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Contains fulltext : 136878.pdf (publisher's version ) (Open Access), BACKGROUND: In many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care. METHODS: We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses. RESULTS: 24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies. CONCLUSIONS: The available evidence continues t

Contains fulltext : 139019.pdf (publisher's version ) (Open Access), BACKGROUND: The rising incidence of melanoma - Switzerland has the highest incidence in Europe - is a major public health challenge. Swiss dermatologist introduced the "Swiss Skin Cancer Day" (SSCD) in 2006, which provides skin cancer screening at no costs. The aim of the study was to describe the participating subjects and their motivation and investigate factors influencing the probability of a clinical diagnosis of skin malignancy. METHODS: 150 dermatologists were involved in the SSCD in May 2012. Dermatologists were not remunerated. Participants had the opportunity to show a single skin lesion to a dermatologist at no cost. A questionnaire for each participating subject collected data about subjects' age, sex, risk factors and reason for encounter; furthermore the dermatologist noted down clinical diagnosis and further management. We used descriptive statistics to report characteristics of participants and skin lesions. We built two multiple logistic regression models, one regarding the clinical diagnosis of skin malignancy and one regarding the further management. RESULTS: 5266 subjects (55.6% female) were assessed; in 308 (5.8%) participants a clinical diagnosis of skin malignancy was found. In 1732 participants (32.9%) a clinical follow up or an excision was recommended. In the multiple logistic regression model age, sex, skin phototype and the reason for participation at the SSCD were found as significant risk factors regarding the clinical diagnosis of skin malignancy. Participants with skin cancer risk factors were more likely to get a clinical follow up recommended even if the clinical diagnosis was benign. CONCLUSION: A self-perceived suspicious lesion was the strongest predictor for a clinical diagnosis of skin malignancy at the SSCD. This suggests that skin self-examination might also work in general population. Future research should focus on better access to a specialist in case a suspicious skin lesion was discovered. Safety and quality of the SSCD

BACKGROUND: There is increasing evidence that a strong primary care is a cornerstone of an efficient health care system. But Switzerland is facing a shortage of primary care physicians (PCPs). This pushed the Federal Council of Switzerland to introduce a multifaceted political programme to strengthen the position of primary care, including its academic role. The aim of this paper is to provide a comprehensive overview of the situation of academic primary care at the five Swiss universities by the end of year 2012. RESULTS: Although primary care teaching activities have a long tradition at the five Swiss universities with activities starting in the beginning of the 1980ies; the academic institutes of primary care were only established in recent years (2005 - 2009). Only one of them has an established chair. Human and financial resources vary substantially. At all universities a broad variety of courses and lectures are offered, including teaching in private primary care practices with 1331 PCPs involved. Regarding research, differences among the institutes are tremendous, mainly caused by entirely different human resources and skills. CONCLUSION: So far, the activities of the existing institutes at the Swiss Universities are mainly focused on teaching. However, for a complete academic institutionalization as well as an increased acceptance and attractiveness, more research activities are needed. In addition to an adequate basic funding of research positions, competitive research grants have to be created to establish a specialty-specific research culture.

Quintessenz • Seniorensportler (Läufer über 35 Jahre) dominieren Ultramarathons, also Läufe, die länger sind als die klassische Marathondistanz von 42,195 km. • Aus physiologischer Sicht wird mit ca. 35 Jahren der Leistungszenit im Langstrecken-Laufsport überschritten. • Das Alter der Spitzenleistung im Ultralaufen steigt mit zunehmender Distanz und/oder der Dauer eines Ultramarathons. • Lebenslanger Ausdauersport vermindert die altersbedingte Abnahme der maximalen Sauerstoffaufnahme um ca. 50%. • Eine Abnahme der Muskelmasse ist kein unabwendbares Schicksal, denn regelmässiges Training lässt den altersbedingten jährlichen Abbau auf bis zu 0,5% schrumpfen.

This study investigated changes in performance and sex difference in top performers for ultra-triathlon races held between 1978 and 2013 from Ironman (3.8 km swim, 180 km cycle, and 42 km run) to double deca iron ultra-triathlon distance (76 km swim, 3,600 km cycle, and 844 km run). The fastest men ever were faster than the fastest women ever for split and overall race times, with the exception of the swimming split in the quintuple iron ultra-triathlon (19 km swim, 900 km cycle, and 210.1 km run). Correlation analyses showed an increase in sex difference with increasing length of race distance for swimming (r2=0.67, P=0.023), running (r2=0.77, P=0.009), and overall race time (r2=0.77, P=0.0087), but not for cycling (r2=0.26, P=0.23). For the annual top performers, split and overall race times decreased across years nonlinearly in female and male Ironman triathletes. For longer distances, cycling split times decreased linearly in male triple iron ultra-triathletes, and running split times decreased linearly in male double iron ultra-triathletes but increased linearly in female triple and quintuple iron ultra-triathletes. Overall race times increased nonlinearly in female triple and male quintuple iron ultra-triathletes. The sex difference decreased nonlinearly in swimming, running, and overall race time in Ironman triathletes but increased linearly in cycling and running and nonlinearly in overall race time in triple iron ultra-triathletes. These findings suggest that women reduced the sex difference nonlinearly in shorter ultra-triathlon distances (ie, Ironman), but for longer distances than the Ironman, the sex difference increased or remained unchanged across years. It seems very unlikely that female top performers will ever outrun male top performers in ultra-triathlons. The nonlinear change in speed and sex difference in Ironman triathlon suggests that female and male Ironman triathletes have reached their limits in performance.

QUESTIONS UNDER STUDY: The use of placebo outside of randomised controlled trials raises ethical and legal issues. So far, patients' perspectives have been considered only in quantitative studies. These studies did not distinguish between pure placebos (no pharmacological effect) and impure placebos (pharmacological ingredient, but no disease-specific effect). The aim of our study was to explore patients' conceptualisation, experiences and attitudes regarding the use of placebos in daily clinical practice. METHODS: Qualitative study with a convenience sample of 12 patients and semistructured interviews. The interviews were digitally recorded; full transcripts were obtained. The information was analysed in accordance with the qualitative content analysis method. RESULTS: The definition of placebo given by the participants mostly matched the common understanding of a pure placebo. Most participants supposed that placebos were mainly effective in diseases in which psychological influences play an important role. Furthermore, most participants believed that placebos themselves mainly worked via psychological effects. The acceptance of a hypothetical earlier use of a placebo depended on the success of the therapy. CONCLUSION: Patients were not aware of the differences between pure and impure placebos. Even regarding pure placebos, patients were more open than many physicians would expect. Trust between the patient and the general practitioner is an important element of the acceptance of a placebo. Appropriate communication could further increase the acceptance. Further research is needed to adapt the information given to the patient about possible placebo therapy.

Recent studies investigated participation and performance trends in age group half marathoners and full marathoners for a single event. The present study investigated participation and performance trends in age group athletes in all half marathons and full marathons held in a single country during a given period of time. Changes in running performance and age of 226,754 half marathoners and 86,419 full marathoners competing in Switzerland between 2000 and 2010 were analyzed using linear regression analyses. The number of half marathoners increased (P < 0.01) from 2000 to 2010 for both men (+231%) and women (+299%). In contrast, the number of male and female full marathoners increased until 2005 only and decreased thereafter. The greatest part of the finishers of both genders was assigned to age group 40-44 years in half marathons (19.5% of finishers) and full marathons (22.0% of finishers). Running performance of female full marathoners improved in age groups 30-34, 35-39, 40-44, 45-49 and 50-54 years. Running performance of male full marathoners improved in age groups 25-29, 30-34, 35-39, 45-49 and 55-59 years. Female half marathoners achieved no change in running times in all age groups. For male half marathoners in age groups 30-34, 40-44 and 50-54 years, running performance declined. In conclusion, during the 2000-2010 period in Switzerland, it appeared that participation in half marathons increased but running performance stabilized. In contrast, participation in full marathons decreased but running performance improved. Further investigations are required to collect complete data for other countries and the investigation of other endurance events in Switzerland.

Background: Most industrialized countries are faced with a growing population of patients with chronic diseases and multimorbidity. Evidence performance gaps have been recognized in the treatment of this vulnerable patient group. In England, the Quality and Outcomes Framework (QOF) - based on incentivized quality indicators - has been established to narrow the gap. Objective: We evaluated to what extent clinical data, extracted from electronic medical records (EMRs) of Swiss general practitioners, can be used as quality indicators in terms of a Swiss Quality and Outcomes Framework (SQOF) for diabetes care adopted from the QOF of the UK National Health Service (NHS). Methods: We searched the FIRE database (Family Medicine ICPC Research Using Electronic Medical Records) for patients suffering from diabetes type 1 or type 2. Eligible data were matched with the diabetes indicator set of the NHS QOF and compared with the results in England. Results: A total of 11 out of 17 diabetes indicators could be adopted for the SQOF; 46 practices with 1,781 diabetes patients were included. The practices fulfilled the SQOF diabetes indicator set with 46.9% overall, with highest compliance for blood pressure measurements (97.8% of all practices) and lowest compliance for influenza immunization (45.7%). Our study practices showed higher variation across all indicators and between practices compared to England, but lacking structured data limited calculation of scores and comparability. Conclusions: Our results show that it is technically feasible to establish a diabetes QOF in Swiss primary care based on EMRs. However, a high amount of missing data made it impossible to evaluate the actual quality of care. For a nationwide introduction, standards for electronic medical documentation and EMR use need to be set. It should also be acknowledged that important dimensions of suffering from one or more chronic diseases such as health-related quality of life are not reflected within a system

BACKGROUND: The purpose of the present study was to analyse potential changes in performance of elite breaststroke swimmers competing at national and international level and to compare to elite freestyle swimming performance. METHODS: Temporal trends in performance of elite breaststroke swimmers were analysed from records of the Swiss Swimming Federation and the FINA (Fédération Internationale de Natation) World Swimming Championships during the 1994-2011 period. Swimming speeds of elite female and male breaststroke swimmers competing in 50 m, 100 m, and 200 m were examined using linear regression, non-linear regression and analysis of variance. Results of breaststroke swimmers were compared to results of freestyle swimmers. RESULTS: Swimming speed in both strokes improved significantly (p < 0.0001-0.025) over time for both sexes, with the exception of 50 m breaststroke for FINA men. Sex differences in swimming speed increased significantly over time for Swiss freestyle swimmers (p < 0.0001), but not for FINA swimmers for freestyle, while the sex difference remained stable for Swiss and FINA breaststroke swimmers. The sex differences in swimming speed decreased significantly (p < 0.0001) with increasing race distance. CONCLUSIONS: The present study showed that elite male and female swimmers competing during the 1994-2011 period at national and international level improved their swimming speed in both breaststroke and freestyle. The sex difference in freestyle swimming speed consistently increased in athletes competing at national level, whereas it remained unchanged in athletes competing at international level. Future studies should investigate temporal trends for recent time in other strokes, to determine whether this improvement is a generalized phenomenon.

In La Traversée Internationale du Lac St-Jean, held between 1955 and 2012 in Canada, the fastest women (r(2) = 0.61, p < 0.0001) and men (r(2) = 0.66, p < 0.0001) improved swimming speed over the years but the sex difference remained unchanged at 8.8% ± 5.6% (r(2) = 0.069, p = 0.065). Annually, for the 3 fastest swimmers, both women (r(2) = 0.53, p < 0.0001) and men (r(2) = 0.71, p < 0.0001) improved swimming speed between 1973 and 2012 and the sex difference decreased (r(2) = 0.29, p = 0.0016) from 14.4% ± 11.0% (1973) to 3.7% ± 1.4% (2012).

Contains fulltext : 185026.pdf (publisher's version ) (Open Access), QUESTIONS UNDER STUDY: In Switzerland, skin cancer is one of the most prevalent neoplasms. General practitioners (GPs) are often faced with suspicious skin lesions in their patients. The aim of our study was to assess GPs' competence to diagnose skin cancer and to examine whether this can be improved by a one-day dermatologic education programme. METHODS: STUDY DESIGN: Pre / post-intervention study. STUDY POPULATION: 78 GPs in the Canton of Zurich. INTERVENTION: A one day dermatologic education programme provided by a dermatologist. MEASUREMENTS: Before (T0) and after (T1) the dermatologic education programme, GPs were asked to rate pictures (with a short history) of skin lesions on a visual analogue scale according to their likelihood of malignancy. ANALYSIS: Non-parametric paired Wilcoxon signed rank test was used to compare the sum score of correctly classified skin lesions at T0 and T1. RESULTS: At T0 GPs classified 63.9% lesions correctly (benign: 51.2%; malignant: 76.6%), while at T1 these figures increased to 75.1% (benign: 67.6%; malignant: 82.7%). CONCLUSION: A one-day dermatologic education programme led to improvements in GPs' diagnostic competence in skin cancer, but there remained room for further improvement.

Purpose: The present study investigated the changes in single skinfold thicknesses and body fat during an ultra-endurance cycling race. Methods: One hundred and nineteen ultra-endurance cyclists in the ‘Swiss Cycling Marathon’ covering a distance of 600 km were included. Changes in skinfold thickness, fat mass, skeletal muscle mass and total body water were estimated using anthropometric methods. Results: The subjects were riding at a mean speed of 23.5±4.0 km/h and finished the race within 1,580±296 min. During the race, body mass decreased by 1.5±1.2 kg (P<0.001), and fat mass decreased by 1.5±1.1 kg (P<0.001). Skeletal muscle mass and total body water remained unchanged (P>0.05). The decrease in body mass correlated to the decrease in fat mass (r= 0.20, P=0.03). The skinfold thicknesses at pectoral (-14.7%), abdominal (-14.9%), and thigh (-10.2%) site showed the largest decrease. The decrease in abdominal skinfold was significantly and negatively related to cycling speed during the race (r= -0.31, P<0.001). Conclusion: Cycling 600 km at ~23 km/h led to a decrease in fat mass and in all skinfold thicknesses. The largest decrease in skinfold thickness was recorded for pectoral, abdominal, and thigh site. The decrease in abdominal skinfold thickness was negatively related to cycling speed. The body seems to reduce adipose subcutaneous fat during an ultra-endurance performance at the site of the thickest skinfold.

The aim of the study was to investigate participation and performance trends in relation to the nationality of successful finishers in sing lest age ultra-marathons of more than 200 km. The association between sex and nationality with running speed was investigated in ‘Badwater’ (217 km) held in North America with 208 women and 818 men and ‘Spartathlon’ (246 km) held in Europe with 206 women and 1,814 men between 2000 and 2012. In ‘Badwater’, most of the finishes were achieved by athletes from the USA, followed by athletes from Germany and Great Britain. In ‘Spartathlon’, the highest number of finishes was obtained by athletes from Japan, followed by athletes from Germany and France. In ‘Badwater’, women from the USA were the fastest (7.7 ± 0.4 km/h), followed by women from Canada (6.2 ± 0.6 km/h). For men, the fastest finishes were achieved by competitors from the USA (8.6 ± 0.4 km/h), followed by athletes from Mexico (8.2 ± 1.0 km/h) and Canada (7.0 ± 0.8 km/h). In ‘Spartathlon’, the fastest female finishes were obtained by women from Japan (9.6 ± 0.3 km/h), followed by women from Germany (9.1 ± 0.4 km/h) and the USA (8.8 ± 0.3 km/h). In men, the fastest finishes were achieved by runners from Greece (11.7 ± 0.8 km/h), followed by athletes from Japan (11.4 ± 0.4 km/h) and Germany (11.1 ± 0.3 km/h). These results show that American ultra-marathoners dominated both participation and performance in ‘Badwater’ in the USA. In ‘Spartathlon’ in Europe, however, both female and male runners from Japan were dominating participation whereas male ultra-marathoners from Greece and female ultra-marathoners from Japan dominated performance. Future studies need to investigate participation and performance trends for Japanese ultra-marathoners in other races such as 100 km and 100 miles ultra-marathons.

The purpose of this study was to compare running performance of Kenyans in a flat city marathon and a mountain marathon in Switzerland. Running times of top three overall Kenyan runners were compared with running times of top three overall runners of other nations in a mountain and a flat marathon held in Switzerland between 2003 and 2011. In the mountain marathon top three male Kenyans achieved with 199±23min the 11th fastest running time behind athletes from Italy (177±1min), Switzerland (179±0min), France (186±5min), Great Britain (189±3min), Mexico (189±3min), Germany (192±5min), Czech Republic (195±13min), Morocco (195±7min), USA (196±6min) and Hungary (198±8min). Female Kenyan athletes did not even participate in the mountain marathon. In the city marathon top three male Kenyan athletes achieved the second fastest running time (130±1min) behind Swiss athletes (129±1min), Kenyan female runners had the fifth fastest running time (158±4min) behind athletes from Russia (153±2min), Ethiopia (154±2min), Switzerland (155±2min) and Poland (155±4min). To summarize, Switzerland, Kenyans achieved not the fastest running times in a mountain marathon while they attained the second fastest running times in flat marathon.

BACKGROUND: Atrial natriuretic peptides (ANP) and Brain natriuretic peptides (BNP) stimulate fat cell plasma membrane receptors. They are potent lipolytic agents on isolated fat cells from subcutaneous adipose tissue. The physiological effects of continuous endurance exercise on ANP release and plasma free fatty acids (FFA) concentrations have been well described. The enhancement of fat metabolism using high intensity intermittent exercise protocols has been assessed in more recent investigations. The combined effects of endurance exercise and water immersion on ANP and FFA plasma concentration and the magnitude of excess post-exercise oxygen consumption (EPOC) might be further enhanced by choosing the most effective exercise protocol. Exercise modalities may play a significant role in the future prevention and treatment of obesity.Methods/designThe two testing trials will be performed according to a randomized and cross-over design. Twenty healthy sedentary pre-obese and obese class-1 men will be scrutinized with regard to their metabolic responses to continuous exercise in water and to high intensity endurance exercise in water. Both trials will be matched for energy expenditure. After preliminary testing, the tests will be conducted as repeated measurements. The two different exercise protocols will be compared. The aims of the study are to investigate (1) whether continuous endurance exercise or high intensity intermittent endurance exercise in water elicits both a higher release of ANP and BNP and a higher plasma concentration of glycerol and (2) to determine whether continuous endurance exercise in water or a high intensity intermittent endurance exercise in water would lead to a more pronounced short term (two hours) EPOC effect. DISCUSSION: If our hypothesis would be confirmed, the most effective exercise protocol based on the combined effects of high intensity endurance exercise and water immersion on ANP and BNP release and glycerol plasma concentrations c

Background: Participation and performance trends regarding the nationality of ultraendurance athletes have been investigated in the triathlon, but not in running. The present study aimed to identify the countries in which multistage ultramarathons were held around the world and the nationalities of successful finishers. Methods: Finisher rates and performance trends of finishers in multistage ultramarathons held worldwide between 1992 and 2010 were investigated. Results: Between 1992 and 2010, the bulk of multistage ultramarathons were held in Germany and France, with more than 30 races organized in each country. Completion rates for men and women increased exponentially, with women representing on average 16.4% of the total field. Since 1992, 6480 athletes have competed in Morocco, 2538 in Germany, and 1842 in France. A total of 81.9% of athletes originated from Europe, and more specifically from France (22.9%), Great Britain (18.0%), and Germany (13.4%). Conclusion: European ultramarathoners dominated the athletes who completed multistage ultramarathons worldwide, with specific dominance of French, British, and German athletes. Future studies should investigate social aspects, such as sport tourism, among European athletes to understand why European athletes are so interested in participating in multistage ultramarathons.

Background: This study examined changes according to age group in the number of finishers and running times for athletes in female and male mountain ultramarathoners competing in the 78 km Swiss Alpine Marathon, the largest mountain ultramarathon in Europe and held in high alpine terrain. Methods: The association between age and performance was investigated using analysis of variance and both single and multilevel regression analyses. Results: Between 1998 and 2011, a total of 1,781 women and 12,198 men finished the Swiss Alpine Marathon. The number of female finishers increased (r2 = 0.64, P = 0.001), whereas the number of male finishers (r2 = 0.18, P = 0.15) showed no change. The annual top ten men became older and slower, whereas the annual top ten women became older but not slower. Regarding the number of finishers in the age groups, the number of female finishers decreased in the age group 18–24 years, whereas the number of finishers increased in the age groups 30–34, 40–44, 45–49, 50–54, 55–59, 60–64, and 70–74 years. In the age groups 25–29 and 35–39 years, the number of finishers showed no changes across the years. In the age group 70–74 years, the increase in number of finishers was linear. For all other age groups, the increase was exponential. For men, the number of finishers decreased in the age groups 18–24, 25–29, 30–34, and 35–39 years. In the age groups 40–44, 45–49, 50–54, 55–59, 60–64, 70–74, and 75–79 years, the number of finishers increased. In the age group 40–44 years, the increase was linear. For all other age groups, the increase was exponential. Female finishers in the age group 40–44 years became faster over time. For men, finishers in the age groups 18–24, 25–29, 30–34, 40–44, and 45–49 years became slower. Conclusion: The number of women older than 30 years and men older than 40 years increased in the Swiss Alpine Marathon. Performance improved in women aged 40–44 years but decreased in male runners aged 18–49 years.

OBJECTIVES: The performance and age of peak ultra-endurance performance have been investigated in single races and single race series but not using worldwide participation data. The purpose of this study was to examine the changes in running performance and the age of peak running performance of the best 100-mile ultra-marathoners worldwide. METHOD: The race times and ages of the annual ten fastest women and men were analyzed among a total of 35,956 finishes (6,862 for women and 29,094 for men) competing between 1998 and 2011 in 100-mile ultra-marathons. RESULTS: The annual top ten performances improved by 13.7% from 1,132±61.8 min in 1998 to 977.6±77.1 min in 2011 for women and by 14.5% from 959.2±36.4 min in 1998 to 820.6±25.7 min in 2011 for men. The mean ages of the annual top ten fastest runners were 39.2±6.2 years for women and 37.2±6.1 years for men. The age of peak running performance was not different between women and men (p>0.05) and showed no changes across the years. CONCLUSION: These findings indicated that the fastest female and male 100-mile ultra-marathoners improved their race time by ∼14% across the 1998–2011 period at an age when they had to be classified as master athletes. Future studies should analyze longer running distances (>200 km) to investigate whether the age of peak performance increases with increased distance in ultra-marathon running.

QUESTIONS UNDER STUDY: In Switzerland, skin cancer is one of the most prevalent neoplasms. General practitioners (GPs) are often faced with suspicious skin lesions in their patients. The aim of our study was to assess GPs' competence to diagnose skin cancer and to examine whether this can be improved by a one-day dermatologic education programme. METHODS: Study design: Pre / post-intervention study. Study population: 78 GPs in the Canton of Zurich. Intervention: A one day dermatologic education programme provided by a dermatologist. Measurements: Before (T0) and after (T1) the dermatologic education programme, GPs were asked to rate pictures (with a short history) of skin lesions on a visual analogue scale according to their likelihood of malignancy. Analysis: Non-parametric paired Wilcoxon signed rank test was used to compare the sum score of correctly classified skin lesions at T0 and T1. RESULTS: At T0 GPs classified 63.9% lesions correctly (benign: 51.2%; malignant: 76.6%), while at T1 these figures increased to 75.1% (benign: 67.6%; malignant: 82.7%). CONCLUSION: A one-day dermatologic education programme led to improvements in GPs' diagnostic competence in skin cancer, but there remained room for further improvement.

QUESTION UNDER STUDY: Switzerland is facing a shortage of general practitioners (GPs). Knowledge of the factors influencing career choice is crucial for increasing the attractiveness of general practice. The aim of our study was to report the working conditions of recently certified GPs and the effect of vocational training in general practice on GP skills and knowledge, and economic skills. Furthermore, we recorded when GPs chose general practice as a career, as well as potential barriers to and facilitators of their decision. METHODS: Study design: Cross-sectional survey with an online-based questionnaire. Study group: 1,133 physicians certified in general practice between the years 2000 and 2010. RESULTS: The response rate was 40.6% (456); 426 (44.1% females) were included in further analysis. A total of 341 (80.0%) were currently working in general practice. Female GPs were significantly more often employed (rather than working independently), working part-time and in group practices. Fifty-two (12.2%) of the participants did not work in general practice although they had intended to earlier. The majority (54.3%) of the participants working as GPs decided to become a GP during their residency. Overall, 60.6% of all participants completed vocational training in a general practice, which significantly improved self-perceived general practice skills compared with their colleagues without such training. CONCLUSIONS: Residency is a more important time-period than medical school for career decisions to become a GP. Attractive residency programmes must be developed to engage physicians in this vulnerable phase. The workplace settings of female GPs were significantly different from those ofmale GPs. Vocational training in general practice had a positive effect on self-perceived GP skills.

Background: Participation and performance trends have been investigated in ultramarathons and ultratriathlons but not in ultracycling. The aim of the present study was to investigate (1) participation and performance trends in ultraendurance cyclists, (2) changes in cycling speed over the years, and (3) the age of the fastest male and female ultraendurance cyclists. Methods: Participation and performance trends in the 5000 km Race Across America (RAAM) and in two RAAM-qualifier races – the 818 km Furnace Creek 508 in the United States and the 715 km Swiss Cycling Marathon in Europe – were investigated using linear regression analyses and analyses of variance. Results: On average, ~41% of participants did not finish either the RAAM or the Furnace Creek 508, whereas ~26% did not finish the Swiss Cycling Marathon. Female finishers accounted for ~11% in both the RAAM and the Furnace Creek 508 but only ~3% in the Swiss Cycling Marathon. The mean cycling speed of all finishers remained unchanged during the studied periods. The winner’s average speed was faster for men than for women in the RAAM (22.6 ± 1.1 km · h-1 versus 18.4 ± 1.7 km · h-1, respectively; average speed difference between male and female winners, 25.0% ± 11.9%), the Swiss Cycling Marathon (30.8 ± 0.8 km · h-1 versus 24.4 ± 1.9 km · h-1, respectively; average speed difference between male and female winners, 27.8% ± 9.4%), and the Furnace Creek 508 (27.4 ± 1.6 km · h-1 versus 23.4 ± 3.0 km · h-1, respectively; average speed difference between male and female winners, 18.4% ± 13.9%). In both the Furnace Creek 508 and the Swiss Cycling Marathon, ~46% of the finishers were aged between 35 and 49 years. The mean age of winners, both male and female, across the years in the Furnace Creek 508 and in the Swiss Cycling Marathon was 37 ± 10 years. Conclusion: These findings in ultracycling races showed that (1) ~26%–40% of starters were unable to finish, (2) the percentage of female finishers was ~3%–11%, (3) the g

Objective: Social support is an important element of family medicine within a primary care setting, delivered by general practitioners and practice nurses in addition to usual clinical care. The aim of the study was to explore general practitioner's, practice nurse's and people with type 2 diabetes' views, experiences and perspectives of the importance of social support in caring for people with type 2 diabetes and their role in providing social support. Methods: Interviews with general practitioners (n=10) and focus groups with practice nurses (n=10) and people with diabetes (n=9). All data were audio-recorded, fully transcribed and thematically analysed using qualitative content analysis by Mayring.Results: All participants emphasized the importance of the concept of social support and its impacts on well-being of people with type 2 diabetes. Social support is perceived helpful for people with diabetes in order to improve diabetes control and give support for changes in lifestyle habits (physical activity and dietary changes). General practitioners identified a lack of information about facilities in the community like sports or self-help groups. Practice nurses emphasized that they need more training, such as in dietary counselling. Conclusions: Social support given by general practitioners and practice nurses plays a crucial role for people with type 2 diabetes and is an additional component of social care. However there is a need for an increased awareness by general practitioners and practice nurses about the influence social support could have on the individual's diabetes management., Zielsetzung: Soziale Unterstützung stellt ein wichtiges und ergänzendes Element in der hausärztlichen Versorgung dar. In der vorliegende Studie wurden die Einstellungen zu und Erfahrungen mit sozialer Unterstützung sowie deren Bedeutung im hausärztlichen Setting von Allgemeinärzten, Medizinischen Fachangestellten (MFA) und Patienten mit Diabetes mellitus Typ 2 erfasst.Methodik: Es wurden Interviews mit Allgemeinärzten (n=10) sowie Fokusgruppen mit MFAs (n=10) und Patienten mit Diabetes mellitus Typ 2 (n=9) durchgeführt. Die Daten wurden aufgezeichnet, transkribiert und thematisch unter Verwendung der qualitativen Inhaltsanalyse nach Mayring analysiert.Ergebnisse: Alle Teilnehmer betonen die Relevanz des Konzepts der sozialen Unterstützung und vor allem den daraus resultierenden Einfluss auf das Wohlbefinden von Patienten mit Diabetes mellitus Typ 2. Soziale Unterstützung wird von den befragten Patienten als hilfreiches Konzept empfunden, um die eigenen Werte zu verbessern und um Lebensstilveränderungen umzusetzen (körperliche Aktivität oder Ernährungsumstellung). Allgemeinärzte nehmen ihrerseits einen Mangel an Informationen über kommunale Angebote wie zum Beispiel Sportkurse oder auch Selbsthilfegruppen wahr. MFAs wünschen sich mehr Fortbildungsmöglichkeiten, um in der Praxis zum Beispiel Ernährungsberatung durchführen zu können. Fazit: Soziale Unterstützung durch Praxisteams in der hausärztlichen Versorgung spielt eine wichtige Rolle für Patienten mit Diabetes mellitus Typ 2. Allerdings sollten sich sowohl Allgemeinärzte als auch MFAs noch mehr darüber bewusst werden, welchen Einfluss und Nutzen soziale Unterstützung auf das individuelle Diabetesmanagement haben kann.

The prevalence of exercise-associated hyponatraemia (EAH) has been investigated in endurance athletes such as runners and Ironman triathletes, but not in ultra-endurance road cyclists. We assessed fluid intake and changes in body mass, urine specific gravity and plasma sodium concentration ([Na(+)]) in 65 ultra-endurance road cyclists in a 720-km ultra-cycling marathon, the 'Swiss Cycling Marathon'. The cyclists lost 1.5 (1.7)% body mass (P < 0.01). No athlete developed EAH. Fluid intake was associated with the change in plasma [Na(+)] (r = -0.32, P < 0.05) and the change in body mass (r = -0.30, P < 0.05). The change in plasma [Na(+)] was related to post-race plasma [Na(+)] (r = 0.63, P < 0.0001). To conclude, ad libitum fluid intake in ultra-endurance cyclists in a single-stage ultra-endurance road cycling race showed no case of EAH. Future studies regarding drinking behaviour in different ultra-endurance disciplines might give insights into why the prevalence of EAH is different in the different disciplines.

BACKGROUND: This case report describes an experienced open-water ultra-endurance athlete swimming in water of 9.9°C for 6 h and 2 min. Methods Before the swim, anthropometric characteristics such as body mass, body height, skinfold thicknesses, and body fat were determined. During and after the swim, body core (rectum) and body surface (forearm and calf) temperatures were continuously recorded. Results The swimmer (53 years old, 110.5 kg body mass, 1.76 m body height, 34.9% body fat, and a body mass index of 35.7 kg/m2) achieved a total distance of 15 km while swimming at a mean speed of 2.48 km/h, equal to 0.69 m/s, in water of 9.9°C. Body core temperature was at 37.8°C before the swim, increased to a maximum of 38.1°C after approximately 20 min of swimming, and then decreased continuously to 36.3°C upon finishing the swim. The lowest body core temperature was 36.0°C between 35 and 60 min after finishing the swim. Sixty minutes after the swim, the body core temperature continuously rose to 36.5°C where it remained. At the forearm, the temperature dropped to 19.6°C after approximately 36 min of swimming and decreased to 19.4°C by the end of the swim. The lowest temperature at the forearm was 17.6°C measured at approximately 47 min before the athlete stopped swimming. At the calf, the temperature dropped to 13.0°C after approximately 24 min of swimming and decreased to 11.9°C at the end of the swim. The lowest temperature measured at the calf was 11.1°C approximately 108 min after the start. In both the forearm and the calf, the skin temperature continuously increased after the swim. Conclusions This case report shows that (1) it is possible to swim for 6 h in water of 9.9°C and that (2) the athlete did not suffer from hypothermia under these circumstances. The high body mass index, high body fat, previous experience, and specific preparation of the swimmer are the most probable explanations for these findings.

Background The fastest Ironman race times in ‘Ironman Hawaii’ were achieved in very recent years. This study investigated the change in sex difference in both race performance and the age of peak performance across years in the top ten athletes for split disciplines and overall race time in the ‘Ironman Hawaii’ between 1983 and 2012. Methods Changes in split times, overall race times, and age of athletes across years for the top ten overall and the fastest swimmers, cyclists, and runners were investigated using regression analyses and analyses of variance. Results Between 1983 and 2012, the overall top ten men and women finishers improved their swimming (only men), cycling, running, and overall race times. The sex difference in overall race time decreased significantly (p = 0.01) from 15.2% to 11.3% across time. For the split disciplines, the sex difference remained unchanged (p > 0.05) for swimming (12.5 ± 3.7%) and cycling (12.5 ± 2.7%) but decreased for running from 13.5 ± 8.1% to 7.3 ± 2.9% (p = 0.03). The time performance of the top ten swimmers remained stable (p > 0.05), while those of the top ten cyclists and top ten runners improved (p < 0.01). The sex difference in performance remained unchanged (p > 0.05) in swimming (8.0 ± 2.4%), cycling (12.7 ± 1.8%), and running (15.2 ± 3.0%). Between 1983 and 2012, the age of the overall top ten finishers and the fastest swimmers, cyclists, and runners increased across years for both women and men (p < 0.01). Conclusions To summarize, for the overall top ten finishers, the sex difference decreased across years for overall race time and running, but not for swimming and cycling. For the top ten per discipline, the sex difference in performance remained unchanged. The athletes improved their performances across years although the age of peak performance increased.

Body Mass Index is associated with endurance performance in athletes. Reported and measured values of body mass and body height in 1,607 endurance athletes (1,352 men, 255 women) showed that men and women both underestimated their body mass and overestimated their body height, leading to an underestimation of Body Mass Index. There were age and sex differences in estimates of height and weight; for both women and men, underestimation of Body Mass Index amounted to 0.4 kg/m2. Master athletes tended to underestimate their body mass and overestimate their body height thus leading to significant differences between estimated and measured Body Mass Index. However, the magnitude of underestimation of BMI probably has a negligible influence on performance predictions. The differences between measured and estimated body mass, height, and BMI were within the range of normal daily variation, and for body height even within the precision of the measurement (0.5 cm).

PRINCIPLES: Most patients with arterial hypertension are treated in primary care. The objective is to assess characteristics of patients with uncontrolled arterial hypertension and its associated determinants in Swiss primary care. METHOD: Data on 122 adult patients with uncontrolled hypertension (mm Hg >140 systolic and/or >90 diastolic) was collected from the baseline data of the on-going randomised controlled "CoCo" trial: Colour-coded Blood Pressure Control. Patient and general practitioner characteristics were analysed to investigate the relationship between BP and patient characteristics. RESULTS: From October 2009 to March 2011 30 general practitioners recruited 122 patients; median age 64 years (IQR 54.8-72), 50% male, median BMI 28.3 kg/m2 (IQR 25.3-31.7), 21.5% smokers. 65.6% performed home blood pressure measurement, 88.5% received pharmacological treatment, 41.8% mono-therapy. Most frequent dual drug combinations: diuretics/angiotensin-receptor-blockers (33.3%), angiotensin-converting-enzyme-inhibitors/beta blockers (both 28.1%). BMI, smoking and age were independent predictors for elevated systolic blood pressure when controlled for gender, home blood pressure measurement, education, pulse rate and number of antihypertensive substances. We found a significant non-linear association between systolic blood pressure and number of antihypertensive substances. Age and any amount of antihypertensive substances were independently and inversely correlated with diastolic blood pressure. The findings did not change when additionally controlled for general practitioner clustering effect. CONCLUSION: Smoking and high BMI are strong and independent factors associated with higher blood pressure levels in patients with uncontrolled arterial hypertension. A high rate of monotherapy and a decrease in the incremental gain on blood pressure control when more antihypertensive agents are used highlight the importance of adequate pharmacological treatment as well as risk fac

Background: A recent study showed that European triathletes performed faster in Double Iron ultratriathlons than North American athletes. The present study analyzed triathletes participating in Double Iron ultratriathlons to determine the origin of the fastest Double Iron ultratriathletes, focusing on European countries. Methods: Participation and performance trends of finishers in Double Iron ultratriathlons from 1985–2011 of the different countries were investigated. Additionally, the performance trends of the top three women and men overall from 2001–2011 were analyzed. Results: A total of 1490 finishers originated from 24 different European countries and the United States. The number of European triathletes increased for both women (r2 = 0.56; P , 0.01) and men (r2 = 0.63; P , 0.01). The number of the North American triathletes increased for women (r2 = 0.25; P , 0.01), but not for men (r2 = 0.02; P . 0.05). Hungarian triathletes showed a significant improvement in both overall race times and in cycling split times, Swiss triathletes improved both their swim and run times, and French triathletes improved their swim times. Conclusion: Men and women triathletes from Central European countries such as France, Germany, Switzerland, and Hungary improved Double Iron ultratriathlon overall race times and split times during the 26-year period. The reasons might be the social and economic factors required to be able to participate in such an expensive and lavish race. Also, a favorable climate may provide the ideal conditions for successful training. Future studies need to investigate the motivational aspects of European ultraendurance athletes.