Pharmacogenomic association between a variant in SLC47A1 gene and therapeutic response to metformin in type 2 diabetes.

Pharmacogenetic studies revealed that variants in genes related to the pharmacokinetics of metformin were associated with glucose-lowering effect of metformin. The aim of this study was to investigate possible associations of the variants in genes encoding organic cationic transporters-solute carrier family 22, members A1, A2 (SLC22A1, SLC22A2) and solute carrier family 47, member A1 (SLC47A1) with response to metformin in type 2 diabetes. One hundred forty-eight drug-naive patients with type 2 diabetes were included in the study. Genotyping for SLC22A1 rs622342, SLC22A2 rs316019 and SLC47A1 rs2289669 variants was performed using real-time PCR with subsequent melting-curve analysis. SLC47A1 rs2289669 genotype was significantly associated with the reduction in haemoglobin A1c (HbA1c) after 6 months. Twenty percentage of patients with diabetes that are homozygous for A-allele of SLC47A1 had twofold reduction in HbA1c in comparison with the patients carrying G-allele (GG + GA: 0.55 ± 0.09% vs. AA: 1.10 ± 0.18%, p = 0.018). In conclusion, the results of this study might have in future practical implication in personalised treatment of patients with type 2 diabetes.

Conclusions and recommendations for policies on rural aging in the first decades of the 21st century.

The 2000 Forum on Rural Aging: Policy Debates was one of the main tracks of the first International Conference on Rural Aging held in Charleston, WVa., in June 2000. The 2000 Forum was a follow-up to the Expert Group Meeting on Rural Aging, which met at Shepherdstown, WVa., in May 1999. That group considered policy implications of the 1999 International Year of Older Persons for rural aging in four key areas: the situation of older people, multigenerational relationships, lifelong development, and the development and aging of rural populations. As a direct follow-up of the Shepherdstown Expert Group Meeting, the 2000 Forum on Rural Aging formulated the Conclusions and Recommendations for Policies on Rural Aging through a series of working groups. The Conclusions and Recommendations were endorsed by the Conference Plenary Session on June 11, 2000. The Draft Recommendations for Policies on Rural Aging were availablefor comments on the Internet in the remaining part of the year 2000. Many comments were received. Hana Hermanova and Sally Richardson incorporated the comments into the finalized version.

New challenges in ageing: home care.

Most nations are undergoing two fundamental demographic changes: concentration of their population in cities and accelerated pace of population ageing. The fastest-growing population is that 85 years and over. Morbidity increases with advancing age, functional capacities decrease; this results in decreased performance of activities of daily liver and need for services. The challenge is particularly strong in urban areas. Modern societies seek solutions in maintaining the elderly in their homes through home care programmes for those who are functionally impaired, homebound, and need support in home-making and home nursing. Home care is firmly established in programmes for the elderly. In order to become a scientific discipline home care has to define its boundaries, identify clients by careful multidisciplinary assessment, provide answers regarding its cost-effectiveness, evaluate outcomes of home caring develop indicators of high-quality care and advise appropriate home care technology, which is affordable and accessible. Home care for the elderly population living in remote rural areas is one of the future challenges.

Epidemiology of disability and implications for practice.

The epidemiology of disability is a vast field aiming to bring more precise information about the 10% of the world's population that is disabled to the attention of national and local administrations. This information is essential for management of the problems of disability in an appropriate way and making best use of resources. The current epidemiological studies are done by different methods, and use non-standardized terminology with very free interpretation of the IDH concepts. The classifications--ICD and ICIDH--play their role in creating the disability databases. The challenge for the future is to harmonize all these processes.

Geriatric primary care: a European perspective, Part II.

Europe is considered the parent of geriatric medicine, which was first recognized as a specialty in the United Kingdom. For the benefit of U.S. primary care physicians, GERIATRICS Editor-in-Chief Robert N. Butler, MD, convened a panel of leading European geriatricians in Lausanne, Switzerland, for a discussion of the successes and problems they are encountering in providing medical care to the aging world population. In Part I (Geriatrics 1992; 47 [Jan]:31-41) panelists described the healthcare services available to the elderly. In Part II, they discuss treatment and evaluation of dementia, use of hypnotics, rehabilitation approaches, and dietary and exercise recommendations for the elderly.

Geriatric primary care: a European perspective, Part I.

Europe is considered the parent of geriatric medicine, which was first recognized as a specialty in the United Kingdom. For the benefit of U.S. primary care physicians, GERIATRICS Editor-in Chief Robert N. Butler, MD, convened a panel of leading European geriatricians in Lausanne, Switzerland, for a discussion of the successes and problems they are encountering in providing medical care to the aging world population. In this first installment, the panelists describe the healthcare services available to the elderly, particularly in the United Kingdom and Switzerland. A physician who is a regional adviser for the World Health Organization adds the perspective of other European nations.

The WHO programme on health of the elderly.

The aging of population is a world-wide phenomenon bearing important policy implications for both developing and developed nations. The health programme for the elderly in the years 1990 to 1995 will focus on approaches leading to the well-being of aged persons. This might be achieved by reducing their functional dependency due to the deterioration of their health, social and economic status. This objective will be realized through the following approaches: --support to Member States in the formulation and implementation of policies promoting the well-being of the elderly; --data collection and information dissemination important to decision making, service planning and policy formulation; --cooperation with national programmes in organising comprehensive care systems for the elderly including training components; --promotion of research directed towards the well-being of the elderly; --development or adaptation, when applicable, of technologies appropriate for the elderly in developing countries; --encouragement of multilateral international collaboration for the well-being of the elderly.

Disability indicators and WHO programme: "health for all by the year 2000".

The WHO worldwide policy "Health for all by the year 2000" has been adapted into "Targets for health for all by the year 2000" for Europe. The issue of the elderly is addressed by the slogan "Add life to years", the issue of the disabled by "Better opportunities for disabled persons". To support the monitoring process towards attainment of the regional targets, a list of regional indicators was proposed. These indicators are either parts of the national health information systems already, or are developed ad hoc through sample surveys. The indicators in care of the elderly and disabled are reviewed with regard to previous developments of data base on consequences of diseases, malformations and injuries.

Priorities in disability prevention and rehabilitation.

One in ten of the world's population is disabled. The nature of the disability depends on the age and social environment of the person at risk. These problems were highlighted during the United Nations International Year of Disabled Persons. This has led to the identification of a number of main problems which the present World Health Organization programmes hope to solve, as part of the wider aim of Health for All by the Year 2000.