Mary Pierce

Risk of diabetes in offspring of parents with non-insulin-dependent diabetes.

Diabetes mellitus affects about 2% of Western European populations and represents a lifetime risk of 10-1 5%. It i s by far the commonest endocrine disorder and its incidence and prevalence are increasing.’ Current ideas about the pathogenesis of non-insulin dependent (type 2) diabetes (NIDDM) increasingly encourage calls for preventive action.24 Such action inevitably requires an evaluation of risk status for the disease. There are two main primary preventive strategies: a ’general population’ approach and a ’high risk’ approach. The former consists of the non-selective application of preventive measures across the whole population to reduce the risk factors for NIDDM, for example, by avoiding obesity, promoting normal body weight and by encouraging more physically active lifestyles. The ’high risk’ strategy concentrates preventive activity on people defined as being at particularly high risk. If this latter strategy is adopted, it is important to identify which people are specially vulnerable, and to have estimates of the magnitude of their enhanced risk. This review concerns itself with one readily identifiable high-risk group: people with a positive parental history of NIDDM. A number of factors, both genetic and environmental, influence the offspring’s risk of developing NIDDM. Factors affecting the individual’s genetic endowment include family history, type of diabetes involved, whether one or both of the parents have diabetes, and race. Risk of disease expression i s also related to lifestyle factors, the most important of which are probably obesity5 and physical inactivity.” The roles of intrauterine and early life environment factors have been emphasized recently by the work of Hales, Barker and colleagues on the predictive relationship between low foetal and infant growth rates and impaired glucose tolerance in later life.’

Diabetes mellitus in the family: perceptions of offspring’s risk

Aims The study aimed to explore the beliefs and concerns of people with Type 2 diabetes mellitus (DM) about their children’s risk of developing the disease and the possibilities for prevention.

Do peer review models affect clinicians’ trust in journals? A survey of junior doctors

BackgroundThe aim of this survey was to determine the level of awareness and understanding of peer review and peer review models amongst junior hospital doctors and whether this influences clinical decision-making.MethodsA 30-question online anonymous survey was developed aimed at determining awareness of peer review models and the purpose of peer review, perceived trustworthiness of different peer review models and the role of peer review in clinical decision-making. It was sent to 800 trainee doctors in medical specialties on the University College London Partners trainee database.ResultsThe response rate was (178/800) 22%. Most respondents were specialist registrars. Checking that research is conducted correctly (152/178, 85%) and the data interpreted correctly (148/178, 83%) were viewed as the most important purposes of peer review. Most respondents were aware of open (133/178, 75%), double-blind (125/178, 70%) and single-blind peer review (121/178, 68%). 101/178 (57%) had heard of collaborative, 87/178 (49%) of post publication and 29/178 (16%) of decoupled peer review. Of those who were aware of double-blind, single-blind open and collaborative peer review, 85 (68%), 82 (68%), 74 (56%) and 24 (24%), respectively, understood how they worked. The NEJM, Lancet and The BMJ were deemed to have most trustworthy peer review, 137/178 (77%), 129/178 (72%) and 115/178 (65%), respectively. That peer review had taken place was important for a journal content to be used for clinical decision-making 152/178 (85%), but the ability to see peer review reports was not as important 22/178 (12%). Most felt there was a need for peer review training and that this should be at the specialist registrar stage of training.ConclusionsJunior hospital doctors view peer review to be important as a means of quality control, but do not value the ability to scrutinize peer review themselves. The unquestioning acceptance of peer review as final validation in the field of medicine emphasises not only the responsibility held by medical journals to ensure peer review is done well but also the need to raise awareness amongst the medical community of the limitations of the current peer review process.