% CI (0.55-0.64)) was associated with better CVH in both populations. In addition, higher gender scores were associated with increased prevalence of heart disease compared with female sex. The magnitude of this risk was higher in Austrians. ConclusionsThese results demonstrate that individuals with characteristics typically ascribed to women reported poorer cardiovascular health and higher risk of heart disease, independently from biological sex and baseline CV risk factors, in both countries. Female sex exhibited better CV health and a lower prevalence of heart disease than male in both populations. However, gender factors and magnitude of gender impact varied by country.

Impact of comorbidities on mortality in hospitalized influenza patients with diabetes – Analysis of the Austrian Health Insurance

AimsTo assess the impact of characteristics and comorbidities on the hospitalization rate and 30- and 90-days all-cause mortality after hospitalization for influenza-related illness (IRI) in individuals with diabetes. MethodsData of 507,184 individuals with diabetes enrolled in the national Austrian Health Insurance database during 2013–2017 were analyzed. Hospitalization for IRI was defined as per International Classification of Disease 10 codes (J09, J10, J11). All-cause mortality was calculated for 30- and 90-days post-hospitalization. ResultsOf the total diabetes population, 1994 (0.4%) were hospitalized for IRI during 2013–2017. The rate of comorbidities was higher in individiuals who were hospitalized due to IRI as compared with the general diabetes population. Overall 30-days cumulative mortality following hospitalization for IRI was 7.9% and 90-days mortality was 10.3%. The risk (adjusted Hazard Ratio, 95% Confidence Interval) of IRI related 90-days mortality increased with age (50–59: 3.00, 0.65–13.94; 60–69: 4.16, 0.99–17.55; 70–79: 4.79, 1.16–19.76; 80+: 7.15, 1.74–29.46), heart failure (1.97, 1.31–2.98), renal disease (1.50, 1.05–2.14), and Charlson comorbidity index (1.14, 1.08–1.19). ConclusionsOlder age, heart failure, renal disease, and Charlson comorbidity index were significant predictors of mortality following hospitalization for IRI in individuals with diabetes. These findings could help in improving the clinical management and performance of surveillance and health systems concerning IRI in Austria.

The Influence of Occupational Categories on Overall and Domain-Specific Physical Activity and the Association with Chronic Diseases. An Analysis Using the Austrian Health Interview Survey.

Background: The performance of physical activity (PA) in different domains varies between different occupational groups and they contribute differently to the prevention and management of chronic diseases. This study aimed to give a fuller picture of the potential influence occupational categories have on the different domains of PA among the Austrian population of working age. Methods: A total of 8251 gainfully employed persons in 9 major and 39 sub-major occupational groups from the Austrian Health Interview Survey 2014 were analyzed. PA was measured with the Physical Activity Questionnaire of the European Health Interview Survey (EHIS-PAQ) and the prevalence of 17 chronic diseases was obtained. Results: A total of 48.2% were mostly active when working, 18.4% reported transport-related PA in the upper quintile, 50.4% performed at least 150 min per week of moderate PA or cycling, 32.7% performed muscle-strengthening PA at least twice a week, and 76.3% were either mostly physically active when working or complied with the aerobic PA guidelines. As a general rule, people in physically active occupational groups tended to perform less PA in their leisure time and vice versa. Occupational groups with especially low amount of PA were Information Technology workers, directors, and secretarial staff. People with a chronic disease tended to perform less PA, but there was an interaction between occupation and chronic disease on PA. Conclusions: Domain-specific programs to promote PA should be developed for various occupational categories.

Differences in the prevalence of physical activity and cardiovascular risk factors between people living at low (

Living at moderate altitude (up to about 2,000 m) was shown to be associated with distinct health benefits, including lower mortality from cardiovascular diseases and certain cancers. However, it remains unclear, whether those benefits are mainly due to environmental conditions (e.g., hypoxia, temperature, solar ultra-violet radiation) or differences in lifestyle behavior, including regular physical activity levels. This study aims to compare altitude-related differences in levels of physical activity and the prevalence of cardiovascular risk factors such as obesity, hypertension, hypercholesterolemia, and diabetes in an Alpine country. We interrogated the Austrian Health Interview Survey (ATHIS) 2019, a nationally representative study of persons aged over 15 years living in private Austrian households. The results confirm a higher prevalence of hypertension (24.2% vs. 16.8%) in men living at low (<1,001 m) compared to those at moderate (1,001 to 2,000 m) altitude. Women living above 1,000 m tend to have a lower prevalence of hypercholesterolemia (14.8% vs. 18.8%) and diabetes (3.2% vs. 5.6%) than their lower living peers. Both sexes have lower average body mass index (BMI) when residing at moderate altitude (men: 25.7, women: 23.9) compared to those living lower (26.6 and 25.2). Severe obesity (BMI > 40) is almost exclusively restricted to low altitude dwellers. Only men report to be more physically active on average when living higher (1,453 vs. 1,113 weekly MET minutes). These novel findings confirm some distinct benefits of moderate altitude residence on heath. Beside climate conditions, differences in lifestyle behavior, i.e., physical activity, have to be considered when interpreting those health-related divergences, and consequently also mortality data, between people residing at low and moderate altitudes.

Positive Psychological Factors and Impairment in Rheumatic and Musculoskeletal Disease: Do Psychopathology and Sleep Quality Explain the Linkage?

Little is known about potential mechanisms of action linking protective positive psychological variables and functional disability in patients with rheumatic and musculoskeletal disease. The present study was undertaken to examine symptoms of psychopathology, including stress, depression, anxiety, and sleep quality, as serial mediators of the association between gratitude, self-compassion, self-forgiveness, and functional impairment. We assessed risk and protective factors for functional disability in patients with fibromyalgia (FM), osteoarthritis (OA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) who were recruited from an Austrian health care facility. Respondents completed online surveys, including the Gratitude Questionnaire 6-item form, the Self-Compassion Scale short form, the Self-Forgiveness and Forgiveness of Others Index, the Perceived Stress Scale 4, the Patient Health Questionnaire 2, the 2-item Generalized Anxiety Disorder Scale, the Sleep Condition Indicator, and the Health Assessment Questionnaire. Bivariate and serial mediation analyses were conducted. For our sample of 1,218 patients (52% female, n = 632; AS [37%], OA [34%], RA [14%], and FM [24%]), stress, depression, and anxiety, in parallel as first-order mediators, and sleep quality as a second-order mediator, explained the association between positive psychological variables and functional disability. Positive psychological factors exert a beneficial downstream effect on mental well-being, sleep health, and health-related functional impairment. Therapeutic promotion of gratitude, self-compassion, and self-forgiveness may improve mental and physical health in patients with rheumatic and musculoskeletal disease.

Abstract 16147: Sex, Gender Factors and Cardiovascular Health in Canadian and Austrian Populations

Introduction: Little evidence exists differentiating the effect of biological sex from gender-related (i.e. psycho-socio-cultural) characteristics in cardiovascular outcomes. Hypothesis: Here, we explored the association between sex, gender, and cardiovascular health (CVH) among Canadians (CAN) and Austrians (AT). Methods: Data from the Canadian Community Health Survey (CCHS) (n=63,522, 55% Females) and Austrian Health Interview Survey (AT-HIS) (n=15,771, 56% Females), were analyzed. The CANHEART index, a measure of ideal CVH composed of 6 cardiometabolic risk factors ranging from 0 (worst) to 6 (ideal), was calculated in the CCHS as well as AT-HIS databases (ATHEART). A country-specific gender score was computed using principal component analysis-derived propensity score methods. The final gender scores (Range=0-1, higher score identifying characteristics traditionally ascribed to women) included: i) household size, perceived life stress, education, sense of belonging to community, marital status, and income (CAN); ii) household size, frequency of negative emotions, education, marital status and income (AT). Results: Median CANHEART and CAN gender scores were 4 [3-5] and 0.53 [0.49-0.60] while median ATHEART and AT gender scores were 4 [3-5] and 0.55 [0.46-0.64]. Although higher gender scores (CCHS: β=-1.33, 95%CI (-1.44,-1.22); AT-HIS: β=-1.11, 95%CI (-1.30,-0.91)) were associated with worse CVH, female sex (CCHS: β=0.35, 95% CI (0.33,0.37); AT-HIS: β=0.59, 95%CI (0.55,0.64)) was associated with better CVH in both populations. Additionally, higher gender scores were associated with a higher risk of heart disease, compared to female sex. The magnitude of this risk was higher in AT population (Table1). Conclusions: Individuals with characteristics typically ascribed to women reported poorer CVH and exhibited higher risk of heart disease independent of biological sex. Gender factors must be targeted for improving cardiovascular health.

Adherence to high-intensity statin therapy after acute coronary syndrome and its impact on patient outcome

Abstract Background Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially lipid lowering therapy – via high-intensity statins (atorvastatin and rosuvastatin) – proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and stent thrombosis. However, profound epidemiological measures on adherence to statin intake after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to high-intensity statin therapy after ACS and its impact on patient outcome from an Austrian nationwide perspective. Methods Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to high-intensity statins was investigated according to handing in prescriptions for rosuvastatin and atorvastatin at local pharmacies. Patients were followed prospectively until the primary study endpoint (=mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to high-intensity statin therapy on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model. Results During the observation period a total of 23.240 patients (median age: 65 years [55–75]; male: 67.7% [n=15.728]) met the inclusion criteria. Individuals that died during the index event (n=366; 1.6%), presented with a re-ACS (n=569; 2.4%) or were lost during follow-up (n=158; 0.6%) were not included within the final analysis. Of alarming importance 66.4% (n=15.422) of all patients presenting with ACS did not take high-intensity statins as recommended by current guidelines. The highest rate of drug interruption/end of therapy was observed within the first month after the index event with more than 50% of all cases. During patient follow-up until 01/2018 a total of 3522 (15.2%) individuals died. Non-adherence to high-intensity statins had a strong an independent association with mortality with an adjusted hazard ratio of 1.16 (95% CI: 1.06–1.25; p&amp;lt;0.001) (see Figure 1). Conclusion The present nationwide investigation highlighted an overall low adherence to high-intensity statins after ACS, with the highest interruption/end of therapy rate within the first month after the index event. Since the intake of high-intensity statins after ACS was associated with a 14% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of drug-adherence and intensified patient follow-up should be promoted, in order to prevent fatal atherothrombotic events. Figure 1. Cumulative mortality Funding Acknowledgement Type of funding source: None

Adherence to dual anti-platelet therapy after acute coronary syndrome and its impact on patient outcome

Abstract Background Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially dual anti-platelet therapy (DAPT) – including aspirin plus a P2Y12 inhibitor – proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and stent thrombosis. However, profound epidemiological measures on adherence to DAPT intake after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to DAPT after ACS and its impact on patient outcome from an Austrian nationwide perspective. Methods Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to DAPT was investigated according to handing in prescriptions for aspirin and P2Y12 inhibitors at local pharmacies. Patients were followed prospectively until the primary study endpoint (=mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to DAPT on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model. Results During the observation period a total of 22.331 patients (median age: 65 years [55–75]; male: 69.7% [n=15.176]) met the inclusion criteria. Patients presenting with the indication for oral anticoagulation (n=2165; 9.7%), individuals that died during the index event (n=151; 0.7%), patients that presented with a re-ACS (n=396; 1.7%) or those who were lost during follow-up (n=96; 0.4%) were not included within the final analysis. Of alarming importance 70.7% (n=15.792) of all patients presenting with ACS did not take DAPT as recommended by current guidelines. The highest rate of drug interruption/end of therapy was observed within the first month after the index event with almost 50% of all cases. During patient follow-up until 14 months after the index event 513 individuals died. Non-adherence to DAPT proved a strong an independent association with mortality with an adjusted hazard ratio of 1.25 (95% CI: 1.09–1.41; p&amp;lt;0.001). (see Figure 1) Conclusion The present nationwide investigation highlighted an overall low adherence to DAPT after ACS, with the highest interruption/end of therapy rate within the first month after the index event. Since the intake of DAPT after ACS was associated with a 20% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of drug-adherence and intensified patient follow-up should be promoted, in order to prevent fatal atherothrombotic events. Figure 1. Cumulative Mortality Funding Acknowledgement Type of funding source: None

Adherence to cardiac rehabilitation after acute coronary syndrome and its impact on patient outcome

Abstract Background Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially cardiac rehabilitation proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and overall modification of cardiovascular risk factors. However, profound epidemiological measures on adherence to a recommended cardiac rehabilitation after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to cardiac rehabilitation after ACS and its impact on patient outcome from an Austrian nationwide perspective. Methods Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to recommended cardiac rehabilitation was investigated according to health insurance documentation. Patients were followed prospectively until the primary study endpoint (= mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to cardiac rehabilitation on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model. Results During the observation period a total of 16.518 patients (median age: 64 years [54–74]; male: 68.4% [n=11.306]) met the inclusion criteria. Of alarming importance 86.6% (n=14.305) of all patients presenting with ACS did not perform any cardiac rehabilitation as recommended by current guidelines. During patient follow-up until 01/2018 a total of 1774 (10.7%) individuals died. Adherence to recommended cardiac rehabilitation had a strong an independent inverse association with mortality with an adjusted hazard ratio of 0.73 (95% CI: 0.54–0.98; p=0.036) (see Figure 1). Conclusion The present nationwide investigation highlighted an overall low adherence to recommended cardiac rehabilitation after ACS. Since cardiac rehabilitation after ACS was associated with a 27% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of cardiac rehabilitation and associated intensified risk factor modification should be promoted, in order to prevent fatal atherothrombotic events. Figure 1. Cumulative mortality Funding Acknowledgement Type of funding source: None

Use of Clopidogrel, Prasugrel, or Ticagrelor and Patient Outcome after Acute Coronary Syndrome in Austria from 2015 to 2017.

Background: Dual antiplatelet therapy improves patient outcome after acute coronary syndrome (ACS), but prescription differences of P2Y12 inhibitor treatments exist. The aim of the present investigation was to study the long-term utilization and patient outcomes of clopidogrel, prasugrel, and ticagrelor in patients with ACS from 2015 to 2017 in Austria. Methods: Data from 13 Austrian health insurance funds of patients with a hospital discharge diagnosis of ACS for the years 2015 to 2017 were analyzed. The primary end point was to investigate the recurrence of ACS or death. Results: Of 49,124 P2Y12 inhibitor-naive patients with a hospital discharge diagnosis of ACS, 25,147 subjects filled a P2Y12 inhibitor prescription within 30 days after the index event. Of these patients, 10,626 (42.9%) subjects had a prescription for clopidogrel, 4788 (19.3%) for prasugrel, and 9383 (37.8%) for ticagrelor. Ticagrelor was the most frequently prescribed P2Y12 inhibitor among patients below 70 years old, and clopidogrel in those aged ≥70 years. Occurrence of an endpoint was highest in elderly patients. After adjustment for age, sex, and pre-existing medication as proxy for comorbidity, the hazard ratio for ACS or death for prasugrel vs. clopidogrel of 0.70 (95% CI: 0.61; 0.79) was similar to that of ticagrelor vs. clopidogrel (0.70; 95% CI: 0.64; 0.77). Conclusion: Prescription of ticagrelor or prasugrel after ACS were associated with a lower risk of ACS recurrence or death compared to clopidogrel.

Dermatologists\u2019 perceptions of suicidality in dermatological practice: a survey of prevalence estimates and attitudes in Austria

BackgroundChronic illnesses belong to suicide risk factors. The goal of the current study was to estimate the rate of suicide-related behaviors in patients with atopic dermatitis, psoriasis, or acne from a third-person perspective (namely, Austrian dermatologists).MethodsA link to a questionnaire specially developed for this study was emailed to 450 self-employed dermatologists in Austria, from which a total of 45 participated.ResultsThree dermatologists reported more than five patients with atopic dermatitis, psoriasis, or acne who committed suicide in 2017. Seven doctors treated between 1 and 10 such patients suffering from suicidal ideation. These results are suggestive for a low rate of suicidal ideations in Austrian dermatology ordinations. The majority of dermatologists in the sample (82%) knew that these patients are at higher suicide risk. 60% of participants also believed that it rather would not be a problem for them to recognize suicidal ideation. When facing patients in a suicide crisis, reported intervention steps were: referring them to a specialist in psychiatry, or having a conversation about it. In the sample, most challenging about suicide was lack of time and lack of knowledge. Dermatologists were also interested in cooperating with mental health professionals and in the implementation of new prevention strategies (e.g., suicide-related training programs). Analysis revealed that private specialists, as compared with contract physicians, had fewer patients, but spent more time with them. Yet, these differences did not appear to influence the quality of treatment they provided. Treatment quality was defined as the extent to which doctors tell their patients that additional psychological treatments could be helpful and asking them about their emotional state. Female gender and a professional background in psychology impacted positively on treatment quality.ConclusionsPossible explanations for the low rate of suicidal ideations reported include the advanced Austrian health care system and dermatologists’ underestimation of the problem. Implications of the study are to promote cooperation between dermatologists and mental health professionals and to address patient suicidality from a first-person perspective (i.e., the patients).

Epidemiology of major lower extremity amputations in individuals with diabetes in Austria, 2014–2017: A retrospective analysis of health insurance database

AimsTo describe the incidence, mortality, and trend of major lower extremity amputations (LEA) and to assess risk factors of all-cause mortality after major LEA in individuals with diabetes. MethodsProcedure codes of major LEA were extracted from the Austrian Health Insurance database (N = 507,180) during 2014–2017 to estimate crude and age-standardized rates per 100,000 population. Short- (30-day, 90-day) and long-term (1-year, 5-year) all-cause mortality after major LEA was estimated from the date of amputation till the date of death. ResultsThe age-standardized rate of major LEA was 6.44 with an insignificant annual change of 3% (p = 0.825) from 2014 to 2017. Cumulative 30-day mortality was 13.5%, 90-day 22.0%, 1-year 34.4%, and 5-year 66.7%. Age, male sex, above-knee amputation, Charlson index, and heart failure were significantly associated with both short- and long-term mortality. Cancer, dementia, heart failure, peripheral vascular disease, and renal disease were associated with long-term mortality. ConclusionsThe rate of major LEA in individuals with diabetes remained stable during 2014–2017 in Austria. Short- and long-term mortality rates were considerably high after major LEA. Old age, male sex, above-knee amputations, and Charlson Index were significant predictors of both short- and long-term mortality and comorbidities were significant predictors of long-term mortality only.

Therapeutic Models for Children and Adolescents with Gender Dysphoria: Overview with Focus on Austrian Treatment Reality

Therapeutic Models for Children and Adolescents with Gender Dysphoria: Overview with Focus on Austrian Treatment Reality Young people whose experienced gender differs from their aligned sex are increasingly visible in public life as well as in the medical care system. For those children and adolescents, who can experience a high degree of suffering because of the discrepancy between aligned sex and desired gender, treatment guidelines have been developed. In this short narrative review, classification options, epidemiological data, health-care data and treatment guidelines are presented with an emphasis on the Austrian health care system.

Influencing factors and determinants of health literacy

Abstract Health literacy has demonstrable effects on health status and quality of life and is a prerequisite for health-promoting behavior. Thus, health literacy is naturally an Austrian health target. Actions to strengthen health literacy should specifically address its determinants and influencing factors. To provide the best available knowledge for this goal, we developed an impact model of how influencing factors (indirect influence) and determinants (direct influence) will lead to increased health literacy based on the best available evidence We conducted an umbrella review on systematic, narrative and scoping reviews that deal with concepts, models or definitions of health literacy. The systematic literature search in MEDLINE (Ovid/Epistemonikos) identified 256 relevant abstracts. Two authors checked the abstracts and included 32 in the full text assessment. Fourteen studies were ultimately included in the umbrella review. We extracted influencing factors, determinants, and outcomes and coded, summarized, and renamed them in an inductive approach to ensure uniform terminology. In total, we identified 10 specific influencing factors and 13 measurable determinants. A graphical impact model visualizes the causal relationships between influencing factors and determinants and how they affect the main dimensions of health literacy together: decision, appraisal, access &amp; seek. The impact model illustrates that health literacy is prevalent when decisions are made and implemented and that strengthening health literacy is best achieved through approaches that influence the determinants at the individual and situational level. With the list of specific influencing factors and measurable determinants, the impact model presented differs from all health literacy models available to date. The impact model gives clear recommendations on which concrete influencing factors and determinants programs for strengthening health literacy should be used to aim for positive changes. Key messages Interventions to strengthen health literacy should aim to improve both situational and individual determinants. A key situational determinant is the availability of accessible, understandable and reliable health information.

Outcome monitoring of the Austrian health targets

Abstract Background The ten Austrian Health Targets, developed in a Health-in-All-Policies process and adopted in 2012 with a time horizon until 2032, are monitored by a series of indicators. The (interim) results are reported regularly. Methods Indicators were discussed intensively with experts and defined in advance. The outcome monitoring enables to observe developments over time, to analyse differences by gender, education and region, and comparisons with other EU-countries. For each indicator an overall qualitative assessment is done. This makes monitoring very comprehensive. The challenge is to communicate the monitoring results in an easily understandable way. Therefore, besides reports and presentations further in depth-discussions about communication formats with decision makers were required. Results The outcome monitoring shows that there is potential for development in all areas: Between 2006 and 2014 only 25 % of the outcome-indicators developed positively. As far as equal opportunities are concerned, the most improvements were seen in gender differences, significantly less for educational differences and hardly any positive developments in regional differences. In an EU comparison, Austria performs well concerning 15 out of 35 indicators (43 %). However, for some indicators - contrary to the EU trend - no improvements can be observed. Conclusions The results confirm the relevance of the ten health targets and identify whole-of-society areas for action. The monitoring provides steering impulses and information enabling decision-making for politics, administration, the health target plenary, and the intersectoral working groups. Key messages The monitoring contributes to strategic steering, helps optimising strategy and action plans and enhancing the overall process. Stakeholder involvement is important for development of a format to communicate the results in the best comprehensible way.

Enhancing efficiency and outcome in cancer care integrating patient's and survivorship perspectives

Abstract Although the Austrian health care system generally presents the highest standards and excellence structures of cancer care, patient outcomes continue to lag behind in the global comparison with respect to include the patient's perspective in cancer care. Therefore, potential inefficiencies must be considered in future health system development to achieve more efficient processes and higher outcomes for patients suffering from cancer. The contribution presents the development of the All.Can initiative in Austria, in line with a cancer care framework and derived health targets for patients suffering from cancer including a special focus on the patient's and survivorship perspectives and enhancing the influence of patient organisations in current Austrian cancer care. The proceeding is based on a systemic and applied approach to embed All.Can Austria in the national health landscape and ensure a strategic orientation with a concept paper including literature review and stakeholder research. One important point was to include health professionals in the process and experts from different political sectors with a strong relationship to health according to the concept of health in all policies, referring to the real needs of e.g. patients and cancer survivors. The next step consisted of the development of a policy framework for all sectors to empower patient organisations to gain more efficient structures that incorporates multi-stakeholder involvement. The developed cancer care framework and targets of All.Can Austria aiming at new priorities in Austrian cancer care, creating high-level political commitment to patient outcomes and providing a basis for the empowerment of patient organisations, in consequence changing the system step by step and piloting innovations in cancer care. A special tool will support the allocation of resources for projects in prevention and health promotion linked to the developed health policy framework. Key messages Establishing the All.Can initiative in Austria to empower patient organisations by building innovative structures in Austrian cancer care. Enhancing efficiencies and patient outcomes in cancer care according to health in all policies.

Sex-specific trends in smoking prevalence over seven years in different Austrian populations: results of a time-series cross-sectional analysis.

ObjectivesAim of this study was to examine trends over time in smoking status in men and women, and in subgroups, in Austria, a country with poor smoking regulation policies.Design and participantsTwo cross-sectional surveys (Austrian Health Interview Surveys for 2007 and 2014), each with more than 15 000 participants from the general population, aged ≥15 years.Outcome measuresPrevalence of self-reported daily smoking. ORs for daily smoking in subgroups, presented as results of logistic regression models, adjusted for sociodemographic variables and presence of chronic diseases.ResultsPrevalence of daily cigarette smoking was 26.0% for men in both years, and increased from 19.1% to 22.0% (p<0.001) in women from 2007 to 2014. Smoking prevalence increased especially in female patients with diabetes mellitus (from 9.9% to 16.4%, p=0.005), obesity (from 17.1% to 21.6%, p=0.010) and hypertension (from 11.2% to 14.2%, p=0.010). Smoking prevalence increased significantly in unemployed men (from 43.6% to 57.1%, p<0.001). In women, smoking prevalence increased in those aged 30–64 years (from 21.9% to 26.3%, p<0.001) and 65+ (from 3.9% to 6.2%, p=0.002), with primary (from 17.2% to 24.4%, p<0.001) and secondary education (from 21.4% to 23.4%, p=0.021), and with a European (from 16.6% to 26.1%, p<0.001) and non-European migration background (from 25.0% to 32.8%, p=0.003). In the adjusted analysis for women in 2014, there was a higher likelihood of smoking (OR 1.22, 95% CI 1.12 to 1.32, p<0.001) compared with 2007, and for those affected by a chronic disease (OR 1.15, 95% CI 1.06 to 1.25, p=0.002).ConclusionsThere has been a remarkable increase in smoking prevalence over the 7-year period in women in Austria, especially for those with chronic diseases, higher age, lower education and a migration background. Better political and clinical efforts are needed to reduce the high tobacco use in Austria.

Challenges and opportunities of digitalization for health and well-being at work

Abstract Background Developments in the working world (e.g. digitalization) are imposing new demands on employees. However, it remains unclear how digitalization affects health and well-being at work and how companies can respond to emerging challenges and opportunities. In order to stimulate the discussion of these issues, the Austrian Health Promotion Fund supported 20 projects focusing on ‘Workplace Health Promotion (WHP) in the Working world 4.0'. The central research questions were: What challenges and opportunities regarding “Work 4.0” were identified and what measures have the companies developed? Methods We used a combination of different qualitative and quantitative research methods and instruments. As a first step in this multi-stage process, we conducted workshops with the WHP project managers of each company. Subsequently, we carried out a document analysis of the developed catalogues of measures to identify the underlying opportunities and challenges. To quantify and validate these results, we invited the project leaders and team members to participate in an online survey. Results As the WHP projects in the companies progressed, the focus shifted from the challenges to the opportunities offered by digitalization. On average, opportunities were rated more important than challenges in the online survey. The most important challenges were sensitization of managers, permanent accessibility as a health risk and mental stress and strain. The most important opportunities were the optimization of knowledge transfer, communication and documentation. The measures implemented ranged from the use of innovative tools, to knowledge transfer on methods and health-related content, to changes in materials and organization. Conclusions The examination of digitalization in the context of health and well-being at work has highlighted the positive aspects of digitalization. The health promotion measures implemented can serve as examples of good practice for other companies. Key messages As companies began to consciously examine digitalization in the context of health and well-being at work, the focus shifted from the challenges of digitalization to the opportunities it offers. To meet the challenges of digitalization and to act on emerging opportunities, companies have implemented numerous different measures that can serve as examples of good practice for other companies.