Obesity and its associated disorders, including diabetes and cardiovascular
disease, have now reached epidemic proportions in the Western world,
resulting in dramatic increases in healthcare costs. Understanding the pro-cesses and metabolic perturbations that contribute to the expansion of adi-pose depots accompanying obesity is central to the development of
appropriate therapeutic strategies.
The prevalence of diabetes mellitus is growing at epidemic
proportions in the United States and worldwide (1). Most
alarming is the steady increase in type 2 diabetes, especially
among young and obese persons. An estimated 7% of
Americans are afflicted with diabetes, and with the longevity
of this population increasing, the prevalence of diabetesrelated
complications will continue to rise.
Foot disorders are a major source of morbidity and a leading
cause of hospitalization for persons with diabetes.
THE POLITICS OF DESIGN
Willful blindness has reached epidemic proportions in our time. Nowhere is this more evident than in recent actions by the U.S. Congress to deny outright the massive and growing body of scientiﬁc data about the deterioration of the earth’s vital signs, while attempting to dismantle.
The Pesticide-Induced Diseases Database, launched by Beyond
Pesticides, facilitates access to epidemiologic and laboratory
studies based on real world exposure scenarios that link public
health effects to pesticides. The scientific literature documents
elevated rates of chronic diseases among people exposed to
pesticides, with increasing numbers of studies associated with
both specific illnesses and a range of illnesses.
Obesity in America, and indeed in the world, is reaching epidemic
proportions. At this writing, more than 65 percent of
American adults and nearly one-quarter of our children are
overweight or obese. Data from the surgeon general’s office
have linked more than four hundred thousand premature
deaths annually to the direct health effects of obesity (second
only to smoking)—and the numbers continue to climb.
Pink culture” is ubiquitous. We are surrounded by pink
ribbons that raise awareness about breast cancer and urge
women to be screened against this deadly disease. In the marketplace,
we are bombarded with “pink” products – pink sneakers,
pink kitchen mixers, and even pink buckets of fried chicken – all
designed to raise awareness and funds for breast cancer research
and education. But is “pink culture” the best means to these
ends? Are we doing the best we can to fi ght breast cancer?...
Ideas and trends can be as contagious as viruses. Seemingly unrelated, small events can
mount to epidemic proportions, and “the slightest push” in “just the right place” will
change everything. This is what Malcolm Gladwell (2000) calls the Tipping Point, a
unique moment “when everything can change all at once.”
After decades of changes, health care is approaching this transforming moment—
and we want to be among those who deliver the push in the right place, creating a new
system, a “virtual health system,” that delivers the greatest good to the greatest number.
Potential Biases of Screening Tests The common biases of screening are lead time, length-biased sampling, and selection. These biases can make a screening test seem beneficial when actually it is not (or even causes net harm). Whether beneficial or not, screening can create the false impression of an epidemic by increasing the number of cancers diagnosed. It can also produce a shift in proportion of patients diagnosed at an early stage that improves survival statistics without reducing mortality (i.e.
The World Bank and the Center for
International Comparisons at the University of Pennsylvania, USA. As the trend from 1990 to
2010 is estimated, the time reference of the data gathered starts from 1985, in order to cover
fully the period around 1990. Deaths due to AIDS were obtained from UNAIDS (unpublished
tables from the Global Report: UNAIDS Report on the Global AIDS Epidemic 2010.
As the proportion of both minority populations and people aged 60 and older increases in the United States, and the
obesity epidemic continues, people with diabetes are becoming a larger part of the practices of family physicians and
other primary care clinicians. Health care professionals involved in new or expanding diabetes care practices can use
these guiding principles to ensure that they provide essential components of comprehensive diabetes care.