Diabetes mellitus is one of the most common endocrine disorders affecting almost 6% of the world's population. The number of diabetic patients will reach 300 million in 2025 (International Diabetes Federation, 2001). More than 97% of these patients will have type II diabetes. The projected increase in the number of diabetic patients will strain the capabilities of healthcare providers the world over. Thus it is of paramount importance to revisit the causes and epidemiology of diabetes mellitus. Diabetes mellitus is caused by both environmental and genetic factors. The environmental factors that may lead to the development of diabetes mellitus include physical inactivity, drugs and toxic agents, obesity, viral infection, and location. While type I diabetes is not a genetically predestined disease, an increased susceptibility can be inherited. Genetic susceptibility plays a crucial role in the etiology and manifestation of type II diabetes, with concordance in monozygotic twins approaching 100%. Genetic factors may have to be modified by environmental factors for diabetes mellitus to become overt. An individual with a susceptible gene may become diabetic if environmental factors modify the expression of these genes. Since there is an increase in the trend at which diabetes prevail, it is evident that environmental factors are playing a more increasing role in the cause of diabetes mellitus. The incidence of type I diabetes ranged from 1.9 to 7.0/100,000/yr in Africa, 0.13 to 10/100,000/yr in Asia, approximately 4.4/100,000/yr in Australasia, 3.4 to 36/100,000/yr in Europe, 2.62 to 20.18/100,000/yr in the Middle East, 7.61 to 25.7/100,000/yr in North America, and 1.27 to 18/100,000/yr in South America. The epidemiology of type II diabetes is equally bleak. The prevalence of type II diabetes ranged from 0.3 to 17.9% in Africa, 1.2 to 14.6% in Asia, 0.7 to 11.6% in Europe, 4.6 to 40% in the Middle East, 6.69 to 28.2% in North America, and 2.01 to 17.4% in South America.

No abstract

No abstract

Authors' abstractAn instrument to assess 'ethical sensitivity' has been developed. The IntroductionEthics has become a common topic of discussion within the medical community. In response to various concerns, more and more universities have introduced a new or extended curriculum in ethics for medical students (1). In spite of these efforts, which take a lot of time, for both staff and students, few studies have been done to evaluate the effects of curriculum content or format. A computer search using the search terms 'ethics' and 'evaluation studies' conducted in February 1991 revealed only two articles in the MEDLINE literature that had a specific evaluation component for ethics curricula. Berseth and Durand (2) compared the attitudes toward resuscitation between paediatric residents who attended a series of seminars extending over one year with non-paediatric residents working on the same wards who did not attend. On six different scales they showed significant differences between groups on only one scale after one year. Self, Wolinsky and Baldwin (3) compared two different methods of teaching moral reasoning to medical students. They found that both methods significantly increased 'moral reasoning', with the case-study method being more effective than a lecture format.A preliminary consideration of methods that might be used to evaluate the expanding ethics curriculum in the Faculty of Medicine at the University of Toronto indicated that all the reported methods were problematic. Because of the problems in assessing moral judgement we decided to attempt to assess one of the basic requirements for an ethical response to clinical problems: the ability to recognise that a moral issue exists. We have called this 'ethical sensitivity' in order to reflect the ability to discern that a clinical situation raises considerations with moral content. Using this interpretation, sensitivity does not necessarily require that a dilemma or conflict exist. Nor does it refer to the capacity to make ethically defensible clinical judgements, to resolve moral dilemmas, to analyse concepts, to come to closure, or provide a justification for action.In 1990 we published a paper that described our preliminary attempts to develop an instrument to ascertain the ethical sensitivity of medical students (4). We recognised then that there were several problems we needed to address if any conclusions were to be validly drawn from our results. For example, we suggested that the instrument needed to be modified by 1) providing for better sampling of the groups to be evaluated; 2) controlling for potential bias by instructors who either under-or over-emphasise the instrument's importance; 3) increasing the number of vignettes tested; 4) using a programmed series of vignettes, and 5) administering the vignettes at an earlier point in the year (4). Guided by these concerns, we refined the original instrument and, during 1990, used it to test the ethical sensitivity of a large number of medical students in all classes at the University of Toro...