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Some ambulant people with HIV are cared for primarily by their general practitioner and some in an outpatient clinic. Costs and patterns of care in these settings were studied in 65 such patients based in Zurich, from a limited societal perspective (excluding patient costs) based on medical resource use. Antiretroviral therapy (ART), other medications and patient variables were collected prospectively, and non-medication resources (professional time and investigations) and treatment history data were collected from medical records and by record linkage to the Swiss HIV Cohort Study database. Cost differences between the settings were estimated using multiple regression, controlling for differences in case-mix. ART comprised 80% of the total cost, non-medication costs 15% and non-ART medications 5%. Total costs were higher in the outpatient clinic (estimated additional cost after controlling for case-mix = 3489 Swiss Francs per year at 1999 prices, 95% confidence interval 742 to 6236, p=0.017). The difference was accounted for by higher ART costs in the outpatient clinic, not through a tendency to use more expensive drugs or higher doses but rather through the use of more drugs concurrently. Differences in ART prescribing patterns between the doctors in the outpatient clinic and the general practitioners were considerable and appear worthy of further investigation.

Objectives: To describe health‐care use by persons with HIV in an urban area of Switzerland (Zurich). Further, to compare the different health‐care settings. Design: A 1‐year prospective cohort study recruiting 60 patients at general practices and 60 patients at a specialized university outpatient clinic. Methods: Patients and their treating physicians were interviewed or answered questionnaires, respectively, at baseline, month 6 and 12. Results: During the study period, five patient groups were identified among the 106 enrolled patients, of whom (i) 42% saw a general practitioner exclusively, (ii) 31% were treated at the specialized outpatient clinic, (iii) 8% were in shared care, (iv) 10% changed health‐care model, and (v) 9% were lost to follow‐up. Baseline demographic, psychosocial and clinical data were similar among patient groups. At study end, the proportion of patients with HIV‐1 RNA < 400 copies/mL was 72%, 74%, 88%, 55% among groups (i) to (iv), respectively (ns), and 22% at month 6 among those lost to follow‐up. Indicators for quality of care were similarly good among all patient groups. Conclusions: A well‐working system offers high‐quality healthcare to persons living with HIV, where existing teams of speciality and primary health‐care professionals efficiently and effectively co‐operate.

Ziel der Studie: Diese qualitative Studie befasst sich mit den Kooperationsstrukturen der zwei wichtigsten HIV-Betreuungsinstitutionen (Universitätsspital und niedergelassene Ärztinnen/Ärzte) im Raum Zürich (Schweiz). Ausgehend von der Hypothese, dass eine gute Zusammenarbeit der Betreuungsinstitutionen die Qualität und Effektivität der Behandlung für die Patientinnen und Patienten mit HIV, die mit hochwirksamen antiretroviralen Kombinationstherapien (HAART) behandelt werden, erhöht, werden die Kooperationsstrukturen untersucht. Methodik: Qualitative Daten wurden in drei Fokusgruppen mit Ärztinnen und Ärzten der verschiedenen Betreuungsinstitutionen erhoben. Anhand eines strukturierten Gesprächsleitfadens wurden verschiedene Aspekte der Kooperation (Status quo, Defizite, Verbesserungsmöglichkeiten) erfasst und nach der Dimension Konsens versus Dissonanz inhaltsanalytisch ausgewertet. Ergebnisse: Kooperation erfolgt auf drei Ebenen (patientenbezogen, fachspezifisch und fortbildungsbezogen) und wird von den Befragten insgesamt als gut beurteilt. Die Institutionen verfügen über unterschiedliche Kompetenzen in der HIV-Betreuung (Spezialisten vs. Generalisten). Sie formulieren unterschiedliche Erwartungen an die Kooperation, was sich auf die Zufriedenheit damit auswirkt. Schlussfolgerungen: Auf Basis der Ergebnisse werden Empfehlungen für eine verbesserte Kooperation aus Sicht der teilnehmenden Ärztinnen und Ärzte angeführt, welche die Qualität der HIV-Betreuung noch weiter erhöhen könnten., Objectives of the Study: This qualitative study looks at structures of co-operation between the two major HIV-care settings in the region of Zurich (Switzerland), i.e. a HIV-specialised outpatient clinic at the University hospital and private practitioners. Hypothesizing that a good co-operation between the institutions increases the quality and effectivity of care for patients living with HIV and treated with highly active antiretroviral therapy (HAART), the structures of co-operation are investigated. Methods: Qualitative data were collected by means of three focus-group discussions with physicians from both settings. By means of a structured interview guide, different aspects of co-operation were assessed (e. g. current status, deficits, degree of satisfaction). Contents analysis of the data revealed consensus versus dissonance pertaining to different areas of co-operation. Results: Results show that co-operation has been implemented effectively on three different planes (case-related, knowledge-related, training-related) and generally has been perceived by the participants to function well. Institutions have different emphasis on care (specialists vs. generalists). They formulate different concepts of co-operation, which result in diverse degrees of satisfaction. Conclusions: On the basis of the results obtained, suggestions for improved co-operation as recommended by the participants are discussed, which could further increase the quality of HIV-related care.

Summary: Objectives: Data from a cross-sectional survey of the Swiss general population were used in an explorative attempt to apply the transtheoretical model of behavioural change to perceived stress. Methods: The sample comprised 575 respondents who reported having experienced stressful situations in the previous month. Other variables assessed included gender, age, education, reported symptoms, and three constructs representing stages and processes of change as well as self-efficacy. Results: Findings indicated that (1) about one third of respondents appeared to cope successfully with the stressful situations they experienced, one third intended to do so, while one quarter appeared to have no intention of managing their stress more effectively. (2) There was no difference in stage of change distribution by gender or age, while those with higher education were more frequently represented in the latter stages than those with lower education. (3) Those in the maintenance stage reported significantly less symptoms than others. Conclusions: We conclude that the assessment of readiness to change could be of valuable support in designing stage-specific interventions in the area of stress management

Summary: Objectives: Even though sports participation in Switzerland appears to be quite elevated, recent research suggests that only about a third of the population are doing enough sports from a health perspective. Methods: Against this background several Swiss health insurance companies together with the Swiss Olympic Association have recently developed a novel approach to get people to start physical exercise: Under the label of <> sport clubs offer training and information courses aimed at motivating and helping previously inactive people to take on regular exercise. Results: The paper presents results from an interdisciplinary evaluation of the first three years of the <> campaign. Starting from an overview of the basic idea and features of the campaign it asks whether <> has reached its self-declared goal of "getting Switzerland moving”. Available evidence on the social background of participants and their further activities shows that by systematically avoiding any reference to conventional notions of sport and by stressing the health and fun aspect instead, <> has indeed managed to mobilise an important group with underaverage levels of activity (particularly middle-aged women). In addition, on average the level of physical exercise of participants appears to have increased. Yet, the number of participants is below the original target values and, contrary to the campaign's initial goal, participants are reluctant to leave the programme after one course to take up an independent activity or to join a club. Conclusions: The paper explores the achievements and problems of the campaign so far and offers an explanation of recent problems which can also serve as a basis for the implementation of similar programmes in other countries

OBJECTIVES: To describe health-care use by persons with HIV in an urban area of Switzerland (Zurich). Further, to compare the different health-care settings. DESIGN: A 1-year prospective cohort study recruiting 60 patients at general practices and 60 patients at a specialized university outpatient clinic. METHODS: Patients and their treating physicians were interviewed or answered questionnaires, respectively, at baseline, month 6 and 12. RESULTS: During the study period, five patient groups were identified among the 106 enrolled patients, of whom (i) 42% saw a general practitioner exclusively, (ii) 31% were treated at the specialized outpatient clinic, (iii) 8% were in shared care, (iv) 10% changed health-care model, and (v) 9% were lost to follow-up. Baseline demographic, psychosocial and clinical data were similar among patient groups. At study end, the proportion of patients with HIV-1 RNA < 400 copies/mL was 72%, 74%, 88%, 55% among groups (i) to (iv), respectively (ns), and 22% at month 6 among those lost to follow-up. Indicators for quality of care were similarly good among all patient groups. CONCLUSIONS: A well-working system offers high-quality healthcare to persons living with HIV, where existing teams of specialty and primary health-care professionals efficiently and effectively co-operate.

Afin de tenir compte de ces recommandations pour notre alimentation quotidienne, il faut adapter aussi bien les menus domestiques destinés à la famille que les menus des cantines sur les lieux de travail, et ceci de façon simultanée. Ce but peut être atteint sans modifier nos traditions alimentaires, ni même notre approvisionnement. Le respect de ces directives permettra d'équilibrer rapidement notre alimentation et adapter notre consommation à nos besoins réels.