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This cross-sectional study evaluates subsequent journal publication of COVID-19­related articles initially posted as medRxiv preprints in 2020.

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Connectedness to nature and nature contact can provide many benefits to humans, like stress reduction, recovery from illness, and increased positive emotions. Likewise, recreational horseback riding is a widespread sports activity with the potential to enhance physical and psychological health. Yet, the influence of connectedness to nature on the wellbeing of older aged recreational horseback riders has not been investigated so far. The aim of the present study therefore was to explore the relationship between nature relatedness and physical, psychological and social wellbeing and happiness. The study sample was composed of Austrian recreational horseback riders aged 45 years and older, who were compared with dog owners and people without pets (n = 178). We found significantly higher nature relatedness, significantly higher overall wellbeing and a significantly better mood rating in recreational horseback riders compared to people without pets and similar scores compared to dog owners. Physical wellbeing is correlated with overall nature relatedness in horseback riders and dog owners, but no correlation was found in people without pets. A structural equation model shows a direct relationship between nature relatedness and mood in horseback riders and an indirect relationship through pet attachment in dog owners. The results suggest the activity with horses and dogs in nature environments is a source of wellbeing, enjoyment, self-confidence and social contacts.

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The aim of the study was to determine if and how emotional attachment to their animal of older-aged (45+) horseback riders affects their physical, psychological and social wellbeing in comparison to dog owners. Overall, 124 individuals 45+ years answered questionnaires about pet attachment and wellbeing. Comparisons were carried out using a general linear model with activity group (rider/dog owner) as the main variable of interest. Horseback riders had no significantly lower pet attachment scores compared to dog owners. Gender differences of pet attachment were found in riders, with women having higher love factor scores. Self-reported mood during activities with the animal was significantly correlated with overall pet attachment, pet love and personal growth by contact with the pet in both, riders and dog owners. We observed no correlation of physical wellbeing during and after the activity with the animal and overall pet attachment in dog owners and horseback riders. Psychological wellbeing during the activity was significantly correlated with overall pet attachment in riders and social wellbeing during the activity in both groups. Recreational horseback riders nearly reach pet attachment scores of dog owners, increasing social and psychological wellbeing in a manner similar to that in dog owners.

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Objective: This study aimed to analyze the Austrian health care system using the ecology of care model. Our secondary aim was to compare data from Austria with those available from other countries.Design: 3508 interviews employing a 30-item questionnaire related to the utilization of the health care system including demographic factors were conducted. Participants were chosen by a Random Digital Dialing procedure. Further, a literature review of studies of other countries use of the ecology of care model was conducted.Main outcome measures: Austria has one of the highest utilization of health care services in any of the assessed categories. The comparison with the literature review shows that Austria has the highest utilization of specialists working in the outpatient sector as well as the highest hospitalization rates. Taiwan and Korea have comparable utilization patterns. Canada, Sweden, and Norway are countries with lower utilization patterns, and the U.S. and Japan are intermediate.Conclusion: In Austria and similarly organized countries, high utilization of all health care services can be observed, in particular, the utilization of specialists and hospitalizations. The over-utilization of all levels of health care in Austria may be due to the lack of a clear demarcation line between the primary and secondary levels of care, and the presence of universal health coverage, which also allows for unrestricted and undirected access to all levels of care. Previous studies have shown that comparable countries lack the health benefits of a strong primary care system with its coordination function.Key pointsIn Austria and similarly organized countries, there appears to be high utilization of health care in general, as well as with particular utilization of specialists and hospitalizations.The high utilization of all levels of care in Austria may be the result of competition, lack of a clear demarcation line between the primary and secondary level of care, and the presence of universal health coverage.Pathways between primary and secondary care should be strengthened as previous studies have shown that comparable countries lack the health benefits of strong primary care and its function for health care coordination.

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AIM: To assess the rates of specialist visits and visits to hospital emergency departments (ED) among patients in Austria with and without concurrent general practitioner (GP) consultation and among patients with and without chronic disease. METHODS: The cross-sectional questionnaire study was conducted in the context of the QUALICOPC project in 2012. Fieldworkers recruited 1596 consecutive patients in 184 GP offices across Austria. The 41-question survey addressed patients' experiences with regard to access to, coordination, and continuity of primary care, as well demographics and health status. Descriptive statistics as well as univariate and multivariate regression models were applied. RESULTS: More than 90% of patients identified a GP as a primary source of care. Among all patients, 85.5% reported having visited a specialist and 26.4% the ED at least once in the previous year. Having a usual GP did not change the rate of specialist visits. Additionally, patients with chronic disease had a higher likelihood of presenting to the ED despite having a GP as a usual source of care. CONCLUSION: Visiting specialists in Austria is quite common, and the simple presence of a GP as a usual source of care is insufficient to regulate pathways within the health care system. This can be particularly difficult for chronic care patients who often require care at different levels of the system and show higher frequency of ED presentations.

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The optimization of enzyme properties for specific reaction conditions enables their tailored use in biotechnology. Predictions using established computer-based methods, however, remain challenging, especially regarding physical parameters such as thermostability without concurrent loss of activity. Employing established computational methods such as energy calculations using FoldX can lead to the identification of beneficial single amino acid substitutions for the thermostabilization of enzymes. However, these methods require a three-dimensional (3D)-structure of the enzyme. In contrast, coevolutionary analysis is a computational method, which is solely based on sequence data. To enable a comparison, we employed coevolutionary analysis together with structure-based approaches to identify mutations, which stabilize an enzyme while retaining its activity. As an example, we used the delicate dimeric, thiamine pyrophosphate dependent enzyme ketoisovalerate decarboxylase (Kivd) and experimentally determined its stability represented by a T50 value indicating the temperature where 50% of enzymatic activity remained after incubation for 10 min. Coevolutionary analysis suggested 12 beneficial mutations, which were not identified by previously established methods, out of which four mutations led to a functional Kivd with an increased T50 value of up to 3.9°C.

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The compartmentalization of chemical reactions is an essential principle of life that provides a major source of innovation for the development of novel approaches in biocatalysis. To implement spatially controlled biotransformations, rapid manufacturing methods are needed for the production of biocatalysts that can be applied in flow systems. Whereas three-dimensional (3D) printing techniques offer high-throughput manufacturing capability, they are usually not compatible with the delicate nature of enzymes, which call for physiological processing parameters. We herein demonstrate the utility of thermostable enzymes in the generation of biocatalytic agarose-based inks for a simple temperature-controlled 3D printing process. As examples we utilized an esterase and an alcohol dehydrogenase from thermophilic organisms as well as a decarboxylase that was thermostabilized by directed protein evolution. We used the resulting 3D-printed parts for a continuous, two-step sequential biotransformation in a fluidic setup.

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BACKGROUND: Cardiovascular disease is the main cause of death in Austria. However, no systematic information exists regarding characteristics and treatments of contemporary patients with stable coronary artery disease (CAD) in Austria. We assembled two retrospective physicians' databases to describe demographics, clinical profiles, and therapeutic strategies in patients with stable CAD. In addition, we compared patient profiles of secondary care internists and hospital-based cardiologists with those of general practitioners in a primary care setting outside of hospital. METHODS: The study population was identified from retrospective chart review of 1020 patients from 106 primary care physicians in Austria (ProCor II registry), and was merged with a previous similar database of 1280 patients under secondary care (ProCor I registry) to yield a total patient number of 2300. RESULTS: Female patients with stable CAD were older, had more angina and/or heart failure symptoms, and more depression than males. Female gender, type 2 diabetes mellitus, higher CCS class and asthma/COPD were predictors of elevated heart rate, while previous coronary events/revascularization predicted a lower heart rate in multivariate analysis. There were no significant differences with regard to characteristics and management of patients of general practitioners in the primary care setting versus internists in secondary care. CONCLUSIONS: Characteristics and treatments of unselected patients with stable ischemic heart disease in Austria resemble the pattern of large international registries of stable ischemic heart disease, with the exception that diabetes and systemic hypertension were more prevalent.

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BACKGROUND: Sanfu acupoint herbal patching (SAHP) is extensively used in people with stable asthma in China. However, the evidence available is scarce. This systematic review aims to evaluate the preventive and therapeutic effect and safety of SAHP in people with stable asthma. METHODS: We searched seven electronic databases for randomised controlled trials (RCTs). The Cochrane risk of bias tool was utilised to evaluate the methodological quality of the included studies and RevMan 5.3 and GRADEpro 3.6.1 were applied to perform data analyses. RESULTS: A total of 34 RCTs involving 3313 participants were included. The overall methodological quality of the trials was of high risk of bias. SAHP plus conventional therapy (CT) decreased the mean frequency (times per year) of asthma exacerbations compared with CT alone (MD: -1.42; 95% CI: -2.19 to -0.65; 7 RCTs), and similar effect was found for SAHP versus sham SAHP (MD: 0.42; 95%CI: 0.26-0.69; 1 RCT). For lung function (including PEF%, FEV1% and FEV1/FVC), SAHP plus CT showed better effect than CT alone, and so did SAHP versus sham SAHP on PEF and PEF%. Adverse effects in the SAHP groups were reported to be mild and well tolerated. CONCLUSIONS: SAHP alone or combined with CT appears to be more effective than sham SAHP or CT on reduction of asthma exacerbations, improving lung function, and SAHP seems to be safe. However, the findings should be interpreted with caution due to limitations in trial quality. Further, rigorously designed, large-scale trials are warranted for robust evidence.

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BACKGROUND: Health services research, especially in primary care, is challenging because the systems differ widely between countries. This study aimed to explore the different understanding of the terminology used, particularly, regarding the professions nursing and medical secretaries. METHODS: The study was an add-on study to the Quality and Costs in Primary Care (QUALICOPC) project in Austria and designed as qualitative research. The qualitative phase was conducted by using semi-structured telephone interviews with general practitioners (GP). and17 GPs participated in the study. RESULTS: No uniform meaning of the terms commonly utilized for the abovementioned health professions could be found among Austrian GPs. For example, under the profession term practice assistants, nurses as well as literal medical secretaries with and without special education and related work competencies and responsibilities were subsumed. CONCLUSIONS: Our study results show that no uniform meaning of the terms commonly utilized for above described health profession could be found even within one country by GPs. These findings are highly relevant, especially, when trying to compare results with similar data from other countries or negotiating about workforce issues. Our findings implicate several action points for health services research and health policy. We propose the development of a harmonized terminology in Europe for the health profession based on standards of undergraduate and postgraduate education, competencies and continuous education commitments. This would not only benefit comparative health system research but also patient safety across Europe.

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BACKGROUND: The aim of this study was to compare influenza vaccination coverage rates in Austria and Croatia, countries with missing data in the Eurosurveillance and European Centre for Disease Prevention and Control reports. In addition, we assessed demographic factors of GPs and patients and calculated associations regarding vaccination rates. METHODS: This cross-sectional study was conducted within the context of thethe appropriateness of prescribing antibiotics in primary health care in Europe with respect to antibiotic resistance (APRES) project. Between November 2010 and July 2011, 40 GP practices attempted to recruit 200 patients to complete questionnaires about their influenza vaccination status and demographics. Statistical analyses included subgroup analyses and logistic regression models. RESULTS: Data from 7269 patient questionnaires could be analyzed (3309 Austria and 3960 Croatia). The vaccination coverage rates were low (2009/2010: A 18.2 vs. C 20.9%, P < 0.001; 2010/2011: A 13.7 vs. C 18.6%; P < 0.001). The rates were found to be highest in persons aged 65 years and older (2009/2010: A 35.1 vs. C 49.5%, P < 0.001; 2010/2011: A 31.1 vs. C 45.7%, P < 0.001) and lowest in children (2009/2010: A 8.5 vs. C 2.0%, P < 0.001; 2010/2011: A 4.3 vs. C 1.6%, P = 0.002). Besides, demographics in the adjusted regression model for Austria being vaccinated was associated with consulting a female GP (OR, 4.20; P < 0.001) and in Croatia with five or more GP consultations per year (OR, 4.41; P < 0.001). CONCLUSION: The vaccination coverage rates for Austria and Croatia were low, with the highest rates found in persons aged 65 years and older, showing that public coverage of the vaccination costs might increase vaccination rates. However, other factors seem to be relevant, including the engagement of GPs.

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Background. As there might be relevant differences with regard to research utilization in the general hospitals, we aimed to study research utilization among registered nurses working in traditional Chinese medicine hospitals. Methods. A total of 648 registered nurses from 4 tertiary-level hospitals in China were recruited for participation. A modified BARRIERS Scale and self-designed questionnaires were used for data collection. Data were analyzed with descriptive statistics, t-tests, and one-way ANOVAs and Spearman correlation analysis. Results. Overall, items which belong to the subscale "Research" were identified as the most important barriers. Among the individual items, the lack of time on the job was ranked as the top barrier, followed by the lack of knowledgeable colleagues and by overwhelming research publications. Clinical experience, working pressure, job satisfaction, and research experience could be identified as associated factors for barriers to research utilization. Conclusions. Registered nurses in traditional Chinese medicine hospitals felt high barriers to research utilization. Reducing registered nurses' working pressure, promoting their positive attitude to nursing, and improving research training might be helpful for increasing research utilization. Close cooperation between clinical and nursing schools or academic research centres might facilitate the necessary change in nursing education and routine.

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BACKGROUND: Multidisciplinary Primary Health Care Teams (PHCT) provide a comprehensive approach to address the social and health needs of communities. It was the aim of this analysis to assess the number of PHCT in Austria, a country with a weak PHC system, and to compare preventive activities, psychosocial care, and work satisfaction between GPs who work and those who do not work in PHCT. METHOD: Within the QUALICOPC study, data collection was performed between November 2011 and May 2012, utilizing a standardized questionnaire for GPs. A stratified sample of GPs from across Austria was invited. Statistical analyses included descriptive statistics and tests. RESULTS: Data from 171 GPs questionnaires were used for this analysis. Of these, 61.1 % (n = 113) had a mono-disciplinary office, 26.3 % (n = 45) worked in an office consisting of GP, receptionist and one additional primary care profession, and 7.6 % (n = 13) worked in a larger PHCT. GPs that worked in larger PHCT were younger and more involved in psychosocial and preventive care. No differences were found with regard to work satisfaction or workload. CONCLUSIONS: This study gives insight into the structures of PHC in Austria. The results indicate a low number of PHCT; however, the overall return rate in our sample was low with more male GPs, more GPs from urban areas and more GPs working in offices together with other physicians than the national average. Younger GPs demonstrate a greater tendency to implement this primary care practice model in their practices, which seems to be associated with an emphasis in psychosocial and preventive care. If Austria is to increase the number of PHC teams, the country should embrace the work of young GPs and should offer relevant support for PHCT. Future developments could be guided by considering effective models of good practice and governmental support as in other countries.

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AIM: To assess the workload of general practitioners (GPs) in Austria, with a focus on identifying the differences between GPs working in urban and rural areas. METHODS: Within the framework of the Quality and Costs of Primary Care in Europe (QUALICOPC) study, data were collected from a stratified sample of GPs using a standardized questionnaire between November 2011 and May 2012. Data analysis included descriptive statistics and regression analysis. RESULTS: The analysis included data from 173 GPs. GPs in rural areas reported an average of 49.3 working hours per week, plus 23.7 on-call duties per 3 months and 26.2 out-of-office care services per week. Compared to GPs working in urban areas, even in the fully adjusted regression model, rural GPs had significantly more working hours (B 7.00; P=0.002) and on-call duties (B 18.91; P<0.001). 65.8% of all GPs perceived their level of stress as high and 84.6% felt they were required to do unnecessary administrative work. CONCLUSION: Our findings show a high workload among Austrian GPs, particularly those working in rural areas. Since physicians show a diminishing interest to work as GPs, there is an imperative to improve this situation.

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BACKGROUND: This study aimed to identify associations between GP patient's knowledge about the spectrum of effectiveness of antibiotics and the probability of vaccination against influenza. The underlying hypothesis was that individuals with an understanding that antibiotics are ineffective against viruses, common colds, and flu were more likely to be vaccinated than persons lacking this knowledge. METHODS: This cross-sectional study was conducted within the context of the European APRES project in Austria. Between November 2010 and July 2011, patients were recruited from GP practices to complete questionnaires about their knowledge about antibiotics and their influenza vaccination status. Statistical analyses included subgroup analyses and logistic regression models. RESULTS: Data of 3224 patients was analyzed, demonstrating that patients with better knowledge concerning antibiotics had a significantly higher likelihood of being vaccinated (OR 1.35, CI 95 % 1.18-1.54). While the overall vaccination rate was low (18.6 % in 2009/2010 and 14.0 % in 2010/2011), elderly compared to younger adults (OR 0.06 CI 95 % 0.03-0.13) and healthcare workers (OR 2.24, CI 95 % 1.42-3.54) demonstrated higher likelihood of vaccination. Additionally, female GPs had significantly more vaccinated patients than male GPs (OR 2.90, CI 95 % 1.32-6.40). DISCUSSION: There has been little prior study on the association between a patient's knowledge of the effectiveness spectrum of antibiotics and influenza vaccination status. Given the public health imperative to increase annual prevalence of influenza vaccination, understanding this educational gap can improve specificity in counseling as well as vaccination rates. Ultimately, we found that those with a better knowledge on about antibiotics had a significantly higher likelihood of being vaccinated. CONCLUSIONS: The results of this study demonstrate that vaccination prevalence is associated with patient's knowledge about antibiotics. It can be concluded that one strategy to improve the overall low vaccination rates for seasonal influenza in Austria would be, particularly for male GPs, to have a specific discussion with patients about these circumstances by focusing on younger patients. Further, public health efforts could supplement in-office strategies to improve this area of health literacy.

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