Mise en place d'un programme de prévention et de prise en charge du diabète en Suisse: le point de vue des patients et des professionnels de la santé [Implementation of a diabetes disease management program in Switzerland: patients' and healthcare professionals' point of view].

BACKGROUND: A reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the "Diabetes Cantonal Program", within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate. METHODS: We organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis. RESULTS: Patients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients' and professionals' needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem. CONCLUSION: The identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.

Tectonic subsidence of the Lomonosov Ridge

The Cenozoic sedimentary record revealed by the Integrated Ocean Drilling Program's Arctic Coring Expedition (ACEX) to the Lomonosov Ridge microcontinent in 2004 is characterized by an unconformity attributed to the period 44-18 Ma. According to conventional thermal kinematic models, the microcontinent should have subsided to >1 km depth owing to rifting and subsequent separation from the Barents-Kara Sea margin at 56 Ma. We propose an alternative model incorporating a simple pressure-temperature (P-T) relation for mantle density. Using this model, we can explain the missing stratigraphic section by post-breakup uplift and erosion. The pattern of linear magnetic anomalies and the spreading geometry imply that the generation of oceanic crust in the central Eurasia Basin could have been restricted and confined by non-volcanic thinning of the mantle lithosphere at an early stage (ca. 56-40 Ma). In response to a rise in temperature, the mantle mineral composition may have changed through breakdown of spinet peridotite and formation of less dense plagioclase peridotite. The consequence of lithosphere heating and related mineral phase transitions would be post-breakup uplift followed by rapid subsidence to the deep-water environment observed on the Lomonosov Ridge today.

Late mesozoic to neogene radiolarian biostratigraphy and palaeoceanography in the Caribbean and East pacific region

^Raduolarians constitute a good tool for contributing to the biostratigraphy of accreted terranes and in deep-sea sediment sequences. The use of radiolarians is also proven to be valuable as a palaeoceanographic indicator. The present study evaluates radiolarians in three different geological settings, in order to better constrain the age of the sites and to try to understand their palaeoenvironmental situation at different periods, particularly in the Caribbean-Central America area. On the Jarabacoa Block, in Central Dominican Republic, a hundred meters of siliceous mudstones (Pedro Brand section in the Tireo Group) was dated as Turonian- Coniancian in age using radiolarians. A 40Ar-39Ar whole rock age of 75.1±1.1 Ma (Campanian), obtained in a basalt dyke crosscutting the radiolarian bearing rocks, a consistent minimum age for the pelagic-hemipelagic Pedro Brand section. The Jarabacoa Block is considered as the most complete outcrop section of Pacific ocean crust overlain by a first Aptian-Albian phase of Caribbean Large Igneous Province-type activity (CLIP), followed by the development of a Cenomanian-Santonian intraoceanic arc, which is in turn overlain by a late Campanian-Maastrichtian CLIP-phase. The Tireo Group records an episode of pelagic to hemi-pelagic and intermediate to acidic arc-derived sedimentation, previous to the youngest magmatic phase of the CLIP. Thus, the section of Pedro Brand has been interpreted in this study as being part of the intraoceanic arc. In northern Venezuela, a greenish radiolarite section from Siquisique Ophiolite (basalts, gabbros and some associated cherts) in Guaparo Creek has been studied. In previous studies, the Ophiolite unit (Petacas Creek section) has been dated as Bajocian-Bathonian, based on ammonites present in interpillow sediments from basalt blocks. New dating of the present study concluded in an Aptian?-Albian-Cenomanian age for the Guaparo creek section (middle Cretaceous), based on radiolarian assemblage associated to basalts-gabbros rocks of the unit. Previous plagioclase 40Ar-39Ar ages from the Siquisuique Ophiolite may be slightly younger (94-90 Ma.) and may, therefore, represent younger dykes that intruded onto a well-developed sheeted dyke complex of the Siquisique. The geochemistry of these rocks and the palaeotectonic reconstruction of the Caribbean area during this period suggest that these rocks were derived from a mid-ocean ridge with an influence of deep mantle plume. The Siquisique Ophiolite most probably represents a fragment of the proto-Caribbean basin. The Integrated Ocean Drilling Program Expedition 344 drilled a transect across the convergent margin off Costa Rica. Two sites of this expedition were chosen for radiolarian biostratigraphy and palaeoceanographic studies. Both sites (U1381C and U1414A) are located in the incoming Cocos plate, in the eastern Equatorial Pacific. The succession of U1381C yields a Middle Miocene to Pleistocene age, and presents an important hiatus of approximately 10 Ma. The core of U1414A exposes a continuous sequence that deposited during Late Miocene to Pleistocene (radiolarian zones RN6-RN16). The ages were assigned based on radiolarians and correlated with nannofossil zonation and tephra 40Ar-39Ar datation. With those results, and considering the northward movement of the Cocos plate motion (about 7 cm/year), deduction is made that the sites U1381C and U1414A were initially deposited during the Miocene, several hundreds of kilometres from the current location, slightly south of the Equator. This suggests that the faunas of these sites have been subjected to different currents, first influenced by the cold tongue of the South Equatorial Current and followed by the warm Equatorial Countercurrent. At last, coastal upwelling influenced faunas of the Pleistocene. -- Les radiolaires sont considérés comme un outil utile à la biostratigraphie des terrains accrétés et des sédiments profonds. Leur utilité est aussi prouvée comme étant remarquable au niveau des reconstructions paléocéanographiques. La présente étude évalue l'importance et la présence des radiolaires de trois localités géologiquement différentes d'Amérique Centrale-Caraïbes, dans le but d'améliorer les model d'âges et de mieux comprendre la situation paléoenvironnementale à travers le temps. Dans le Bloque de Jarabacoa, au centre de la République Dominicaine, une section de cent mètres (section de Pedro Brand, Groupe de Tireo) a été datée comme faisant partie du Turonien-Santonien, en utilisant les radiolaires. Une datation 40Ar-39Ar sur roche totale de 75±1.1 Ma (Campanien) a été obtenu pour vin dyke traversant les sédiments riches en radiolaires, en cohérence avec l'âge minimum accordé à la section de Pedro Brand. Aux Caraïbes, le Bloque de Jarabacoa est considéré comme l'affleurement le plus complet présentant une succession de croûte océanique d'origine Pacifique recouverte d'une première phase d'activité volcanique de type CLIP (Caribbean Large Igneous Province) d'âge Aptien- Albien, de dépôts d'arc volcanique intra-océanique d'âge Cénomanien-Santonien, puis d'une seconde phase de type CLIP d'âge Campanien-Maastrichtien. Le Groupe de Tireo enregistre un épisode de dépôt pélagiques-hémipélagiques et d'arc volcanique, antérieur à la plus jeune phase de type CLIP. Cette étude place donc la formation de la section de Pedro Brand au moment du développement de l'arc intra-océanique. A Guaparo Creek (nord du Vénézuela), une section de radiolarite verdâtre faisant partie des ophiolites de Siquisique (basaltes, gabbros, cherts) a été étudiée. Dans des études précédentes, sur la localité de Petacas Creek, l'unité ophiolitique a été daté d'âge Bajocien- Bathonien (Jurassique) sur la base d'ammonites trouvées dans des sédiments intercalés entre des laves en coussins. Les nouvelles datations de notre étude, basées sur des assemblages à radiolaires de l'unité à basaltes-gabbros, donnent un âge Aptien?-Albien-Cénomanien (Crétacé moyen). Les âges de l'Ophiolite de Siquisique, précédement calculés par la méthode sur plagioclases, pourraient être légèrement plus jeune (94-90 Ma) et donc représenter des intrusions plus récentes de dykes dans le complexe filonien déjà bien dévelopé. La géochimie de ces roches magmatiques, ainsi que les reconstructions paléotectoniques de la zone Caraïbes durant cette période, suggèrent que ces formations sont dérivées d'une ride médio-océanique associée à l'influence d'un panache mantellique. L'ophiolite de Siquisique représente très probablement un fragment du bassin de proto¬Caraïbe. L'expédition 344 du programme IODP (Integrated Ocean Drilling Program) a eu lieu dans l'optique de forer et dresser une coupe de la marge convergente au large du Costa Rica. Deux sites de cette expédition ont été choisis pour les besoins des études de biostratigraphie et de reconstruction paléocéanographique. Ces deux sites (U1381C et U1414A) sont situés sur la plaque subductante de Cocos, dans la zone Pacifique est-équatoriale. La carotte U1381C expose une séquence s'étalant du Miocène moyen au Pléistocène, et présente un important hiatus d'environ 10 Ma. La carotte U1414A expose une séquence continue s'étalant du Miocène tardif au Pléistocène (zone à radiolaires RN6-RN16). Les âges ont été assignés sur la base des radiolaires et corrélés avec les zones à nanofossiles et les datations 40Ar-39Ar sur téphras. Avec ces résultats, et en considérant le mouvement nord de la plaque de Cocos (environ 7 cm/an), déduction est faite que les deux sites étaient initialement situés, au cours du Miocène, à plusieurs centaines de kilomètres de leur location actuelle, au sud de l'équateur. Cela suggère que les faunes de ces sites ont été sujettes à différents courants; premièrement influencées par la langue froide du SEC (South Equatorial Current), puis par les eaux chaudes du ECC (Equatorial Countercurrent). Pour terminer, les remontées d'eau côtières ont influencées les faunes Pléistocène.