Diabetes care in Switzerland: good, but perfectible: a population-based cross-sectional survey.

BACKGROUND: While Switzerland invests a lot of money in its healthcare system, little is known about the quality of care delivered. The objective of this study was to assess the quality of care provided to patients with diabetes in the Canton of Vaud, Switzerland. METHODS: Cross-sectional study of 406 non-institutionalized adults with type 1 or 2 diabetes. Patients' characteristics, diabetes and process of care indicators were collected using a self-administered questionnaire. Process indicators (past 12 months) included HbA1C check among HbA1C-aware patients, eye assessment by ophtalmologist, microalbuminuria check, feet examination, lipid test, blood pressure and weight measurement, influenza immunization, physical activity recommendations, and dietary recommendations. Item-by-item (each process of care indicator: percentage of patients having received it), composite (mean percentage of recommended care: sum of received processes of care / sum of possible recommended care), and all-or-none (percentage of patients receiving all specified recommended care) measures were computed. RESULTS: Mean age was 64.4 years; 59% were men. Type 1 and type 2 diabetes were reported by 18.2% and 68.5% of patients, respectively, but diabetes type remained undetermined for almost 20% of patients. Patients were treated with oral anti-diabetic drugs (50%), insulin (23%) or both (27%). Of 219 HbA1C-aware patients, 98% reported ≥ one HbA1C check during the last year. Also, ≥94% reported ≥ one blood pressure measurement, ≥ one weight measurement or lipid test, and 68%, 64% and 56% had feet examination, microalbuminuria check and eye assessment, respectively. Influenza immunization was reported by 62% of the patients.The percentage of patients receiving all processes of care ranged between 14.2%-16.9%, and 46.6%-50.7%, when considering ten and four indicators, respectively. Ambulatory care utilization showed little use of multidisciplinary care, and low levels of participation in diabetes-education classes. CONCLUSIONS: While routine processes-of-care were performed annually in most patients, diabetes-specific risk screenings, influenza immunization, physical activity and dietary recommendations were less often reported; this was also the case for multidisciplinary care and participation in education classes. There is room for diabetes care improvement in Switzerland. These results should help define priorities and further develop country-specific chronic disease management initiatives for diabetes

CoDiab-VD: protocol of a prospective population-based cohort study on diabetes care in Switzerland.

BACKGROUND: Diabetes represents an increasing health burden worldwide. In 2010, the Public Health Department of the canton of Vaud (Switzerland) launched a regional diabetes programme entitled "Programme cantonal Diabète" (PcD), with the objectives to both decrease the incidence of diabetes and improve care for patients with diabetes. The cohort entitled CoDiab-VD emerged from that programme. It specifically aimed at following quality of diabetes care over time, at evaluating the coverage of the PcD within this canton and at assessing the impact of the PcD on care of patients with diabetes. METHODS/DESIGN: The cohort CoDiab-VD is a prospective population-based cohort study. Patients with diabetes were recruited in two waves (autumn 2011--summer 2012) through community pharmacies. Eligible participants were non-institutionalised adult patients (≥ 18 years) with diabetes diagnosed for at least one year, residing in the canton of Vaud and coming to a participating pharmacy with a diabetes-related prescription. Women with gestational diabetes, people with obvious cognitive impairment or insufficient command of French were not eligible. Self-reported data collected, included the following primary outcomes: processes-of-care indicators (annual checks) and outcomes of care such as HbA1C, (health-related) quality of life measures (Short Form-12 Health Survey--SF-12, Audit of Diabetes-Dependent Quality of Life 19--ADDQoL) and Patient Assessment of Chronic Illness Care (PACIC). Data on diabetes, health status, healthcare utilisation, health behaviour, self-management activities and support, knowledge of, or participation to, campaigns/activities proposed by the PcD, and socio-demographics were also obtained. For consenting participants, physicians provided few additional pieces of information about processes and laboratory results. Participants will be followed once a year, via a mailed self-report questionnaire. The core of the follow-up questionnaires will be similar to the baseline one, with the addition of thematic modules adapting to the development of the PcD. Physicians will be contacted every 2 years. DISCUSSION: CoDiab-VD will allow obtaining a broad picture of the care of patients with diabetes, as well as their needs regarding their chronic condition. The data will be used to evaluate the PcD and help prioritise targeted actions. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, identifier NCT01902043, July 9, 2013

Magnetic excitations in a new anisotropic Kagom\'{e} antiferromagnet

The Nd-langasite compound contains planes of magnetic Nd3+ ions on a lattice topologically equivalent to a kagom\'{e} net. The magnetic susceptibility does not reveal any signature of long-range ordering down to 2 K but rather a correlated paramagnetism with significant antiferromagnetic interactions between the Nd and a single-ion anisotropy due to crystal field effect. Inelastic neutron scattering on Nd-langasite powder and single-crystal allowed to probe its very peculiar low temperature dynamical magnetic correlations. They present unusual dispersive features and are broadly localized in wave-vector Q revealing a structure factor associated to characteristics short range-correlations between the magnetic atoms. From comparison with theoretical calculations, these results are interpreted as a possible experimental observation of a spin liquid state in an anisotropic kagom\'{e} antiferromagnet.Comment: to appear in Physica

Reproducibility of diabetes quality of care indicators as reported by patients and physicians.

INTRODUCTION: Self-report of diabetes care has moderate validity and is prone to under- and over-reporting. We assessed reproducibility of a range of processes and outcomes of diabetes care as reported by patients and physicians. METHODS: In a Swiss community-based survey, patients with diabetes and physicians independently reported past 12 months processes of care (HbA1c, lipids, microalbuminuria, blood pressure, weight, foot and eye examinations) and last measured values of HbA1c, height, weight and blood pressure. For dichotomous variables, we assessed reliability by Cohen's kappa and agreement by uniform kappa. For continuous measures, we used Lin's concordance correlation coefficient and limits of agreement, respectively. RESULTS: Mean age of the 210 patients was 65 years; 40% were women, and 51% had diabetes for >10 years. Agreement was good for recommended processes of care such as blood pressure (uniform kappa = 0.94), HbA1c (0.93), weight (0.88) and lipid (0.78), but lower for microalbuminuria, foot and eye examinations (all <0.50). Cohen's kappa values were all low (<0.25). Comparisons of reported continuous variables showed large limits of agreement for height (±6 cm) and weight (8-10 kg) despite high concordance correlation coefficients (0.93 and 0.97). Concordance correlation coefficients were smaller for HbA1c (0.72) and blood pressure (0.5-0.6), with large limits of agreement (±2% and ±25 mmHg). CONCLUSION: While agreement of routine processes of care was good, agreement was less satisfactory for microalbuminuria, foot and eye examinations. Reports of continuous outcomes yielded good reliability but too wide limits of agreement. Quality of care evaluation relying on self-report only should be made cautiously

Inhomogeneous magnetism in the doped kagome lattice of LaCuO2.66

The hole-doped kagome lattice of Cu2+ ions in LaCuO2.66 was investigated by nuclear quadrupole resonance (NQR), electron spin resonance (ESR), electrical resistivity, bulk magnetization and specific heat measurements. For temperatures above ~180 K, the spin and charge properties show an activated behavior suggestive of a narrow-gap semiconductor. At lower temperatures, the results indicate an insulating ground state which may or may not be charge ordered. While the frustrated spins in remaining patches of the original kagome lattice might not be directly detected here, the observation of coexisting non-magnetic sites, free spins and frozen moments reveals an intrinsically inhomogeneous magnetism. Numerical simulations of a 1/3-diluted kagome lattice rationalize this magnetic state in terms of a heterogeneous distribution of cluster sizes and morphologies near the site-percolation threshold

Formation of collective spins in frustrated clusters

Using magnetization, specific heat and neutron scattering measurements, as well as exact calculations on realistic models, the magnetic properties of the \lacuvo compound are characterized on a wide temperature range. At high temperature, this oxide is well described by strongly correlated atomic $S$=1/2 spins while decreasing the temperature it switches to a set of weakly interacting and randomly distributed entangled pseudo spins $\tilde S=1/2$ and $\tilde S=0$. These pseudo-spins are built over frustrated clusters, similar to the kagom\'e building block, at the vertices of a triangular superlattice, the geometrical frustration intervening then at different scales.Comment: 10 page

Baseline data of a population-based cohort of patients with diabetes in Switzerland (CoDiab-VD)

QUESTIONS UNDER STUDY: To describe a population-based sample of patients with diabetes and the quality of their care in the canton of Vaud, Switzerland, as a baseline measure for the evaluation of the "Programme cantonal Diabète". METHODS: We conducted a self-administered paper-based questionnaire survey. Non-institutionalised adult (aged ≥18 years) patients with diabetes diagnosed for at least 1 year and residing in the canton of Vaud were recruited by community pharmacies. Women with gestational diabetes, people with obvious cognitive impairment or people not sufficiently fluent in French were excluded. Primary outcomes were recommended processes-of-care and outcomes of care (glycosylated haemoglobin [HbA1c], generic and disease-specific health-related quality of life (HRQoL), overall care score in relation to the Chronic Care Model). Other measures included diabetes education, self-management support and self-efficacy, health status, health behaviour and demographics. RESULTS: A total of 519 patients with diabetes were included. Whereas the mean HbA1c level was 7.3% (n = 177, 95% confidence interval 7.1-7.5), diabetes-specific processes-of-care and influenza vaccination were reported by less than two-thirds of the patients. Physical activity and diet recommendations results mirrored patients' difficulties with their management in daily life and diabetes-specific HRQoL was worst in the dimensions relative to diet (eating and drinking) and sex life. A minority of patients reported ever having participated in diabetes education courses (32.8%). Overall, patients were satisfied with their care and the support they received. CONCLUSIONS: This study provides a broad picture of the experiences of people living with diabetes in the canton of Vaud. It shall guide the development of targeted interventions within the "Programme cantonal Diabète"

Double superconducting transition in the filled skutterudite PrOs4Sb12 and sample characterizations

A thorough characterization of many samples of the filled skutterudite compound PrOs4Sb12 is provided. We find that the double superconducting transition in the specific heat Tc1~1.89K and Tc2~1.72K tends to appear in samples with a large residual resistivity ratio, large specific heat jump at the superconducting transition and with the highest absolute value of the specific heat above Tc1. However, we present evidence which casts doubt on the intrinsic nature of the double superconducting transition. The ratio of the two specific heat jumps \Delta C(Tc1)/\Delta C(Tc2) shows a wide range of values on crystals from different batches but also within the same batch. This ratio was strongly reduced by polishing a sample down to 120um. Remarkably, three samples exhibit a single sharp transition of ~15mK in width at Tc~1.7K. The normalized specific heat jump (C-Cnormal)/Cnormal at Tc of two of them is higher than ~32% so larger than the sum of the two specific heat jumps when a double transition exists. As an evidence of better quality, the slope in the transition is at least two time steeper. We discuss the origins of the double transition; in particular we consider, based on X-ray diffraction results, a scenario involving Pr-vacancies. The superconducting phase diagram under magnetic field of a sample with a single transition is fitted with a two-band model taking into account the good values for the gap as deduced from thermal conductivity measurements.Comment: 10 pages, 9 figures, 2 tables, submitted to Physical review

Electronic and structural properties of superconducting MgB2_2, CaSi2_2 and related compounds

We report a detailed study of the electronic and structural properties of the 39K superconductor \mgbtwo and of several related systems of the same family, namely \mgalbtwo, \bebtwo, \casitwo and \cabesi. Our calculations, which include zone-center phonon frequencies and transport properties, are performed within the local density approximation to the density functional theory, using the full-potential linearized augmented plane wave (FLAPW) and the norm-conserving pseudopotential methods. Our results indicate essentially three-dimensional properties for these compounds; however, strongly two-dimensional $\sigma$-bonding bands contribute significantly at the Fermi level. Similarities and differences between \mgbtwo and \bebtwo (whose superconducting properties have not been yet investigated) are analyzed in detail. Our calculations for \mgalbtwo show that metal substitution cannot be fully described in a rigid band model. \casitwo is studied as a function of pressure, and Be substitution in the Si planes leads to a stable compound similar in many aspects to diborides.Comment: Revised version, Phys.Rev.B in pres

Superconductivity in Pseudo-Binary Silicide SrNixSi2-x with AlB2-Type Structure

We demonstrate the emergence of superconductivity in pseudo-binary silicide SrNixSi2-x. The compound exhibits a structural phase transition from the cubic SrSi2-type structure (P4132) to the hexagonal AlB2-type structure (P6/mmm) upon substituting Ni for Si at approximately x = 0.1. The hexagonal structure is stabilized in the range of 0.1 < x < 0.7. The superconducting phase appears in the vicinity of the structural phase boundary. Ni acts as a nonmagnetic dopant, as confirmed by the Pauli paramagnetic behavior.Comment: 12 pages, 5 figure