Inventory and perspectives of chronic disease management programs in Switzerland: an exploratory survey.

OBJECTIVE: To describe chronic disease management programs active in Switzerland in 2007, using an exploratory survey. METHODS: We searched the internet (Swiss official websites and Swiss web-pages, using Google), a medical electronic database (Medline), reference lists of pertinent articles, and contacted key informants. Programs met our operational definition of chronic disease management if their interventions targeted a chronic disease, included a multidisciplinary team (>/=2 healthcare professionals), lasted at least six months, and had already been implemented and were active in December 2007. We developed an extraction grid and collected data pertaining to eight domains (patient population, intervention recipient, intervention content, delivery personnel, method of communication, intensity and complexity, environment, clinical outcomes). RESULTS: We identified seven programs fulfilling our operational definition of chronic disease management. Programs targeted patients with diabetes, hypertension, heart failure, obesity, psychosis and breast cancer. Interventions were multifaceted; all included education and half considered planned follow-ups. The recipients of the interventions were patients, and healthcare professionals involved were physicians, nurses, social workers, psychologists and case managers of various backgrounds. CONCLUSIONS: In Switzerland, a country with universal healthcare insurance coverage and little incentive to develop new healthcare strategies, chronic disease management programs are scarce. For future developments, appropriate evaluations of existing programs, involvement of all healthcare stakeholders, strong leadership and political will are, at least, desirable.

Identity, immigration, and prejudice in Europe: a recognition approach

Social identity is a double-edged sword. On the one hand, identifying with a social group is a prerequisite for the sharing of common norms and values, solidarity, and collective action. On the other hand, in-group identification often goes together with prejudice and discrimination. Today, these two sides of social identification underlie contradictory trends in the way European nations and European nationals relate to immigrants and immigration. Most European countries are becoming increasingly multicultural, and anti-discrimination laws have been adopted throughout the European Union, demonstrating a normative shift towards more social inclusion and tolerance. At the same time, racist and xenophobic attitudes still shape social relations, individual as well as collective behaviour (both informal and institutional), and political positions throughout Europe. The starting point for this chapter is Sanchez-Mazas' (2004) interactionist approach to the study of racism and xenophobia, which in turn builds on Axel Honneth's (1996) philosophical theory of recognition. In this view, the origin of attitudes towards immigrants cannot be located in one or the other group, but in a dynamic of mutual influence. Sanchez-Mazas' approach is used as a general framework into which we integrate social psychological approaches of prejudice and recent empirical findings examining minority-majority relations. We particularly focus on the role of national and European identities as antecedents of anti-immigrant attitudes held by national majorities. Minorities' reactions to denials of recognition are also examined. We conclude by delineating possible social and political responses to prejudice towards immigrants.

De l'invalide à l'adunatos: réflexions sur l'invalidité et le trouble somatoforme douloureux [From disability to the adunatos: some thoughts on disability and somatoform pain disorder].

Disability, especially if related to a psychiatric disorder, such as somatoform pain disorder, is characterized by medical, psychological, relational, social and societal, as well as financial and political aspects. This manuscript, part of a PhD thesis which reflects on a possible dialogue between an ancient text and the modern conceptualization of disability, tries to address the phenomenological, historical and political dimensions of disability.

Migrating concepts: Immigrant integration and the regulation of religious dress in France and Canada

Religion in general, and Islam in particular, has become one of the main focal points of policy-making and constitutional politics in many Western liberal states. This article proposes to examine the legal and political dynamics behind new regulations targeting individual religious practices of Muslims. Although one could presuppose that church-state relations or the understanding of secularism is the main factor accounting for either accommodation or prohibition of Muslim religious practices, I make the case that the policy frame used to conceptualize the integration of immigrants in each national context is a more significant influence on how a liberal state approaches the legal regulation of individual practices such as veiling. However, this influence must be assessed carefully since it may have different effects on the different institutional actors in charge of regulating religion, such as the Courts and the legislature. To assess these hypotheses I compare two countries, France and Canada, which are solid examples of two contrasting national policy frames for the integration of immigrants.

Burnout and associated factors in employees of a Swiss teaching hospital

Background Working in a teaching hospital is a highly stressful occupation, which can lead to burnout. The consequences of burnout in health professionals can be very serious, both for themselves and patients. The aim of this cross-sectional study was to assess the extent of burnout and associated factors in hospital employees. Methods In the Fall of 2007, all employees of a Swiss teaching hospital were invited to complete a job satisfaction survey. It included the work-related burnout scale (scored 0-100) of the Copenhagen Burnout Inventory (CBI-French version), measuring the degree of physical and psychological fatigue and exhaustion perceived as related to the person's work; a high degree of burnout was defined as a score _50. Logistic regression analyses were used to determine factors associated with a high degree of burnout. Results A total of 4575 individuals returned the questionnaire (response rate 54%). Of them, 1503 (33%) had a high degree of burnout. The rate of burnout was higher among women (34.3% versus 30.5%, P = 0.012) and respondents younger than 40 years (37.7% versus 28.6%, P < 0.001). Executives were less prone to burnout than employees (27.1% versus 33.9%, P < 0.0019). Rates of burnout differed by profession: nurses and physicians had higher rates than administrative and logistic staff (42.8% and 37.4% versus 25.6% and 20.9%, respectively P < 0.001). Burnout was inversely associated with job satisfaction. In multivariate analysis, factors associated with burnout were overall dissatisfaction (OR 3.23; 95% CI 2.66-3.91), dissatisfaction with workload (OR 2.09; 95% CI 1.74-2.51) and work-life balance (OR 2.25; 95% CI 1.83-2.77), being a woman (OR 1.56; 95% CI 1.28-1.90), working fulltime (OR 1.41; 95% CI 1.08-1.85) and working as a nurse, a physician or in the psychosocial sector. Conclusions One-third of respondents, mostly nurses and physicians, experienced burnout and had lower levels of job satisfaction. The factors associated with burnout may help to tailor programmes aiming at reducing burnout at both the individual and organizational level within the hospital.

Political representation in Switzerland : democratic or plutocratic ?

Les inégalités économiques se traduisent-elles dans des inégalités politiques à travers le processus de représentation électorale? Telle est la question centrale de cette thèse qui s'attache, par ailleurs, à investiguer les mécanismes qui tendent à produire une représentation biaisée des préférences politiques des citoyens en fonction de leur statut économique. Focalisé sur le cas de la Suisse et faisant usage des données de l'enquête postélectorale Selects de 2007, ce travail démontre que sur les rares sujets qui divisent les citoyens selon des clivages économiques - la redistribution des richesses et la sécurité sociale en particulier - les élus à l'Assemblée fédérale ont des préférences qui reflètent mieux les opinions des citoyens les plus riches. Cette sous-représentation des opinions des citoyens modestes et de ceux faisant partie du centre de la distribution des revenus peut en partie être attribuée à des différences dans les taux de participation et de connaissance politiques entre ces groupes de citoyens. La thèse met également en évidence le rôle joué par la représentation descriptive - autrement dit, la similitude en termes de statut économique entre les représentants et les représentés - dans la représentation des opinions et intérêts des citoyens. Par ailleurs, la structure du système partisan en Suisse ne reflétant pas la multidimensionnalité des préférences politiques des citoyens, les électeurs ne parviennent pas à traduire la complexité de leurs préférences politiques dans un choix de vote, ce qui, dans la configuration actuelle des forces politiques, tend à favoriser l'élection de représentants aux opinions proches de la droite sur les questions économiques. Enfin, une analyse de la représentation politique au niveau cantonal tend à soutenir la thèse selon laquelle le manque de régulation en matière de financement des partis en Suisse pourrait partiellement expliquer les inégalités dans la représentation des opinions politiques des citoyens aux revenus distincts. - Do economic inequalities translate into political inequalities through electoral representation? This is the central research question of this thesis, which also investigates the mechanisms that lead to potential economically based inequalities in the representation of citizens' policy preferences. Focusing on the case of Switzerland and making use of data provided by the post- electoral survey Selects 2007, this research demonstrates that regarding the rare policy domains in which the preferences of citizens are clearly linked to economic cleavages - redistribution and social security in particular - members of the Federal Assembly have policy preferences that best reflect the policy preferences of richer citizens. The under-representation of the opinions of relatively poor citizens and of those being the in the middle of the income distribution can be to some extent be explained by differences in political participation and political information across income groups. The thesis also puts forward the role played by descriptive representation - the similarity between representatives and represented in terms of their socioeconomic status - for the representation of citizens' preferences and interests. In addition, the structure of the party system in Switzerland does not reflect the multidimensionality of policy preferences among citizens who, as a result, have a hard time translating their complex preferences into a vote choice. Given the configuration of political actors, this tends to favour the election of representatives from the right who do not represent the preferences of their voters on economic issues. Finally, an analysis of representation at the cantonal level tends to confirm that the lack of party finance regulations in Switzerland may partially explain inequalities in the representation of citizens with different levels of income.

Balance Between Investment Protection and Sustainable Development in BITs: the Example of Switzerland

The objective of this article is to examine how substantive and procedural rights granted to foreign investors by Swiss bits are gradually being balanced with social and environmental provisions. Switzerland has enjoyed a long bit practice, as it signed its first treaty with Tunisia fifty years ago. Swiss bits rely on the post-establishment model and include usual standards of treatment. From 1981, they also systematically provide for a dispute settlement mechanism for disputes arising between an investor and a host State. Since the Switzerland - El Salvador bit in 1994, sustainable development concerns have been expressly inserted in some Swiss bits, as well as in several recent free trade agreements. Provisions on this theme are however far from being systematic in Switzerland's bit practice and essentially remain declaratory in nature. The trend towards wider inclusion of sustainable development provisions in bits still faces several practical and political challenges.

The Georgian adolescent health survey: methodological and strategic issues.

OBJECTIVES: To conduct a national survey on adolescent health and lifestyles in Georgia and to thus set up a database on adolescent. METHODS: A two-stage cluster sample of around 8000-10000 in-school 15-18 years adolescents are being reached through a random selection of classes in Georgia. The sample has been stratified by age, region, type of school and language. A self-administered questionnaire of 87 questions has been developed and translated into the four main languages used in Georgia. RESULTS: Up to June 2004, the researchers have reached 511 classes (9306 pupils). In total, 8039 questionnaires have been considered valid. The main concerns encountered for this survey are linked with acceptance of the survey, cross-cultural issues, political and strategic problems as well as inadequate physical environmental support. CONCLUSION: Despite Georgia's unfavourable economical and political situation, it has been possible to run a national survey on the health of adolescents, according to the usual standards used in the field. This survey should allow for 1) the identification of priorities in the field of health care and health promotion 2) the monitoring of adolescent health in the future.

Public perceptions of collectives at the outbreak of the H1N1 epidemic: Heroes, villains and victims

Lay perceptions of collectives (e.g., groups, organizations, countries) implicated in the 2009 H1N1 outbreak were studied. Collectives serve symbolic functions to help laypersons make sense of the uncertainty involved in a disease outbreak. We argue that lay representations are dramatized, featuring characters like heroes, villains and victims. In interviews conducted soon after the outbreak, 47 Swiss respondents discussed the risk posed by H1N1, its origins and effects, and protective measures. Countries were the most frequent collectives mentioned. Poor, underdeveloped countries were depicted as victims, albeit ambivalently, as they were viewed as partly responsible for their own plight. Experts (physicians, researchers) and political and health authorities were depicted as heroes. Two villains emerged: the media (viewed as fear mongering or as a puppet serving powerful interests) and private corporations (e.g., the pharmaceutical industry). Laypersons' framing of disease threat diverges substantially from official perspectives.

The many uses of regulatory impact assessment: A meta-analysis of EU and UK cases

Research on regulation has crossed paths with the literature on policy instruments, showing that regulatory policy instruments contain cognitive and normative beliefs about policy. Thus, their usage stacks the deck in favor of one type of actor or one type of regulatory solution. In this article, we challenge the assumption that there is a predetermined relationship between ideas, regulatory policy instruments, and outcomes. We argue that different combinations of conditions lead to different outcomes, depending on how actors use the instrument. Empirically, we analyze 31 EU and UK case studies of regulatory impact assessment (RIA) - a regulatory policy instrument that has been pivotal in the so-called better regulation movement. We distinguish four main usages of RIA, that is, political, instrumental, communicative, and perfunctory. We find that in our sample instrumental usage is not so rare and that the contrast between communicative and political usages is less stark than is commonly thought. In terms of policy recommendations, our analysis suggests that there may be different paths to desirable outcomes. Policymakers should therefore explore different combinations of conditions leading to the usages they deem desirable rather than arguing for a fixed menu of variables.

A two-level analysis of the determinants of direct democratic choices in European, immigration and foreign policy in Switzerland

This article employs a unique data set - covering 25 popular votes on foreign, European and immigration/asylum policy held between 1992 and 2006 in Switzerland - in order to examine the conditional impact of context upon utilitarian, cultural, political and cognitive determinants of individual attitudes toward international openness. Our results reveal clear patterns of cross-level interactions between individual determinants and the project-related context of the vote. Thus, although party cues and political competence have a strong impact on individuals' support for international openness, this impact is substantially mediated by the type of coalition that is operating within the party elite. Similarly, subjective utilitarian and cultural considerations influence the voters' decision in interaction with the content of the proposal submitted to the voters as well as with the framing of the voting campaign.