Associations between single-nucleotide polymorphisms (+45T>G, +276G>T, -11377C>G, -11391G>A) of adiponectin gene and type 2 diabetes mellitus: a systematic review and meta-analysis.

AIMS/HYPOTHESIS: The associations between adiponectin polymorphisms and type 2 diabetes have been studied widely; however, results are inconsistent. METHODS: We searched electronic literature databases and reference lists of relevant articles. A fixed or random effects model was used on the basis of heterogeneity. Sub-group and meta-regression analyses were conducted to explore the sources of heterogeneity. RESULTS: There were no statistically significant associations between +45T>G (rs2241766), +276G>T (rs1501299), -11391G>A (rs17300539) and type 2 diabetes risk. However, for -11377C>G (rs266729), the pooled OR (95% CI) for G vs C allele was 1.07 (1.03-1.11, p = 0.001). Subgroup analysis by study design revealed that -11377C>G (rs266729) dominant model (CG+GG vs CC, p = 0.0008) and G vs C allele (p = 0.0004) might be associated with type 2 diabetes risk in population-based case-control studies. After stratification by ethnicity, we found that -11377C>G (rs266729) dominant model (CG+GG vs CC, p = 0.004) and G vs C allele (p = 0.001) might be associated with type 2 diabetes risk in white individuals. In individuals with a family history of diabetes, the presence of -11391G>A (rs17300539) dominant model (GA+AA vs GG) and A vs G allele might be associated with increased risk of type 2 diabetes. CONCLUSIONS/INTERPRETATION: The presence of +45T>G (rs2241766), +276G>T (rs1501299) and -11391G>A (rs17300539) do not appear to influence the development of type 2 diabetes. However, G vs C allele of -11377C>G (rs266729) might be a risk factor for type 2 diabetes.

Multiple drug use by older people: exploring the health development and political economy perspectives.

The use of multiple medications by a large number of older people provides grounds for concern in terms of quality of life as well as cost. We argue that problems faced by older people are being over-medicalized in a manner that palliates and obscures social causes such as loss of income, the falling away of social support and a discounted role in society. Primary health care is a policy model for the development of health services which offers a credible strategy for addressing clinical problems associated with growing old in ways that also contribute to recognizing and addressing social and structural problems that may be expressed in people's private troubles.

Diagnosis in chronic illness: disabling or enabling--the case of chronic fatigue syndrome.

This paper examines doctors' and patients' views on the consequences of an increasingly common symptomatic diagnosis, chronic fatigue syndrome (CFS). Two studies were conducted: the first comprised interviews with 20 general practitioners; the second was a longitudinal study, comprising three interviews over a period of 2 years with 50 people diagnosed with CFS. Contrasts were apparent between doctors' practical and ethical concerns about articulating a diagnosis of CFS and patients' experiences with and without such a diagnosis. Seventy per cent of the doctors were reluctant to articulate a diagnosis of CFS. They felt constrained by the scientific uncertainty regarding its aetiology and by a concern that diagnosis might become a disabling self-fulfilling prophecy. Patients, by contrast, highlighted the enabling aspects of a singular coherent diagnosis and emphasized the negative effects of having no explanation for their problems.

Continuing education and peer review in internal medicine (CEPRIME).

Research in adult education shows that educational initiatives are most effective when they are related to perceived needs. The CEPRIME system was devised as a means of using peer review to reveal the educational needs of physicians. Sixteen physicians volunteered to test the system, by allowing a panel of specialists to review copies of their reports to referring general practitioners. The comments of the reviewers, both commendatory and critical, were referred back to the participants, and their evaluation of the system was sought. Although the method was found to have limitations relating both to the adequacy of the report as a document for review, and to the objectivity and relevance of the comments made about it, the results were such as to encourage further development of CEPRIME as a means of appraising physicians of their specific educational needs.

CEPRIME (Continuing Education and Peer Review in Internal Medicine): linking quality assurance with continuing medical education.

This was a pilot project intended to evaluate the practicalities of a new method of linking Peer Review with Continuing Medical Education for consultant physicians (internists). Peer Review of the physicians' reports to the referring general practitioners on each consultation. Sixteen physicians were enrolled for varying periods of time. They submitted from 12 to 454 cases for review (mean 94 cases) overall. One half of the cases attracted comment from the reviewers. The main themes of critical comments have been identified. Appropriate study courses based on the results of the review were developed for some of the participants. The latter were in general agreement that the CEPRIME system has potential to achieve its purpose; but it is obvious that certain modifications would improve the flow of material and the value of the exercise to the physicians.

Quality assurance in hospital medicine: a report.

The Austin Division of Medicine Quality Assurance Programme evaluates the quality of care through reviews of admissions, discharges, deaths, and of outpatient attendances, and through special topic surveys and reviews prepared by providers of care from inside and outside the Division. The main focus of the programme is on the technical quality of medical services although the personal dimension is also discussed. The evaluation of quality of care creates pressures for improvement, primarily through continuing education and by increased administrative awareness of clinical priorities.