The frequency of photosensitizing drug dispensings in Austria and Germany: a correlation with their photosensitizing potential based on published literature

Background

Drug‐induced photosensitivity refers to the development of cutaneous adverse events due to interaction between a pharmaceutical compound and sunlight. Although photosensitivity is a very commonly listed side‐effect of systemic drugs, reliable data on its actual incidence are lacking so far.

Objectives

A possible approach to evaluate the real‐life extent of drug‐induced photosensitivity would be an analysis of the frequency of exposure to a given photosensitizing drug combined with an indicator of its photosensitizing potential. This could serve as a basis for developing a pharmaceutical ‘heatmap’ of photosensitivity.

Methods

The present study investigated the number of reimbursed dispensed packages of potentially photosensitizing drugs in Germany (DE) and Austria (AT) between 2010 and 2017 based on nationwide health insurance‐based databases. In addition, an indicator for the photosensitizing potential was established for each drug based on the number of reports on photosensitivity in the literature.

Results

This analysis includes means of 632 826 944 (+/−14 894 918) drug dispensings per year in DE and 113 270 754 (+/−1 964 690) in AT. Out of these, the mean percentage of drugs that enlist photosensitivity as a potential side‐effect was 49.5% (±0.7) in DE and 48.2% (±1.2) in AT. When plotting the number of reimbursed dispensed packages vs. the number of reports on photosensitivity, two categories of drugs show high numbers for both parameters, that is diuretics and non‐steroidal anti‐inflammatory drugs (NSAIDs).

Conclusions

Diuretics and NSAIDs appear to be responsible for the greatest part of exposure to photosensitizing drugs with potential implication on public health.

Time trends of the prevalence of asthma and allergic disease in Austrian children

After a substantial increase in the prevalence of atopic disease in Europe, recent studies indicate that a plateau has been reached. However, variation across countries and age groups exists. We studied the prevalence and time trends of asthma and allergic disease among schoolchildren in Austria, a country with traditionally low rates of asthma, hay fever, and eczema. As part of the International Study of Asthma and Allergies in Childhood (ISAAC), symptoms and physician diagnoses of asthma and allergic disease of 13,399 Austrian children aged 6-7 yr and 1516 children aged 12-14 yr were surveyed between 1995 and 1997. A similar survey was conducted between 2001 and 2003. Among children aged 6-7 yr, significant increases were seen in the prevalence of physician-diagnosed asthma (+16%; p = 0.013), hay fever (+22%; p < 0.001), and eczema (+37%; p < 0.001) between 1995 and 2003. These changes were paralleled by an increase in the prevalence of symptoms typical for hay fever (itchy eyes and runny nose), but not by an increase in wheeze. Among children aged 12-14 yr, the lifetime prevalence of diagnosed asthma increased by 32%, of hay fever by 19%, and of eczema by 28% (all, p < 0.001). These changes were paralleled by increases in the prevalence of wheezing as documented by both questions before and after a video showing wheezing children but not by symptoms typical for hay fever such as itchy eyes and runny nose. In conclusion, in Austria, contrary to other European countries, the prevalence of asthma and allergic disease increased among schoolchildren. Additional studies are needed to continue monitoring the dynamics of the prevalence of asthma and allergic disease in Austria and to explore trends in their risk factors.

Coffee consumption protects human lymphocytes against oxidative and 3-amino-1-methyl-5H-pyrido[4,3-b]indole acetate (Trp-P-2) induced DNA-damage: Results of an experimental study with human volunteers

Aim of the study was to investigate the impact of coffee on DNA-stability in humans. DNA-damage was monitored in lymphocytes of eight individuals with single cell gel electrophoresis assays before and after consumption of 600 ml coffee (400 ml paper filtered and 200 ml metal filtered/d) for five days. Under standard conditions, no alteration of DNA-migration was seen, but a strong reduction of DNA-migration attributable to endogenous formation of oxidised purines and pyrimidines was detected with restriction enzymes; furthermore DNA-damage caused by reactive oxygen radicals (H2O2 treatment) and by the heterocyclic aromatic amine 3-amino-1-methyl-5H-pyrido[4,3-b]indole-acetate was significantly reduced after coffee consumption by 17% and 35%, respectively. Also in in vitro experiments, inhibition of H2O2 induced DNA-damage was observed with coffee at low concentrations (<or= 25 microl/ml) whereas the diterpenoids cafestol and kahweol caused only marginal effects indicating that the effects of coffee are due to scavenging effects of other constituents. Enzyme measurements showed that additionally induction of antioxidant enzymes may play a role: while the activity of glutathione peroxidase was only marginally increased after coffee consumption, a significant (38%) increase of superoxide dismutase activity was detected. Comparisons with results of earlier studies suggest that coffee consumption may prevent oxidative DNA-damage to a higher extent as diets enriched in fruits and vegetables.

Prevalence of persistent vegetative state/apallic syndrome in Vienna

The aim of the project was to survey the hospital prevalence of apallic syndrome in a federal state in Austria at an exact point in time. To achieve this, a point prevalence study was carried out on 28 November 2001 in the Vienna region. The central element was a questionnaire, which provided an exact recording of the patients' condition. An additional preliminary task was to check all the discharge diagnoses in the hospitals of the Vienna Hospital Association (Wiener Krankenanstalten Verbund) between 1996 and 2000 according to the ICD-9 diagnoses for apallic syndrome. These data should serve to cross-check the recorded results. All hospitals (n = 48) and nursing facilities (n = 44) in Vienna were included in this investigation. As the aim of the study was to record the prevalence of apallic syndrome in the population of Vienna, four patients of the group with full-stage apallic syndrome (n = 36) were excluded as they were from other federal states. In total, 32 hospital patients who met the clinical criteria for apallic syndrome (full-stage) were recorded. The point prevalence of apallic syndrome was 1.9/100,000 inhabitants. As a result of this study, the exact survey of hospital prevalence of apallic syndrome could be found. As a consequence, the Viennese government has developed a rehabilitation concept for patients with apallic syndrome in Vienna.

Rates of postmortem examination in Austria

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.

Association of microsomal epoxide hydrolase polymorphisms and lung cancer risk

Microsomal epoxide hydrolase (mEH) plays a dual role in the detoxification and activation of tobacco procarcinogens. Two polymorphisms affecting enzyme activity have been described in the exons 3 and 4 of the mEH gene, which result in the substitution of amino acids histidine to tyrosine at residue 113, and arginine to histidine at residue 139, respectively. We performed a hospital-based case-control study consisting of 277 newly diagnosed lung cancer patients and 496 control subjects to investigate a possible association between these two polymorphisms and lung cancer risk. The polymorphisms were determined by polymerase chain reaction/restriction fragment length polymorphism and TaqMan assay using DNA from peripheral white blood cells. Logistic regression was performed to calculate odds ratios (ORs), confidence limits (CL) and to control for possible confounders. The exon 3 polymorphism of the mEH gene was associated with a significantly decreased risk of lung cancer. The adjusted OR, calculated relative to subjects with the Tyr113/Tyr113 wild type, for the His113/His113 genotype was 0.38 (95% CL 0.20-0.75). An analysis according to histological subtypes revealed a statistically significant association for adenocarcinomas; the adjusted OR for the His113/His113 genotype was 0.40 (95% CL 0.17-0.94). In contrast, no relationship between the exon 4 polymorphism and lung cancer risk was found. The adjusted OR, calculated relative to the His139/His139 wild type, was for the Arg139/Arg139 genotype 1.83 (0.76-4.44). Our results support the hypothesis that genetically reduced mEH activity may be protective against lung cancer.

The lunar cycle and the number of deliveries in Austria between 1970 and 1999

The effect of the moon on the number of newborns has been investigated extensively with contradictory results but with few significant findings. In this paper, a possible lunar effect is analyzed by a nonlinear Poisson regression model similar to a Fourier analysis based on all children (n = 2,760,362) born in Austria between 1970 and 1999, i.e. 371 lunar cycles. We found no significant effect even when considering the influence of parity and gestation. Our study is in contrast to a French study using a similarly large data base which showed a weak but significant effect. Nevertheless, significant p values based on very large samples must be interpreted cautiously. Our study is in concordance with other studies which often use small and selected samples or rather inefficient statistical methods. We conclude that there is no significant effect of the lunar cycle on the number of deliveries in Austria.

A cohort mortality and nested case-control study of French and Austrian talc workers

OBJECTIVES

To study whether the mortality from non-malignant and malignant respiratory diseases of workers employed in French and Austrian talc mines and mills is related to their long term occupational exposure.

METHODS

Two historical cohorts were set up comprising all male subjects who had been working continuously for at least 1 year in a series of talc producing companies in France and Austria. The French cohort consisted of those employed at a site in the French Pyrenees and working between 1 January 1945 and 31 December 1994. The Austrian cohort consisted of the workers employed between 1 January 1972 and 31 December 1995 in one of four industrial sites in the Austrian Alps. The mortality within the cohorts was compared with local death rates. Two nested case-control studies focusing on non-malignant and malignant respiratory diseases were set up to estimate possible dose-response relations with cumulative exposure to talc dust based on an industry specific job exposure matrix.

RESULTS

Mortality from lung cancer was in small excess in both cohorts (France, standardised mortality ratio (SMR) 1.23, 21 cases observed, 95% confidence interval (95% CI) 0.76 to 1.89; Austria, SMR 1.06, seven observed, 95% CI 0.43 to 2.19). A non-significant excess mortality was found for all non-malignant respiratory diseases in the French cohort due to a significant excess for pneumoconiosis (SMR 5.56, three observed, 95% CI 1.12 to 16.2). The case-control study of non-malignant respiratory disease showed an increased mortality in the highest exposure groups (odds ratio (OR) 2.5 for a cumulative exposure > or = 800 y.mg/m(3)) with a significant trend (OR/100 y.mg/m(3) 1.08) with cumulative exposure to talc. On the contrary, no increasing trend could be found in the case-control study of lung cancer. This result must be interpreted considering the small cohort size. Adjustment on smoking and exposure to quartz did not influence these results to any extent.

CONCLUSIONS

The mortality from non-malignant respiratory disease was found to be related to high cumulative exposure to talc dust. The small excess in lung cancer does not seem to be attributable to talc.

Prostate cancer in Austria: impact of prostate-specific antigen test on incidence and mortality

The aim of the study was to assess the impact of prostate-specific antigen (PSA) testing on prostate cancer mortality in Austria. A join-point regression model and permutation tests were used to identify changes in the slope of age-specific trends respectively calculating the annual percentage change (APC). Age-adjusted incidence increased (P < 0.01) between 1983 and 1997 by 79% from 52.2 to 93.6 cases per 100 000 men/year. Incidence in localized/regional stage disease increased in all ages by 143% from 25.7 to 62.4 cases per 100 000 men/year. Incidence in distant disease decreased (P < 0.01) between 1983 and 1997 in all ages by 38% from 9.5 to 5.9 cases per 100 000 men/year. Incidence in unstaged disease increased (P < 0.01) between 1983 and 1997 in all ages by 300% from 4.5 to 18 cases per 100 000 men/year. Age-adjusted mortality increased (P < 0.05) by 13% from 26.8 in 1983 to 30.3 deaths per 100 000 men/year in 1999. No significant changes of trends in mortality rates were detected in the age groups 50-59 years. In the age group 70-79 years the trend changed (P < 0.05) direction in 1991 and in 1994; 1983 through 1991 APC = 3.52 (95% CI 1.37, 5.72), 1991 through 1994 APC = -10.27 (95% CI -26.20, 9.1) and 1994 through 1999 APC = -0.25 (95% CI -4.55, 4.24). PSA testing increased incidence but no impact on mortality in the target population can be observed so far.

A comparative cross-sectional study of lower urinary tract symptoms in both sexes

OBJECTIVES

The aims of this investigation were to compare prevalence and severity of lower urinary tract symptoms (LUTS) in both sexes and to analyze their effect on everyday life ('botherness') in a cross-sectional study design.

METHODS

Individuals participating in a health survey in Vienna completed a German version of the Bristol LUTS questionnaire. In this questionnaire, storage (irritative) and voiding (obstructive) symptoms were assessed by six items, each followed by a quality of life ('botherness') question.

RESULTS

A consecutive series of 1,191 women (49.8+/-13.5 years) and 1,211 men (48.5+/-11.9 years) were analyzed. The mean increase in LUTS from the youngest (20-39 years) to the oldest (>70 years) age group was 43.7% (7.3%/decade) for men and 23.6% (3.9%/decade) for women. In all decades, storage symptoms were higher for women. Beyond the age of 60 years this discrepancy declined. Voiding symptoms were almost identical in both sexes until the 5th decade, thereafter they increased significantly in men but not in women. 'Urgency' and 'frequency' were more bothersome to older individuals, 'nocturia' and voiding symptoms were almost equally bothersome to younger and older participants.

CONCLUSIONS

These data provide insights into the development of storage and voiding problems with age in both sexes. Sex- and age-stratified analyses of quality of life impairments ('botherness') due to LUTS have demonstrated the importance of age for the impact of LUTS on the bother score.

Polymorphisms of glutathione-S-transferase genes (GSTP1, GSTM1 and GSTT1) and prostate-cancer risk

Several polymorphic glutathione-S-transferase (GST) enzymes are involved in the metabolism of a number of potential prostate carcinogens and are thought to engage in the transport of steroid hormones. A case-control study was conducted to determine the association of the GSTP1, GSTM1 and GSTT1 polymorphisms and prostate-cancer risk. The study population consisted of 166 patients with previously untreated, histologically proven prostate cancer and 166 age-matched control patients with benign prostatic hyperplasia (BPH), all of them Caucasians. In the GSTP1 gene, 2 polymorphic alleles, GSTP1*B and GSTP1*C, have been described in addition to the wild-type allele, GSTP1*A. Both polymorphic GSTP1 alleles have an A-to-G transition in exon 5, causing an isoleucine-to-valine change. The GSTP1*C allele has an additional transition from C to T. For GSTM1 as well as GSTT1, the polymorphic allele is a deletion of the gene. The proportion of individuals homozygous for the GSTP1 variant alleles (GSTP1*B/*B, GSTP1*B/*C and GSTP1*C/*C) was significantly lower in prostate-cancer patients (4.8%) than in BPH controls (14.5%), and the odds ratio (OR) was 0.24 [95% confidence interval (CI) = 0.09-0.61). The heterozygous genotypes (GSTP1*A/*B and GSTP1*A/*C) were also lower in the cancer group, though this was not significant. On the contrary, no significant effect on prostate-cancer risk was detectable for either GSTM1 (OR = 0.86, 95% CI = 0.55-1.36) or GSTT1 (OR = 0.78, 95% CI = 0.43-1.42). Of the polymorphic GSTs, GSTP1 is the most interesting candidate as a biomarker for prostate-cancer risk as we found a 76% reduced risk in men homozygous for the polymorphic GSTP1 alleles compared to those with wild-type GSTP1.

Risk factors for urinary incontinence in both sexes. Analysis of a health screening project

PURPOSE

The aim of this study was to identify factors related to urinary incontinence in both sexes by analysing almost 2.500 individuals participating in a health screening project in the area of Vienna.

MATERIALS AND METHODS

An incontinence questionnaire (Bristol LUTS questionnaire) was included to health investigations. During this investigation (a) a medical history; (b) a physical investigation; (c) sociodemographic parameters including smoking, eating and drinking habits, and (d) urine and blood study including 14 parameters were obtained. The parameters collected during this health investigation were correlated to the presence of urinary incontinence to identify potential risk factors for urinary incontinence.

RESULTS

1,262 women (49.7+/-13.6 years) and 1,236 men (48.6+/-13.0 years) were analyzed. In the female population, 26.3% reported on episodes of urinary incontinence during the past 4 weeks. Among other factors, age (correlation coefficient [r] = 0.22), body mass index (r = 0.20), urgency (r = 0.16), feeling of incomplete bladder emptying (r = 0.21), previous uro-gynecological surgery and fasting blood glucose correlated significantly to urinary incontinence. Five percent of men were incontinent, age (r = 0.12), urgency (r = 0.16), nocturia (r = 0.16), feeling of incomplete emptying (r = 0.16), reduced uroflow (r = 0.18) and previous prostatectomy (r = 0.11) correlated to the presence of urinary incontinence. In both sexes, smoking habits and the education level revealed no association.

CONCLUSIONS

The high prevalence of urinary incontinence, its socioeconomic implications, the continuously ageing population and the fact that a number of potential risk factors, particularly in women, have been identified suggest that targeted prevention is a major task for the future.

Genetic polymorphisms of CYP1A1 and GSTM1 and lung cancer risk

Susceptibility to lung cancer may, in part, be determined by interindividual differences in the cytochrome P450-catalysed bioactivation and the glutathione S-transferase-catalysed detoxification of procarcinogens. Therefore a lung cancer case-control study was set up to investigate the association of three polymorphisms of the CYP1A1 gene (CYP1A1*2A, CYP1A1*2B, CYP1A1*4) and GSTM1*0 genotype with lung cancer risk in Austrian Caucasians. Genomic DNA was isolated from the peripheral blood lymphocytes of 134 male lung cancer patients and 134 age-matched controls with nonmalignant conditions and PCR-based analyses were performed. There was no significant difference in risk between cases and controls, either for the CYP1A1*2A (OR=1.09, 95%CI=0.46-2.58), CYP1A1*2B (OR=1.09, 95%CL=0.46-2.58) or for the CYP1A1*4 polymorphism (OR=0.49, 95%CL=0.20-1.16). The prevalence of the GSTM1*0 genotype in the lung cancer group (47.8%) was comparable to that found in the control group (49.3%) and also had no effect on lung cancer risk (OR=0.94, 95%CL=0.54-1.57). Further, in a subgroup of male ever-smokers (n=126), no significant influence on the relative risk was found for these polymorphisms. Our results suggest that these investigated polymorphisms can not be considered as genetic susceptibility markers for lung cancer within the Austrian Caucasian population.

The influence of genetic predisposition on the prevalence of atopic diseases in Carinthian school children

The reasons for the origin and increasing rise in incidence of atopic diseases such as bronchial asthma, allergic rhinoconjunctivitis and eczema in many countries are still unknown. Our survey carried out within the frame of the ISAAC protocol comprised three districts in the Austrian province of Carinthia. A complete study of first and second year elementary school children was done in order to uncover a relationship between "presumed exposure" to different possible risk factors with that of an atopic disorder (i.e. asthma, hay fever, eczema). The results show a significant association between the occurrence of atopic disorders and genetic predisposition and the fact that a carpet which had previously been present in the child's bedroom, had been removed due to the presence of an allergic disease in a family member. The logistic regression model explains a very small part of the overall variability (R2 = 7.32%).

Association of vitamin D receptor and 17 hydroxylase gene polymorphisms with benign prostatic hyperplasia and benign prostatic enlargement

OBJECTIVES

To determine whether polymorphisms in 17 hydroxylase (CYP17) and vitamin D receptor (VDR) genes have an association to prostate volume/histology and endocrine patterns in elderly men with lower urinary tract symptoms (LUTS).

METHODS

Elderly men with LUTS underwent the following investigations: International Prostate Symptom Score (IPSS), uroflowmetry, serum prostate-specific antigen (PSA) assessment of prostate volume, and an endocrine study. Polymorphisms of CYP17 (T-->C substitution in the 5' promoter region) and VDR (T1055C) genes were detected by polymerase chain reaction followed by restriction-length polymorphism analysis, using DNA from peripheral white blood cells. Clinical and endocrine parameters and the prostate stroma/epithelial ratio were correlated to CYP17 and VDR genotypes.

RESULTS

A total of 148 (mean +/- SD, 67.0 +/- 9.7 years) patients were analyzed. IPSS (17.8 +/- 7.0), prostate volume (41.9 +/- 17.9 cc), maximum flow rate (10.9 +/- 5.8 mL/s), and PSA (4.7 +/- 4.7 ng/mL) indicate a typical LUTS population. Mean endocrine levels were consistently within age-specific reference values. Neither CYP17 nor VDR gene polymorphisms revealed an association to prostate size, PSA, clinical parameters, and endocrine parameters. Men who had the A1/A1 CYP17 genotype had on average a greater stromal/epithelial ratio than men with the A1/A2 or A2/A2 genotypes, yet after adjusting for multiple testing, this significance disappeared.

CONCLUSIONS

Gene polymorphisms of CYP17 and VDR have no association to prostate volume, clinical parameters, and endocrine parameters in elderly men. The association of CYP17 polymorphism and prostate histology warrants further studies. Assessment of gene polymorphisms might provide new insights into the pathogenesis of benign prostatic hyperplasia and benign prostate enlargement and may hold promise as genetic biomarkers of this disease.

[Prevalence of smoking habits of Upper Austria students of the 7th and 8th grade and effect of smoking habits of family and peers]

The aim of the study was to explore the prevalence of different smoking habits in a population of Austrian pupils, 12 to 15 years old, and the relationship of familial and peer group smoking customs with these habits. In 1997 a population-based survey (International Study of Asthma and Allergies in Childhood, ISAAC) was conducted of all 7th and 8th grade school children of a district of Upper Austria. Information on the smoking habits of the adolescents, the family members, and of the peer as well as smoking habits of the teacher, gender, and age of the children was collected. The overall-prevalence of having ever smoked in this population is 57.8%. The percentage of eversmokers among the 12-year-olds is 50%. This amount increases to 63.8% among the 14- to 15-year-olds. The odds ratios for smoking daily is highest among those whose best friend smokes (OR: 70.63, CI: 9.19, 542.40). The risk of daily smoking increases also if the siblings of the juvenile (OR: 4.71, CI: 1.15, 19.35) or the mother (OR: 4.95, CI: 1.67, 14.70) smoke. If the father smokes the risk to smoke monthly is increased (OR: 2.09, CI: 1.28, 3.40). These results point to the fact that smoking prevention programes should take into account the influence of peers and family of the adolescents.

Management of lower urinary tract symptoms of elderly men in Austria

OBJECTIVES

The aim of this nation-wide study was to determine the current management of elderly men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and benign prostatic enlargement (BPE) in Austria, and to assess changes over a 4-year study period from 1995 to 1998.

METHODS

The annual figures of prostatectomies performed in Austria from 1995 to 1998 were collected from the Austrian Institute for Health Affairs. Sales figures for finasteride, alpha(1)-receptor blockers and plant extracts were obtained from IMS market sales and Austrian regional compulsory insurance companies. These data were correlated with the number of males living in Austria during the study period and to the estimated numbers of elderly men with moderate and severe LUTS in this country.

RESULTS

The annual number of transurethral resections of the prostate (TURPs) decreased from 6,302 in 1995 to 5,297 in 1998 (-16%), and the number of open prostatectomies from 506 to 469 (-7%). Extrapolation of these data to 100,000 men aged > or = 55 years revealed that 0.76% underwent TURP in 1995, this figure decreased to 0.59% in 1998. Market sales of alpha(1)-receptor blockers increased by 497% during the study period and those of finasteride by 1.6%, while plant extract market sales declined by 18.2%. In 1998, plant extracts comprised 43.3% of the total BPH market, alpha(1)-receptor blockers 41.5% and finasteride 15.2%.

CONCLUSIONS

During the years 1995-1998, significant changes in medical and surgical BPH therapy were observed in Austria. These data provide the basis for a comparison to the situation in other countries and serve as a baseline investigation for future studies in this country.

Symptoms suggestive of atopic rhinitis in children aged 6-9 years and the indoor environment

BACKGROUND

We aimed to investigate the influence of indoor factors on the prevalence of symptoms suggestive of atopic rhinitis in children aged 6-9 years in Upper Austria.

METHODS

We analyzed the results from an extended ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire, answered by the parents, about indoor environment and symptoms strongly suggesting atopic rhinitis. This was defined as having reported a running, obstructed, or itchy nose apart from having a cold in the last year. The overall response rate was 93.4%. After excluding 6,016 children (17.1%) with changed indoor environment (due to allergies in the family), we analyzed the remaining subsample of 18,606 questionnaires.

RESULTS

The following factors were associated with an increased risk: mother's smoking during pregnancy and/or during time of breast-feeding (OR 1.28; CI 1.07-1.52), synthetic bedding (OR 1.21; CI 1.09-1.36), dampness/mold at home (OR 1.51; CI 1.31-1.74), central heating with gas (OR 1.75; CI 1.06-2.87), and space heating (OR 1.66; CI 1.01-2.98). Cooking with wood (OR 0.62; CI 0.46-0.84) was negatively associated with symptoms.

CONCLUSIONS

The indoor environment plays a role in the symptoms of atopic rhinitis in children. However, the population-attributable risks were not particularly high; they were between -2.7% and 9% for the various exposures considered in this study.

[Therapy of cancers from the viewpoint of the Austrian population]

The aim of this study was to survey the level of knowledge of the Austrian population about cancer treatment and to explore the ratings of the respondents concerning the importance of different modalities of treatment. A representative sample of Austrians > or = 15 years of age (n = 2073) was interviewed. Out of the respondents 94% claim that they have heard or read about chemotherapy. With regard to surgery and radiotherapy, this is stated by 83% and 73%, respectively. Hormonal therapy, immunotherapy and complementary therapy are known by a much smaller percentage (34% and less), whereas 52% claim that they have heard about homeopathy as a form of cancer treatment. The self-assessment of knowledge shows that 64% of all respondents state to have some knowledge about chemotherapy (surgery: 45%, radiotherapy: 26%). Persons with limited formal education report to have a lower level of knowledge. Surgery is rated to be the most important regimen, followed by chemotherapy and radiotherapy. Respondents with some knowledge about a certain treatment give higher ratings concerning the importance of this modality. The survey shows that a high percentage of the Austrian population has heard or read about chemotherapy and claims to have some knowledge about it. Especially the latter is not found for other treatments. Surgery, chemotherapy and radiotherapy are seen as the most important modalities of treatment. Individuals with a low level of education constitute an especially important target group for information about cancer treatment.

A polymorphism in the CYP17 gene is associated with prostate cancer risk

CYP17 encodes the enzyme cytochrome P-450c17 alpha, which mediates both 17 alpha-hydroxylase and 17,20-lyase in the steroid biosynthesis pathway. A polymorphism in the 5; promoter region of the CYP17 gene has been described. Steroid hormones, especially androgens, are believed to play a key role in the etiology of prostate cancer. Therefore, polymorphisms in genes involved in the androgen metabolism may affect the risk of prostate cancer. We conducted a case-control study of 63 patients with untreated histologically proven prostate cancer and 126 age-matched control men with benign prostatic hyperplasia (BPH) to determine whether a polymorphism in the CYP17 gene is associated with prostate cancer risk. This polymorphism was investigated by PCR/RFLP using DNA from lymphocytes. The transition (T-->C) in the risk allele (A2) creates a new recognition site for the restriction enzyme MspAI, which permits designation of the wildtype (A1) and the risk allele (A2). The prevalence of the A2/A2 genotype was significantly higher (P = 0.03) in the cancer group (23.8%) than in the BPH control group (9.5%). We found an increased risk in men carrying 2 A2 alleles (OR = 2.80, 95%CI = 1.02-77.76). For carrier with at least 1 A2 allele, the OR was 0.90 (95%CI = 0.43-1.89). After stratification by median age (66 years) at time of diagnosis, a marked increased risk was found in carriers of the A2/A2 genotype older than 66 years (OR = 8.93, 95%CI = 1.78-49.19, P = 0.01). Although the sample size is rather small and the controls are BPH patients, our results suggest that the CYP17A2/A2 genotype may be a biomarker for prostate cancer risk, especially for older men.

[Epidemiology and prevention of breast cancer]

Breast cancer is the leading cause of cancer in females in Austria (25% of all newly diagnosed cancer cases). So far no comprehensive theory about etiology exists. Risk factors generally considered to be established are: demographic, reproductive and hormonal factors, diet, benign breast disease, familial aggregation and genetics. Most of the risk factors cannot be affected by primary prevention. Nevertheless women should be informed about cancer risk and lifestyle factors. At present secondary prevention through mammographic screening can reduce the impact of breast cancer morbidity and mortality. In Austria the reduction of advanced cancers at diagnosis, followed by a reduction of mortality rates is plausibly related to screening prevalence.

Cross-sectional study of nocturia in both sexes: analysis of a voluntary health screening project

OBJECTIVES

To assess the prevalence of nocturia and its impact on the quality of life in both sexes by analyzing almost 2500 individuals participating in a health survey.

METHODS

During a 12-month period, we included an incontinence questionnaire, which was largely based on the Bristol female lower urinary tract symptoms questionnaire, in the voluntary health examinations in the area of Vienna. In parallel, we recorded the medical history, concurrent medical therapy, physical examination findings, sociodemographic parameters, and blood laboratory study results.

RESULTS

The data of 1247 women (age 49.8 +/- 13.5 years) and 1221 men (age 48.5 +/- 11.9 years) were analyzed. The percentage of individuals with nocturia of two or more times increased constantly with age: less than 30 years, 3.1% of women and 3.4% of men; 30 to 59 years, 7.2% of women and 5. 7% of men; and 60 years old or older, 26.7% of women and 32.4% of men. Age-adjusted extrapolation to the general population (older than 20 years) currently living in Austria yielded that 10.8% of men and 11.8% of women have nocturia of two or more times. Overall, 66. 9% of women and 62.2% of men reported a negative impact of nocturia on their quality of life. The correlation was close between the degree of nocturia with the quality-of-life impairment in both sexes. Several voiding symptoms correlated significantly (P <0.001) with nocturia.

CONCLUSIONS

Nocturia is almost equally present in both sexes, and the incidence and severity increase constantly from early adolescence to senescence. Approximately 10% of the general population (older than 20 years) have nocturia of two or more times, which impairs the quality of life in two thirds.

Urinary incontinence in both sexes: prevalence rates and impact on quality of life and sexual life

The aim of this study was to determine the prevalence of urinary incontinence in both sexes in Austria and to assess its impact on quality of life and sexual function. Voluntary health examinations free of charge are regularly organized in the area of Vienna. From May 1998 to April 1999 we have included in this health examination an incontinence questionnaire containing 37 items, which was largely based on the Bristol female lower urinary tract symptoms (LUTS) questionnaire. This questionnaire asks in detail for various aspects of urinary incontinence/voiding problems, including the impact of urinary incontinence on quality of life and sexual function. In this questionnaire, urinary incontinence was defined as any involuntary loss of urine within the past 4 weeks. The data of 2,498 participants (1,262 women [f]: mean age: 49.7+/-13.6 years and 1,236 men [m]: 48.6+/-13.0 years; age range: 20-96 years) were analyzed. Overall, 26.3% of women and 5.0% of men reported on episodes of urinary incontinence during the past 4 weeks. Prevalence rates increased constantly with age in both sexes: 20-29 years: 4.1% (f), 1.7% (m); 30-39 years: 10.8% (f), 2.7% (m); 40-49 years: 22.9% (f); 3.9% (m); 50-59 years: 34.9% (f), 3.7% (m); 60-69 years: 36.9% (f), 7.6% (m); 70 years or older: 36.0%% (f), 11.5% (m). Overall, 65.7% of women and 58.3% of men stated that quality of life was affected by their incontinence status. A moderate or severe impairment was reported by 18.3% of women and 16.6% of men. Impairment of quality of life was related as statistically significant (P < 0.05) to frequency and degree of incontinence (irrespective of the type of incontinence), the impact on sexual function and need for pads or other incontinence devices. Patient gender, age, and the duration of incontinence had no effect (P > 0.05) on quality of life. An impairment of sexual life by urinary incontinence was stated by 25. 1% of women and 30.5% of women, respectively. Although only 65.7% of women and 58.3% men with urinary incontinence reported on an impairment of quality of life, these data underline the high prevalence and socioeconomic implications of this disorder. The impact of urinary incontinence on quality of life is significantly higher than on sexual function.

Risk factors for lower urinary tract symptoms in elderly men. For the Prostate Study Group of the Austrian Society of Urology

OBJECTIVE

The aim of this study was to confirm previous studies with respect to risk factors for lower urinary tract symptoms (LUTS) as assessed by the International Prostate Symptom Score (IPSS) as well as, for the first time, specifically for storage and voiding symptoms in elderly men.

MATERIAL AND METHODS

During a health survey organised in the area of Vienna in 1996, the following parameters were obtained: (1) IPSS including the quality of life question; (2) a detailed medical history; (3) assessment of all concurrent medical therapies; (4) physical examination with assessment of age, weight, height, body mass index, heart rate and blood pressure; (5) sociodemographic parameters, and (6) a blood laboratory study including kidney and liver function tests, low- and high-density lipoproteins, cholesterol and glucose. Only men aged 40 years or older without previous surgery to the prostate and without concurrent medication for LUTS were analysed. The IPSS, its irritative (storage symptoms) and obstructive (voiding symptoms) components were correlated to these parameters by partial correlation analysis which was controlled for age.

RESULTS

The data of 1,557 men (mean age: 51.3 years; range: 40-96 years) were analysed. The most important risk factor for the development of LUTS was age, as the IPSS (correlation coefficient r = 0.294), its obstructive (r = 0.248) and irritative (r = 0.261) components all correlated significantly (p<0.0001) with patient age. In all life decades there was no significant difference of the IPSS, its obstructive and irritative components in current smokers and non-smokers. The irritative score, however, correlated significantly (p = 0.001; r = 0.158) with the number of cigarettes smoked per day. In men aged 40-49 years, regular alcohol consumption resulted in a higher total IPSS (p = 0.01) and irritative (p = 0.002) score. This difference was not demonstrable in older age groups. Patient weight and body mass index did not correlate with the IPSS, yet there was a trend for a higher IPSS in men with elevated blood pressure and larger waist size.

CONCLUSIONS

This large-scale cross-sectional study underlines the importance of age for the development of LUTS. Few avoidable risk factors for the development of LUTS have been identified, such as obesity, cigarette smoking, elevated blood pressure and alcohol consumption. The subcategorization of LUTS into irritative/obstructive symptoms might provide new insights into the assessment of risk factors for LUTS.

Austrian women's attitudes toward and knowledge of breast self-examination

BACKGROUND

Education of women to perform breast self-examination is a main objective of cancer societies worldwide.

METHODS

By means of a questionnaire, 975 healthy women in an Austria-wide population-based cross-sectional study were asked about their knowledge of breast self-examination (BSE) and mammography, and their cancer histories.

RESULTS

92% of the women knew BSE but only 31% practiced it thoroughly. Women living in rural communities with a life companion and younger women were more likely to practice BSE. Women who had family histories of cancer, especially older women, performed BSE significantly more often. There was a trend towards increasing BSE with increasing personal perception of the risk of cancer, especially among older women. The study showed a positive association between BSE and screening mammography.

CONCLUSIONS

Although knowledge of BSE is widespread, it is actually practiced by only one third of women. Older women but not young women carry out BSE significantly more often when they have family histories of cancer. Information campaigns should target specific groups and emphasize the effectiveness of properly done BSE.

Indoor factors and their association to respiratory symptoms suggestive of asthma in Austrian children aged 6-9 years

The ISAAC (International Study of Asthma and Allergy in Childhood) was founded in 1990 in order to maximise the value of epidemiological research into asthma and allergic diseases, to describe the prevalence of asthma and allergic disease in children living in different locations, to make comparisons within and between countries, to provide a framework for further etiological research and to find prevention strategies. We analysed a sub-sample of a population-based study (1995 to 1997) in Upper Austria. The aim of our study was to investigate the influence of indoor risk factors on wheezing in children 6-9 years old. Our calculations were based on the results of a questionnaire answered by parents about their children's indoor environment at home. Smoking of the mother during pregnancy and/or during breastfeeding (OR 1.28; 95% CI 1.08-1.48), smoking of the mother at the present time (OR 1.25; 95% CI 1.12-1.41), a bird (OR 1.40; 95% CI 1.06-1.85) or rabbit (OR 1.37; 95% CI 1.03-1.82) as a domestic pet, synthetic bedding (OR 1.33; 95% CI 1.18-1.49) and dampness or mould at home (OR 1.43; 95% CI 1.24-1.65) are associated with a significantly increased risk of childhood wheezing in the last 12 months. Other variables such as "smoking of the father", "cooking with gas", "gas central heating" and other "pets" do not achieve statistical significance.

The prevalence of lower urinary tract symptoms in Austrian males and associations with sociodemographic variables

The aim of our study was to assess the prevalence of lower urinary tract symptoms (LUTS) in Austrian males and to correlate the findings with sociodemographic variables. In a population-based cross-sectional study in Austria in the year 1995, data on voiding symptoms were collected from a representative sample of men by using the International Prostate Symptom Score (IPSS). Only 28.6% of the males aged 15 to 89 years (total n = 939) reported no LUTS at all (IPSS = 0). In the group of males who report symptoms, a positive correlation of the IPSS with age is found. Furthermore IPSS correlates with weekly alcohol and nicotine consumption, but not with the respondent's body-mass index (BMI), educational status and monthly household income. The bothersomeness of LUTS increases with age, leaving more than 12% of the males aged 40 to 89 dissatisfied with urinary symptoms. Extrapolated to population numbers, more than 87,000 males in Austria (aged 15 to 89 years) would feel 'terribly' if they were to spend the rest of their lives with urinary symptoms as they were at the time of the survey. Due to an estimated future increase of the proportion of older people in Austria, the number of males with LUTS will rise significantly, thereby placing increased burden on medical resources in the future.

Prevalence of self-reported cervical cancer screening and impact on cervical cancer mortality in Austria

Pap smear screening was introduced in Austria in the late 1960's and was recommended annually for all women older than 20 years ever since. This is an opportunistic screening. The evaluation has to rely on population based data (mortality, stage distribution, screening prevalence). In a representative cross-sectional study (women aged 20-69 years, n = 933, conducted in 1995), 76% reported at least one Pap screening during their life; the highest prevalence (88%) was reported by women aged 50-59 years, the lowest prevalence (65%) by women aged 60-69 years. Forty-eight per cent of all women reported that they had undergone screening at least 4 times (40-49 years: 57%, 20-29 years: 34%). Between 1980 and 1996, mortality due to cancer of the uterus, part unspecified (ICD-9: 179), decreased by 54% (P = 0.0001) and that of cancer of the cervix (ICD-9: 180) by 44% (P = 0.0001). Since 1980, age-specific incidence rates of invasive disease decreased (P = 0.0001) in all 10-year age groups (20-29 years: -59%, 30-39 years: -48%, 40-49 years: -34%, 50-59 years: -62%, 60-69 years: -59%). The incidence of preinvasive disease increased significantly (P = 0.001) in the age groups 20-29 years by 30% and 30-39 years by 45%, respectively. No significant changes are observed in other age groups. Opportunistic screening has reduced mortality from cervical cancer and particularly limited the increase among younger women, but the high proportion of cancer deaths from uterine cancer, in part unspecified, obscures the actual trend. We estimate that the true mortality from cervical cancer has been nearly halved between 1980 and 1996. Most of this reduction must be attributed to the screening activities in the 1970's and we expect a further decrease as a result of the expanded screening activities in the 1980's.

The burden of cancer in Austria

The aim of this study was to assess the overall progress against cancer in Austria by analysing changes in age-adjusted mortality rates from 1970 to 1996. For the years 1970 to 1996, age-adjusted rates for all malignant neoplasms and for selected sites were calculated for men and women, according to year, age and sex. The number of cancer deaths were obtained from the Austrian Central Statistical Office--age-adjusted mortality rates of all malignant neoplasms decreased in men between 1971 and 1996 by 13% (from 289.1 to 251.4 deaths per 100,000), and in women between 1970 and 1996 by 19.1% (from 276.6 to 223.7 deaths per 100,000). Among older people (> or = 55 years) the mortality decreased by 13% in men and by 17% in women; among younger people (< 55 years) by 12% and 30%, respectively. The decrease in total cancer mortality is promoted by three tumour sites (the leading causes of cancer deaths in 1970). In both sexes, the decrease of stomach cancer mortality had the major impact, followed by colorectal cancer in women and by lung cancer in men. The observed changes in mortality are primarily related to changing incidence and early detection, rather than improvements in treatment. Unfortunately, there is evidence that prevention is losing ground in Austria. The implementation of the well-established knowledge of cancer prevention and the strengthening of preventative research is urgently needed.

Prevalence of lower urinary tract symptoms in Austria as assessed by an open survey of 2,096 men

OBJECTIVE

The lack of knowledge on the prevalence of lower urinary tract symptoms (LUTS) in German-speaking countries prompted us to assess this issue in Austria by means of a large open-scale study.

METHODS

A community sample of 2,096 men equal to or older than 20 years, who participated in a health survey in Vienna, completed the recently validated German translation of the International Prostate Symptom Score (IPSS). In addition, a detailed urological history and a physical evaluation (including digital rectal examination) were obtained.

RESULTS

The mean age in the study population was 47 +/- 14 (range 20-96) years. The mean IPSS increased from 2.1 (20-29 years, n = 128) to 2.6 (30-39, n = 322), 3.0 (40-49, n = 902), 5.8 (50-59, n = 325), 5.7 (60-69, n = 219), 6.4 (70-79, n = 158), and 6.1 (>/=80 years, n = 42). The proportion of patients with moderate/severe LUTS defined by an IPSS >7 increased from 6.3% (20-29 years) to 8.4 (30-39), 11.1 (40-49), 27.1 (50-59), 28.3 (60-69), 36 (70-79), and 35.7% (>/=80 years). Overall, 7.8% of the men aged >/=50 years previously underwent transurethral resection of the prostate. In men aged 50-59 years, this proportion was 1.3%, and it increased to 4.2, 20.9, and 27.5% in those aged 60-69, 70-79, and >/=80 years, respectively. 7% of the men had previously consulted an urologist for micturition problems. In all life decades, these patients had higher IPSS levels than those with no previous urological visit.

CONCLUSIONS

Based on the data generated, it is estimated that at present in Austria 26.9% (n = 291,761) of the men aged >/=50 years have moderate and further 2.8% (n = 30,815) severe LUTS. 7.8% of the men aged >/=50 years (n = 84,256) had a previous transurethral resection of the prostate. These data confirm the high prevalence of this condition in Austria.

Prevalence of self-reported screening mammography and impact on breast cancer mortality in Austria

Mammography for breast cancer screening has been available in Austria free of charge since 1974 and has been explicitly recommended for mass screening since 1980. The type of screening is opportunistic. Evaluation has to rely on population-based data (mortality, stage distribution, screening prevalence). In a representative cross-sectional study (women aged 40-79 years, n = 566, conducted in 1995) 58% reported at least one screening mammography; the lowest prevalence was found in the age group 70-74 years: 39.3%, the highest in the age group 50-54 years: 71.4%. 23.1% reported at least 2 mammograms within an interval of less than 2 years; lowest prevalence 70-74 years: 10.7%, highest 50-54 years: 35.7%. Age-standardized mortality rate has stabilized since 1985. Since 1980 age-specific rates have increased significantly in all age groups > 54 years, but a decreasing tendency in most groups has been noted since around 1990. The incidence rates of stage II or worse tumors have increased significantly since 1982, except in the age groups 40-44 and 55-59 years; however, during the past 3 to 6 years the absolute rates of incidence of advanced tumors has decreased in alle age groups. The reduction of advanced cancers at diagnosis, followed by a reduction of mortality rates is plausible related to screening prevalence. More uniform decreasing trends should be expected in the years to come. If not, discontinuation of the current opportunistic form of screening without monitoring and evaluation, financed by public money, has to be discussed.

[Self-assessment of vulnerability to illness by the Austrian population]

Results of a Cross-Sectional Study in 1995: The self-perceived threat of cancer, myocardial infarction, stroke, traffic accidents, diabetes mellitus, AIDS, Alzheimer's Disease and drug abuse was investigated in a survey among a representative sample of Austrians (aged > or = 15 years) in 1995. The most feared disease was cancer (41%), followed by traffic accidents (38%) and myocardial infarction (36%). The disease feared least was drug abuse (6%). Females feared cancer, stroke, diabetes mellitus and Alzheimer's disease significantly more than males. A cluster analysis reveals that respondents who perceive a higher threat by the diseases have low levels of education and live in rural areas. The age distribution of persons who responded with "very threatening" corresponds well with the age-specific prevalence of the disease. Smoking habits, alcohol consumption and body-mass index have no influence on the self-perceived threat of the investigated diseases.

The prevalence of smoking in Austria

BACKGROUND

A population-based cross-sectional study was performed to assess smoking prevalence in Austria and to compare the results with data from 1986.

METHODS

A representative sample of Austrians (n = 2,400) who in 1995 were > or = 15 years of age was obtained. A total of 2,065 respondents were interviewed about their smoking habits.

RESULTS

Approximately 31% of the population age > or = 15 are regular cigarette smokers, 12% are former smokers, 6% smoke occasionally, and 51% have never smoked. Among males, the prevalence of regular smoking increases with age and reaches its highest level between the ages of 25 and 34. The age distribution among female regular smokers shows a similar pattern, peaking in the same age group (35.7% smokers). No significant differences in smoking prevalence were found according to monthly household income, years of school, and number of inhabitants at place of residence. At the time of interview 45.7% of male and 20.9% of female regular smokers consumed > 20 cigarettes per day. Compared with data from 1986 the prevalence of regular smokers increased from 18.1 to 24.2% among females and from 35.5 to 38.9% among males.

CONCLUSIONS

Smoking prevalence increased in Austria between 1986 and 1995 by 33.7% among females and by 9.6% among males. Patterns of smoking among females (prevalence and cigarettes per day) are approaching those of males.

Development of birth weight in Austria from 1970-1995

We analysed the development of birth weight of all Austrian live births in the period 1970-1995. The relationship between birth weight and the variables maternal age, length and sex of the newborn and year of birth is described by means of a linear regression model. Over the 26 years an increase of up to 60 g was observed in the mean birth weight. This positive trend may partly be due to the extensive use of the maternity care program ("mother-and-child Passport") introduced in 1974. Maternity payment was made to the mother it she underwent at least five examinations within the antenatal care program. This payment was reduced from 15,000 AS in 1996 to 2000 AS as from January 1st 1997, a measure which may lead to a reduction in the use of this maternity care program, with consequent negative implications for the morbidity of both mother and child and for the positive trend of birth weight development over the past decades.

The impact of sociodemographic variables on immunization coverage of children

The dependence of immunization coverage of children in the municipalities of Vienna and Klagenfurt on the sociodemographic variables of their parents is investigated. According to the Austrian vaccination program, the following vaccinations are recommended: diphtheria/tetanus (DT), measles/mumps (MM), poliomyelitis (oPV), tickborne encephalitis (TBE), tuberculosis (BCG) and whooping cough (P). The aim of the study is to identify risk groups, as are children that are not well covered. A cross-sectional study using vaccination certificates of second grade schoolchildren in Vienna and Klagenfurt was performed. A multivariate logistic regression model is used. In Vienna a representative sample of second grade schoolchildren (n = 585) was investigated, in Klagenfurt all second grade schoolchildren (n = 824). The investigation took place during the 1993/1994 schoolyear. In Vienna 34.8% of the children have all the vaccinations recommended, in Klagenfurt 59.6%. Children of Austrian mothers have the best immunization coverage, followed by children whose mothers are from 'other countries', 'not stated', and 'former Yugoslavia'. The immunization rate increases with the mother's increasing age. It is lower if the father is unemployed. The effects of the variables age and unemployment are not dependent on nationality. Children from Klagenfurt are more often completely immunized than children from Vienna. The mother's education does not have a significant influence. The Austrian immunization program is not sufficient to provide a high level of herd immunity. The immunization program recommends vaccinations but does not include a system for finding and recording riskgroups (non-immunized). To improve the situation eight steps needed for a setup of surveillance and containment system are recommended.

Childhood cancer mortality in Austria, 1980-1992

This paper is the first to describe trend analyses focusing on cancer mortality among children (aged 0-14) in Austria covering the period 1980-1992. The data used for analysis were abstracted from the official Austrian mortality statistics of the years 1980-1992. Because of the poor reliability of cancer registry data in Austria in the past, the study is based on mortality date only. The reliability of the mortality data is positively related to a high autopsy rate in Austria. Statistical standardization is based on the European standard population. In the period 1980-1992 cancer was the cause of death of 718 children. Leukaemia was responsible for 34.5% of all childhood cancer deaths and 1.5% of all childhood deaths. The mortality of all malignant neoplasms in children decreased significantly (p = 0.0004) from 54.8 per million in 1980 to 33.9 per million in 1992. This trend is mainly due to the reduction in mortality of leukaemia, which has decreased from 22.3 per million in 1980 to 13.1 per million in 1992 (p = 0.0003). The age group 0-4 years experienced the highest overall cancer mortality (46.7 per million). The decreasing trends are primarily caused by better diagnostic and therapeutic procedures and most probably not by decreasing incidence. Due to the small number of cases this positive effect can only be demonstrated in leukaemia mortality, but not for other cancer sites.

[Descriptive epidemiology of cerebrovascular disorders in Austria]

The trend of cerebrovascular mortality (ICD-9: 530-538) is analyzed. Age-standardized mortality rates for men and women were calculated, covering the the period 1970 to 1994. Furthermore, the development of mortality rates (1974 to 1994) was analyzed for age groups and birth cohorts (5-years intervals). The number of deaths has decreased, from a total of 14,734 in 1970 (6109 men, 8625 women) to 9917 (-32%) in 1994 (men 3541, -42%; women 6376, -26%); age-standardized death rates in men from 201.4/10(5) (-54.7%) to 91.9/10(5), in women 160/10(5) to 77/10(5) (-51.7%). The trend within individual age groups does not show any sex-specific differences. In all birth cohorts the mortality trend in men and women decreases towards younger age groups. The observed linear decrease of mortality in men and women towards younger age groups leads to the assumption that this trend is determined by decreasing incidence, indicating a secular trend. This trend may only be explained but by its risk reducing effect in both, men and women of any age group. Establishing a representative stroke register seems most desirable, in order to make possible assertions as to the trend of incidence and prevalence.

[Vaccination status and sociodemographic variables in Viennese public school students]

A representative sample of 585 children, attending 2nd grade elementary school in Vienna, was examined. Vaccination certificates were collected, the parents' attitudes towards recommended vaccinations and data on sociodemographic variables were obtained by questionnaire. Compared to 95.9% of the less educated only 90.4% of the higher educated parents are interested that their children receive all vaccinations recommended (p < 0.01). When the dominant country equals "Austria", parents are more reluctant (p < 0.05) to have their children vaccinated (80.4%), compared to others (former Yugoslavia 92%, Turkey 90.9%, other countries 93.1%). A complete immunization against Diphtheria, Tetanus and Poliomyelitis (DT/OPV) was observed in 65.3% of the children. DT/OPV and additionally Mumps and Measles (MM) in 54% and DT/OPV + MM and Pertussis in 43.8% respectively. The immunization coverage is significantly higher (p < 0.01) in children with the dominant country = Austria (DT/OPV 70.7%, DT/OPV + MM 61.8%, DT/OPV + MM + Pertus sis 51.1%) compared to children from former Yugoslavia (DT/OPV 56.3%, DT/OPV + MM 34.5%, DT/OPV + MM + Pertussis 24.1%), Turkey (DT/OPV 54.5%, DT/OPV + MM 40.9%, DT/OPV + MM + Pertussis 33.3%), and "other countries" (DT/OPV 41.4%, DT/OPV + MM 34.5%, DT/OPV + MM + Pertussis 24.1%).

[Social aspects of dementia]

Calculations of the Austrian Central Statistical Office indicate, that the proportion of elder subjects in relation to the entire inhabitants will increase relevantly. Because of the fact, that diseases with reduced brain function (as well as other diseases) are seen more frequently in a geriatric population, in the future it will become necessary to take suitable social, medical and nursing steps; these steps should provide appropriate health care for most of the afflicted subjects. According to our calculations approximately 87,000 persons suffering from dementia are now living in Austria. The age-pyramid of the population will change and the amount of the geriatric population will increase till the year 2050 about 140% (> or = 65 years) or about 253% (> or = 80 years). Approximately 189,000 people with dementia in the age of 65 years or above have to be attended to special health care. Conditions of cerebral impairment leading to senile dementia will cover the total social surroundings. In our country it will be necessary to incorporate the persons who care for the demented in a comprehensive way.

[Cellular immunodeficiency (including AIDS): incidence and length of stay of hospitalized cases in Austria in 1990]

The incidence of cellular immunodeficiency (including AIDS), treated at hospitals in Austria in the year 1990, was 3.8 per 100,000 (n = 294, males 6.3 per 100,000, females 1.5 per 100,000). On the average every patient with this diagnosis was admitted to the hospital 3.6 times per year. The average hospitalization time was 7.5 days, summing up to a mean of 27.3 days of stay per case per year. A total of 8031 days was necessary for the hospital care of these patients, costing AS 86873 for care per person in 1990 (AS 3,180 per day in the hospital). In relation to the grand total of approximately 1.8 million admissions to Austrian hospitals, patients with the diagnosis "cellular immunodeficiency (including AIDS)" cover only 0.06% of all admission and 0.03% of patient days per year respectively.

[Effect of dexfenfluramine on eating behavior and body weight of obese patients: results of a field study of Isomeride in Austrian general practice]

In a multicenter study by 243 practicing physicians in Austria 819 severely obese subjects of both sexes without overt disease were encouraged to keep a calorie-restricted diet to reduce weight. After a run-in period of more than two weeks of dieting patients started taking 15 mg dexfenfluramine (Isomeride) twice daily for three month. While their weight was fairly stable during the run-in period progressive weight loss occurred during taking dexfenfluramine due to obvious changes in eating habits and appetite allowing to keep the reducing diet more strictly. Females lost 7.7 +/- 3.9 kg while obese men lost 9.32 +/- 4.6 kg. Laboratory tests obtained before starting dexfenfluramine and after 3 months at termination of medication showed blood glucose, cholesterol, LDL and triglycerides to decrease while HDL-cholesterol increased moderately. Dexfenfluramine was well tolerated by the majority of patients. Side effects such as fatigue, sedation, flatulence or diarrhea occurred in only 7.9% of the probands initially and dropped to 2.1% during the third month of the medication. It is concluded that Dexfenfluramine modifies eating habits and appetite thus making weight reducing diets easier acceptable and resulting in weight loss. It is suggested that Dexfenfluramine has a role in treatment regimes for morbid and refractory obesity.

[Epidemiologic progression of dementia diseases in Austria until the year 2050]

Population projections of the Austrian Central Statistical Office show a dramatic increase of the proportion of people of 65 years of age and over in Austria until the year 2050. Since this population group is at higher risk to develop dementia, it will be necessary to suitably modify the presently available facilities for social and medical care to meet this increasing demand. Based on official demographic data and epidemiological findings of the "Eurodem"-group (12) our computations show that the number of demented persons, aged 65 or over, will rise from presently 80,000 to over 189,000 in 2050 (1990: 1,023/100,000, 2050: 2,509/100,000 persons of the total population), equivalent to an increase by 140%. By forecasting the number of persons affected, it should be possible to intensify (and in some areas introduce) long-term health planning in respect of aged people, dementia and social, financial and medical care in Austria.

[Smoking rooms in Austrian schools--results of 2 questionnaires in the years 1987 and 1989]

To determine the number of schools offering smoking facilities to the attending pupils, questionnaires concerning smoking-rooms were sent to all schools with pupils over 16 years of age. The study was conducted in 1987 and 1989 to get information on changes, as well as on the present state of affairs. In 10.2% of Austrian schools smoking-rooms are offered. This number has increased substantially since 1987 (6.0% of all schools). The percentage of schools offering such facilities is highest in Vienna (smoking-rooms for pupils in 29.7% of schools). The type of school with most smoking-rooms is the high school known as "Allgemeinbildende höhere Schule, AHS" (28.3% of AHS offer smoking-rooms). Independent of the presence of smoking facilities, 80% of Austrian schools take action against smoking, predominantly by organizing information campaigns.

[Cholesterol screening in schools--initial results]

Screening for cardiovascular risk factors was performed in November 1988 among 236 school children in Sölden (Tyrol/Austria). 77.5 per cent of the children had a raised blood cholesterol (greater than or equal to 160 mg/dl = 4.14 mmol/l), and 36.4 per cent a high cardiovascular risk (cholesterol greater than 190 mg/dl = 4.91 mmol/l). The mean cholesterol level for boys was 175.4 mg/dl (4.54 mmol/l), and for girls 186.9 mg/dl (4.83 mmol/l). All children with cholesterol greater than or equal to 160 mg/dl were sent to their general practitioner for follow up.