Sleeping habits in the Austrian population

OBJECTIVES

To gain reliable data on sleeping habits and sleep disturbances of the Austrian population.

BACKGROUND

Exact data on sleeping habits are of interest in relation to assessment of sleep disturbance-related illnesses and general social processes.

METHODS

A prospective, cross-sectional study was performed with recruitment of a representative sample of 1049 Austrians (aged 15-82 years), according to the Federal Statistics population characteristics. Interviews were conducted in the households of the participants by specially trained interviewers of an institute for empirical research.

RESULTS

Men consider their quality of sleep to be significantly better than women (P=0.00234), and younger persons consider their quality of sleep to be significantly better than older persons (P=0.00001). In comparison, women and people over the age of 50 report worse subjective sleep quality, worse sleep efficiency, more difficulty in falling asleep and sleep maintenance, more apneic events, more pathologic limb movements, more daytime dysfunction, and more intake of sleeping medication. Other sociodemographic factors influence sleep reports to a lesser extent.

CONCLUSIONS

Subjectively disturbed sleep (prevalence in the total population 24.9%), excessive hypnotic drug intake (prevalence 13.0%), and daytime dysfunction (prevalence 17.4%) are a widespread problem, especially in women and older people. With increasing life expectancy in Western societies, the prevalence of sleep disturbances will increase.

Sleep and quality of life in the Austrian population

PURPOSE

To compare the self-reported estimation of sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) and life quality assessed by the Quality of Life Index (QLI).

BACKGROUND

The PSQI comprised 19 questions and assessed a wide variety of factors relating to sleep quality. The QLI consisted of 10 items for self assessment of different dimensions of life quality.

SUBJECTS

A representative Austrian sample (n = 1049) aged above 15 years.

PROCEDURE

Interviews in the homes of the participants.

RESULTS

32.1% could be classified as poor sleepers (37% females, 26.5% males). Sleep quality decreased with increasing age, especially in women. Overall quality of life was highest in younger (15-29 years) and lowest in elderly subjects (over 50 years). Life quality decreased with increasing age. Between subjective sleep quality and quality of life a moderate, significant correlation was found (r2= 0.6721).

CONCLUSIONS

Complaints about a bad quality of sleep could be used as a screening method in the exploration of patients' quality of life (QoL).

[Analysis of the needs for diagnosis and therapy of tobacco dependence in Austria]

In Austria we find 2.3 Mio. tobacco users (29% of the population). 1.3 Mio. are dissonant smokers, they want to stop (18%) or reduce (37%) tobacco consumption. The assumption that 10% of dissonant smokers (130,000 tobacco users) need a diagnosis and therapy leads to a bottleneck: 130,000 patients versus 20 therapists. Demanded consequences of this disproportion are training for health-care workers, implementation of diagnosis and treatment, financing and refunding. Diagnosis and therapy of tobacco dependence should be offered in highly specialised organisations such as the prototypical Nicotine Institute in Vienna, in hospitals and in primary health care.

Heroin and opiate emergencies in Vienna: analysis at the municipal ambulance service

Vienna suffered an epidemic of heroin abuse in recent years, with drug-deaths due to opioids increasing from 62 in 1991 to 143 in 1993. The aim of this study was to make observations about illicit opioid-use with the ambulance service as a data source. From June 1994 to August 1995, the structured run records of the ambulance service were reviewed. Those with a presumptive diagnosis of "heroin or opiate" overdose were collected, characteristics of emergencies and patients were analyzed. The run records demonstrated a large number of non-fatal emergencies due to opioids, involving 528 men and 179 women in 1087 emergencies. These emergencies were on the average 6.8 times as prevalent as drug-fatalities. A group of 189 persons could be identified, who caused 52.2% of all emergencies and showed a threefold mortality rate during the observation period. In Vienna, the records of the municipal ambulance service provided valuable insights on opioid-abuse. We suggest local analysis of non-fatal emergencies due to opioids, as this might lead to a new source of information on illicit abuse of these drugs.

Blood pressure awareness in Austria. A 20-year evaluation, 1978-1998

AIM

To evaluate public awareness following a nationwide educational campaign on hypertension.

METHODS AND RESULTS

In 1978 the Austrian Heart Foundation conducted a nationwide educational campaign to increase the awareness of the population regarding the importance of recognizing and treating high blood pressure. Following this campaign, five opinion polls of random and representative samples were conducted to measure the awareness and knowledge of the population relating to issues of high blood pressure. The poll results indicated that during the period immediately following the awareness campaign, knowledge and perception of the dangers of high blood pressure increased. However, this effect dissipated during subsequent years. In 1978, 14% of the population were reported to be hypertensive and 10% had no relevant information about their blood pressure status. In 1998, those who labelled themselves as hypertensive dropped to 12%, while those who did not know their blood pressure values, increased to 14%. The percentage of the population who recalled having their blood pressure measured during the last 3 months dropped from 49% in 1978, to 34% in 1993, and remained at 34% in 1998.

CONCLUSION

We conclude that the intensive blood pressure education campaign had only a temporary effect on improving blood pressure awareness. Improved strategies are needed to achieve better community control of hypertension.

[Reduced smoking--a possible strategy for control of tobacco-associated illnesses?]

The aim of the publication is to discuss reduced smoking as a concept to control tobacco-related diseases. New scientific studies show that nicotine-replacement medications may be an untapped source in efforts to reduce smoking. This new indication for nicotine-replacement therapy was licensed for the first time in Denmark by the registration authority. Austrian data have shown that approximately 10 years after implementation, a 1% reduction in smoking could prevent 14 male cancers deaths each year. A 50% reduction could save 700 male lives. 100,000 lives (male and females) could be saved in the European Union annually by a reduction like this including other tobacco-related diseases. Even a 1% reduction would save 1,000 lives. These data are supplemented by the new hypothesis of longer induction time (of lung cancer): Even if this theory fails for the individual smoker, a remarkable gain in years of life will result for society if illness is a probability-based event. A new term of delayed and/or reduced incidence will be a result of this hypothesis. Nevertheless, primary abstinence will remain the most desirable goal in efforts to control tobacco-related diseases. However, most primary prevention campaigns failed, and it will take 30-40 years to translate primary prevention into major health benefits. Reduced smoking should be licensed as a valid method for those unwilling or unable to stop smoking.

Measurement of expired carbon monoxide among medical students to assess smoking behaviour

CO-Measurement of medical students was taken during a compulsory public health training at the University of Vienna. The students were not informed previously, so a non-response bias was excluded. Measurements were done with Bedfont EC50-MICRO Carbon monoxide monitor. The cut off point was set at 11 ppM. One hundred and seventy-three students were measured. Define indication of active smoking was found in 9%. With exception of one student all the others with carbon monoxide over 10 ppM called themselves active smokers. CO measurement will replace at some stage the usual question regarding the number of cigarettes consumed. Students also had the opportunity to learn a new diagnostic technique.

Alternative nicotine delivery systems (ANDS)--public health-aspects

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

[European Medical Association Smoking or Health (EMASH)--consensus on smoking cessation: guidelines for physicians]

The present study summarizes the latest scientific findings on smoking cessation and the various therapeutic possibilities. The guidelines presented here were compiled by the experts of EMASH (European Medical Association Smoking or Health). Accurate diagnosis and adequate treatment of nicotine dependence is essential for achieving sustained abstinence. Diagnostic procedures including the Fagerström Test for Nicotine Dependence (FTND) and various modes of nicotine replacement therapy (chewing gum, plaster, nasal spray and inhaler) are described. New symptoms of nicotine dependence (nocturnal sleep disturbing nicotine craving, nicotine pre-abstinence syndrome), that permit a more precise diagnosis, are discussed.

[Different occupational groups of women and selected nutrition-related risk factors for osteoporosis]

This paper studies the prevalence of risk factors considered responsible for osteoporosis in women of 4 occupational groups: farmers, blue collar workers, white collar workers/civil servants and housewives. We analyzed nutritional factors associated with osteoporosis in the scientific literature. The total sample comprises of 2185 individuals of which 658 women were taken into the analyses. The data set was based on a health survey conducted in 10 selected rural communities of Styria in Austria between 1995 and 1996. Sociodemographic data, lifestyles, internal and external resources as well as indicators off ill-health were surveyed through standardized personal interviews. The results show that the women of the 4 occupational groups were differently strained regarding nutritional risk factors. Our results suggest that efficient intervention programs to prevent osteoporosis need to specifically focus on the various life contexts of women.

Self-reported prevalence of venous diseases in the general population of Austria--results of the SERMO (Self-Reported Morbidity) Study

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

[Vienna standard in diagnosis of nicotine dependence: Vienna Standard Smoking Inventory]

The Standard Vienna Smokers' Inventory (VSSI) ("Wiener Standard Raucher-Inventar" [WSR]) is based on the authors' experience and was designed to optimize primary and additional diagnostic procedures associated with smoking cessation treatment. The aim of this inventory is to enable therapists interested in smoking cessation interventions to initiate diagnostic procedures as well as to use efficient therapeutic modalities. The study also highlights those areas of the patient's history which should be given special attention and the theoretical background of these areas. The various comprehensive sections of the WSR include general data pertaining to the patient's life, the basic situation (basic rate), especially with regard to nicotine dependence, pre-abstinence syndrome and "tar" exposition values, follow-up of smoking habits, earlier attempts to give up smoking, and possible barriers to cessation of smoking--such as insufficient motivation, "nocturnal sleep disturbing nicotine craving" or carbohydrate dependence. Furthermore, previous illnesses, pre-existing risk factors and regular intake of drugs are also discussed. Finally, the study emphasizes that the WSR should be used by the therapist according to his/her level of training and experience, thus providing the possibility to use specific, individual approaches to deal with specific individuals and situations.

Impact of nasal continuous positive airway pressure treatment on quality of life in patients with obstructive sleep apnoea

Quality-of-life (QoL) issues have become increasingly important in health care practice and research. Obstructive sleep apnoea syndrome (OSAS) results in an especially serious reduction in QoL. The purpose of this study was to measure the QoL (life satisfaction) of OSAS patients treated with nasal continuous positive airway pressure (nCPAP). We aimed to determine whether and to what extent the QoL of OSAS patients using nCPAP differs from that of randomly selected subjects without this disorder. The QoL of 67 patients treated for at least 3 months with nCPAP, 21 OSAS patients at the time of OSAS diagnosis, and 113 randomly selected persons visiting the hospital (controls) was investigated with the help of the Munich life-quality dimension list (MLDL), an instrument for cognitive assessment of elementary components (physical condition, psyche, social life, everyday life) of QoL. It was found that QoL of OSAS patients treated with nCPAP did not significantly differ from that of control subjects with regard to elementary components. The 21 untreated OSAS patients showed significantly lower scores in all four subcategories: physical condition (p<0.0005), psyche (p<0.01), social life (p<0.0005) and everyday life (p<0.007). Thus, it may be concluded that nasal continuous positive airway pressure therapy has an important impact on the quality of life of obstructive sleep apnoea syndrome patients, and signifies a further advantage in addition to clinical aspects. Treated patients are as satisfied or dissatisfied with their life as persons without this illness.

[Health monitor (SERMO study)--concept, methodology and a paradigmatic result on subjective morbidity in headache]

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

[Diagnosis and therapy of nicotine dependence]

The 1988 Report of the US-Surgeon General states very clearly, that the use of tobacco products is not a matter of free choice, but is the result of an addiction as scientifically valid as the addiction to heroin and other narcotics. Using the Fagerström Test for Nicotine Dependence (FTND) to assess nicotine dependence in a population 6,000 randomly selected Austrians were interviewed. 42% of men and 27% of women were found to be smokers. 3 groups of smokers differing in dependence can be described: 36.5% are nicotine addicted; 30.2% must be psychosocial dependent because they show nearly no sign of nicotine dependence; and there is a group between. The scientific literature provides informations on many methods and techniques for a smoking cessation, both pharmacological approaches have been tried to treat nicotine dependence in man. According to scientific standards and many controlled studies, nicotine has been the only drug found to be effective in treating nicotine dependence. Many techniques, ranging from self help to sophisticated combined therapeutic approaches including pharmacological interventions, are now available to deal with the nicotine addiction.

Prehospital opiate emergencies in Vienna

To establish baseline data on prehospital emergencies caused by opiates during a 4-month period, a retrospective analysis of run records of the Emergency Medical System in Vienna, the capital of Austria, was conducted. During the study period, there were 308 opioid emergencies involving 240 persons, an average of 2.5 overdoses per day. Severely compromised patients were treated in 67.8% of the 308 emergencies, and 79.3% of emergencies were transported to hospital; 52.5% of the involved persons were younger than 22 years of age. Sex distribution and periodicity and frequency of emergencies differed among age groups. A subgroup of individuals involved repeatedly in emergencies was identified, partly showing temporal clustering of fatal and nonfatal overdoses. Persons involved in opiate emergencies belong to heterogenous subgroups. At a local level, research should be initiated to clarify the pattern and impact of these emergencies on overall drug abuse prevention.

[Epidemiology of health problems caused by passive smoking]

Smoking has long been known to cause premature death and different illnesses. Each year 3 million people die from smoking related diseases worldwide. In recent years there has been concern that non-smokers may also be at risk for some of these adverse effects on health as a result of their exposure to tobacco smoke in various environments polluted by smokers. In 1986 the National Research Council and the Surgeon General of the U.S. Public Health Service independently assessed the health effects of exposure to environmental tobacco smoke (ETS). Both reports conclude that ETS can cause lung cancer in adult non-smokers and that children of parents who smoke have an increased frequency of respiratory symptoms and acute lower respiratory tract infections. The condition of asthmatic children improves significantly when they are removed from ETS. The most severe form of passive smoking is induced by smoking during pregnancy. The effects concern birth weight, complications of pregnancy and impaired development in childhood.