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".

European Council of Legal Medicine (ECLM) accreditation of forensic pathology services in Europe.

Forensic experts play a major role in the legal process as they offer professional expert opinion and evidence within the criminal justice system adjudicating on the innocence or alleged guilt of an accused person. In this respect, medico-legal examination is an essential part of the investigation process, determining in a scientific way the cause(s) and manner of unexpected and/or unnatural death or bringing clinical evidence in case of physical, psychological, or sexual abuse in living people. From a legal perspective, these types of investigation must meet international standards, i.e., it should be independent, effective, and prompt. Ideally, the investigations should be conducted by board-certified experts in forensic medicine, endowed with a solid experience in this field, without any hierarchical relationship with the prosecuting authorities and having access to appropriate facilities in order to provide forensic reports of high quality. In this respect, there is a need for any private or public national or international authority including non-governmental organizations seeking experts qualified in forensic medicine to have at disposal a list of specialists working in accordance with high standards of professional performance within forensic pathology services that have been successfully submitted to an official accreditation/certification process using valid and acceptable criteria. To reach this goal, the National Association of Medical Examiners (NAME) has elaborated an accreditation/certification checklist which should be served as decision-making support to assist inspectors appointed to evaluate applicants. In the same spirit than NAME Accreditation Standards, European Council of Legal Medicine (ECLM) board decided to set up an ad hoc working group with the mission to elaborate an accreditation/certification procedure similar to the NAME's one but taking into account the realities of forensic medicine practices in Europe and restricted to post-mortem investigations. This accreditation process applies to services and not to individual practitioners by emphasizing policies and procedures rather than professional performance. In addition, the standards to be complied with should be considered as the minimum standards needed to get the recognition of performing and reliable forensic pathology service.

Report on the Community Development Block Grant and Home Investment Partnerships Programs administered by the Region XII Council of Governments for the period July 1, 2005 through November 21, 2008

Report on the Community Development Block Grant and Home Investment Partnerships Programs administered by the Region XII Council of Governments for the period July 1, 2005 through November 21, 2008

Stable isotope compositions of mammoth teeth from Niederweningen, Switzerland: Implications for the Late Pleistocene climate, environment, and diet

Oxygen and carbon isotope compositions of well-preserved mammoth teeth from the Middle Wurmian (40-70 ka) peat layer of Niederweningen, the most important mammoth site in Switzerland, were analysed to reconstruct Late Pleistocene palaeoclimatic and palaeoenvironmental conditions. Drinking water (delta(18)O values of approximately -12.3 +/- 0.9 parts per thousand were calculated front oxygen isotope compositions of mammoth tooth enamel apatite using a species-specific calibration for modern elephants. These delta(18)O(H2O) values reflect the mean oxygen isotope composition of the palaeo-precipitation and are similar to those directly measured for fate Pleistocene groundwater from aquifers in northern Switzerland and southern Germany. Using a present-day delta(18)O(H2)o-precipitation-air temperature relation for Switzerland, a mean annual air temperature (MAT) of around 4.3 +/- 2.1 degrees C can be calculated for the Middle Wurmian at this site. This MAT is in good agreement with palaeotemperature estimates on the basis of Middle Wurmian groundwater recharge temperatures and beetle assemblages. Hence, the climatic conditions in this region were around 4 degrees C cooler during the Middle Wurmian interstadial phase, around 45-50ka BP, than they are today. During this period the mammoths from Niederweningen lived in an open tundra-like, C(3) plant-dominated environment as indicated by enamel (delta(13)C values of -11.5 +/- 0.3 parts per thousand and pollen and macroplant fossils found in the embedding peat. The low variability of enamel delta(13)C and delta(18)O values from different mammoth teeth reflects similar environmental conditions and supports a relatively small time frame for the fossil assemblage. (C) 2006 Elsevier Ltd and INQUA. All rights reserved.

TRENDS IN HOSPITAL MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION IN SWITZERLAND, 1998 TO 2008 THE REGION MAKES THE DIFFERENCE: DISPARITIES IN MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION WITHIN SWITZERLAND

The aim of this master's thesis was to assess the ten- year trends and regional differences in management and outcome of acute myocardial infarction (AMI) within Switzerland. The thesis is composed of two articles. First, in the article "Trends in hospital management of acute myocardial infarction in Switzerland, 1998 to 2008" over 102,700 cases of AMI with corresponding management and revascularization procedures were assessed. The results showed a considerable increase in the numbers of hospital discharges for AMI, namely due to the increase of between- hospital transfers. Rates of intensive care unit admissions remained stable. All types of revascularization procedures showed an increase. In particular, overall stenting rates increased with drug-eluting stents partly replacing bare stents. Second, in the article "The region makes the difference: disparities in management of acute myocardial infarction within Switzerland" around 25,600 cases of AMI with corresponding management were assessed for the period of 2007-2008 and according to seven Swiss regions. As reported by our results, considerable regional differences in AMI management were stated within Switzerland. Although each region showed different trends regarding revascularization interventions, Leman and Ticino contrast significantly by presenting the minimum and maximum rates in almost all assessed parameters. As a consequence these two regions differ the most from the Swiss average. The impact of the changes in trends and the regional differences in AMI management on Swiss patient's outcome and economics remains to be assessed. Purpose: To assess ten-year trends in management and outcome of acute myocardial infarction (AMI) in Switzerland. Methods: Swiss hospital discharge database for the 1998 to 2008 period. AMI was defined as a primary discharge diagnosis code I21 according to the CIM-10 classification of the World Health Organization. Management and revascularization procedures were assessed. Results: Overall, 102,729 hospital discharges with a diagnosis of AMI were analyzed. The number of hospital discharges increased almost three-fold from 5530 in 1998 to 13,834 in 2008, namely due to a considerable increase in between-hospital transfers (1352 in 1998, 6494 in 2008). Relative to all hospital discharges, Intensive Care Unit admission rate was 38.0% in 1998 and remained stable (36.2%) in 2008 (p for trend=0.25). Percutaneous revascularization rates increased from 6.0% to 39.9% (p for trend<0.001). Non-drug-eluting stent use increased from 1.3% to 16.6% (p for trend<0.05). Drug eluting stents appeared in 2004 and increased to 23.5% of hospital discharges in 2008 (p for trend=0.07). Coronary artery bypass graft increased from 1.0% to 3.0% (p for trend<0.001). Circulatory assistance increased from 0.2% to 1.7% (p for trend<0.001). Thrombolysis showed no significant changes, from 0.5% to 1.9% (p for trend=0.64). Most of these trends were confirmed after multivariate adjustment. Conclusion: Between 1998 and 2008 the number of hospital discharges for AMI increased considerably in Switzerland, namely due to between-hospital transfers. Overall stenting rates increased, drug-eluting stents partly replacing bare stents. The impact of these changes on outcome and economics remains to be assessed.

Principis deontològics dels professionals de la informació i la documentació: el codi de l'European Council of Information Associations (ECIA)

Qualsevol professió té, o hauria de tenir, un codi de regles ètiques que els seus membres normalment respecten i que fan servir com a guia en el cas que hagin de prendre decisions moralment difícils. Durant la reunió celebrada el novembre de 1998 a Lisboa, les associacions membres de l'ECIA van acordar adoptar un codi ètic que fos vàlid per als professionals de tots els països de la Unió Europea. Aquest codi no pot ser més que un enunciat de principis generals i deixa en mans de cada associació la facultat de desenvolupar-lo per tal que respongui a necessitats especials o nacionals. Un primer projecte fou presentat i discutit a la reunió de l'ECIA de març de 1999. La present revisió incorpora les modificacions proposades aleshores, elements provinents de codis d'altres organitzacions que foren presentats en la reunió a la consideració de l'autor, així com alguns aclariments.

Consensus 2012 sur le diagnostic et le traitement des patients atteints de démence en Suisse [Consensus 2012--diagnosis and treatment of patients with dementia in Switzerland].

The 2012 Swiss consensus paper on diagnosis and management of patients suffering from dementia resulted from the work of an expert panel who met on March 23d to 25th in Luzem. Based on a literature review, panel members wrote a first draft that was subsequently circulated among multiple dementia experts in Switzerland. After adaptation and revisions according to comments, all consulted dementia specialists and panel members fully endorse the consensus content. The conference was financed by the Swiss Alzheimer Forum.

Concept de first responders en Suisse romande: état des lieux et perspectives [Concept of first responders in Western Switzerland: current situation and future perspectives].

The notion of "First Responder" (FR) refers to the system of first-aid volunteers who act to initiate the first-aid care before the classical emergency help arrives. In 2011, the French-speaking Switzerland counts 19 groups, divided up between four cantons (Fribourg, Vaud, Neuchâtel, Valais). The geographical distribution of those FR shows the stakes of these peripherical areas, with the accessibility difficulties for the emergency services, and a low demography of ambulances and doctors. The number of interventions carried out by the FR has significantly increased during the last years. The association of a quality formation, an excellent knowledge of the ground and a quick intervention has a positive impact on the survival of the patients with vital emergency or traumatic conditions.

Erste Resultate der HOT-Studie in der Schweiz. [Initial results of the HOT-study in Switzerland (hypertension optimal treatment)]

The HOT study (hypertension-optimal treatment) is an international clinical study on primary prevention of cardiovascular events in 19,193 hypertensive patients worldwide. It aims at the recognition of the optimal diastolic blood pressure value (< 90, < 85 or < 80 mmHg?) in order to maximize the possible benefit of an antihypertensive therapy. In addition, the HOT study investigates whether low doses of aspirin (75 mg/day) are able to reduce the occurrence of severe cardiovascular events. In Switzerland a total of 797 patients have been enrolled in the study. Antihypertensive therapy was initiated with felodipine = Plendil (5 mg/day). This vasoelective calcium antagonist could reduce diastolic blood pressure values to < 90 or < 80 mg/Hg, respectively, in one of two or one of three patients within the first three months. In nine or six patients, respectively out of ten a reduction of diastolic blood pressure values to < 90 or < 80 mmHg was reached within one year by combination of felodipine with other antihypertensive drugs (ACE inhibitors, beta blockers and diuretics).