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

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

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

Effect of Sr substitution on superconductivity in Hg2(Ba1-ySry)2YCu2O8-d (part2): bond valence sum approach of the hole distribution

The effects of Sr substitution on superconductivity, and more particulary the changes induced in the hole doping mechanism, were investigated in Hg2(Ba1-ySry)2YCu2O8-d by a "bond valence sum" analysis with Sr content from y = 0.0 to y = 1.0. A comparison with CuBa2YCu2O7-d and Cu2Ba2YCu2O8 systems suggests a possible explanation of the Tc enhancement from 0 K for y = 0.0 to 42 K for y = 1.0. The charge distribution among atoms of the unit cell was determined from the refined structure, for y = 0.0 to 1.0. It shows a charge transfer to the superconducting CuO2 plane via two doping channels pi(1) and pi(2), i.e. through O2(apical)-Cu and Ba/Sr-O1 bonds respectively.Comment: 13 pages, 5 figures, accepted for publication in Journal of Physics: Condensed Matte

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

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

Easy-Axis Kagom\'e Antiferromagnet: Local-Probe Study of Nd3_3Ga5_5SiO14_{14}

We report a local-probe investigation of the magnetically anisotropic kagom\'e compound Nd$_3$Ga$_5$SiO$_{14}$. Our zero-field $\mu$SR results provide a direct evidence of a fluctuating collective paramagnetic state down to 60 mK, supported by a wipe-out of the Ga nuclear magnetic resonance (NMR) signal below 25 K. At 60 mK a dynamics crossover to a much more static state is observed by $\mu$SR in magnetic fields above 0.5 T. Accordingly, the NMR signal is recovered at low $T$ above a threshold field, revealing a rapid temperature and field variation of the magnetic fluctuations.Comment: 4 pages, 4 figure

Absence of a structural transition up to 40 Gpa in MgB2 and the relevance of magnesium non-stoichiometry

We report measurements on MgB2 up to ~40GPa. Increasing pressure yields a monotonous decrease of the lattice parameters and of the c/a ratio, but no structural transition down to parameters smaller than those of AlB2. The transition superconducting temperature also decreases with temperature in a sample dependent way. The results are explained by an increase of the filling of the 2D pxy bands with pressure, the Mg stoichiometry determining the starting position of the Fermi level. Our measurements indicate that these hole bands are the relevant ones for superconductivity.Comment: submitted March 9th 2001, PRB accepte

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