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Showing papers by "World Health Organization published in 1988"


01 Jan 1988
TL;DR: It is proposed that the chapters on external causes of injury and poisoning, and factors influencing health status and contact with health services, should form an integral part of ICD-10, for the first time in its history based on an alphanumeric coding scheme.
Abstract: The International Classification of Diseases has, under various names, been for many decades the essential tool for national and international comparability in public health. This statistical tool has been customarily revised every 10 years in order to keep up with the advances of medicine. At first intended primarily for the classification of causes of death, its scope has been progressively widening to include coding and tabulation of causes of morbidity as well as medical record indexing and retrieval. The ability to exchange comparable data from region to region and from country to country, to allow comparison from one population to another and to permit study of diseases over long periods, is one of the strengths of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD). WHO has been responsible for the organization, coordination and execution of activities related to ICD since 1948 (Sixth Revision of the ICD) and is now proceeding with the Tenth Revision. For the first time in its history the ICD will be based on an alphanumeric coding scheme and will have to function as a core classification from which a series of modules can be derived, each reaching a different degree of specificity and adapted to a particular specialty or type of user. It is proposed that the chapters on external causes of injury and poisoning, and factors influencing health status and contact with health services, which were supplementary classifications in ICD-9, should form an integral part of ICD-10. The title of ICD has been amended to "International Statistical Classification of Diseases and Related Health Problems"', but the abbreviation "ICD" will be retained.(ABSTRACT TRUNCATED AT 250 WORDS)

2,084 citations


01 Jan 1988
TL;DR: The considerable variation in mortality levels and trends observed among different countries points to the possibility for action by countries heavily affected by cardiovascular diseases and provides a basis for action and further research in each country and at the international level.
Abstract: In most industrialized countries, mortality in general, and cardiovascular disease mortality in particular, have shown decreasing trends since around 1970, following stagnation or increases observed during the 1950s and 1960s. In some countries, however (e.g. in Eastern Europe), male mortality from cardiovascular diseases increased during recent years. The levels and trends of mortality from cardiovascular diseases vary considerably among countries. Measured in terms of age-standardized rates, the ratio between the highest and the lowest rates around 1985 was about 2 for total mortality but about 4 for all cardiovascular diseases combined. With further breakdowns the ratio was even greater, i.e. 4-5 for heart diseases and 6-7 for cerebrovascular disease. For ischaemic heart disease alone, the ratio reached as high as 10, though part of this wide range should be attributed to artefacts due to the varying diagnostic practices followed in different countries. The speed of mortality changes also differed among countries, ranging from a rapid decrease to a rapid increase. In general, the trends were much more favourable in females than in males. Consequently, sex differentials have been widened. The male/female ratio in mortality for ischaemic heart disease has now exceeded 3 in a number of countries. The ratio for cerebrovascular diseases, which used to be close to 1 in many countries in the early 1950s, has also increased, often reaching the level of 1.5 or higher. Differentials were observed also among different age groups in some countries. There seems to be a tendency for mortality change, either an increase or a decrease, to be quicker in younger age groups than in older ones. These varying levels and trends in cardiovascular disease mortality have no doubt been caused by a multitude of risk factors operating in each country, affecting the incidence of cardiovascular diseases and their prognosis. Much is already known about these risk factors and about the measures to be taken by the health services as well as by individuals for prevention and effective therapy. The considerable variation in mortality levels and trends observed among different countries points to the possibility for action by countries heavily affected by cardiovascular diseases. Mortality surveillance in each country and at the international level thus reveals how each country's situation and trends compare with others and provides a basis for action and further research. Progress in WHO's MONICA (MONItoring of trends and determinants in CArdiovascular disease) project will clarify various aspects of the role played by risk factors in different communities.

504 citations


01 Jan 1988
Abstract: The Expanded Programme on Immunization (EPI) was established in 1974 to develop and expand immunization programmes throughout the world. In 1977, the goal was set to make immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles and tuberculosis available to every child in the world by 1990. Problems encountered by the Programme have included: lack of public and governmental awareness of the scope and seriousness of the target diseases; ineffective programme management; inadequate equipment and skills for vaccine storage and handling; and insufficient means for monitoring programme impact as reflected by increasing immunization coverage levels and decreasing incidence of the target diseases. When the EPI was initiated in 1974, fewer than 5% of children in developing countries were receiving a third dose of DPT and poliomyelitis vaccines in their first year of life. These coverage levels have now surpassed 50% in developing countries, and millions of cases of the target disease have been prevented. Over 700,000 measles deaths were prevented by immunization in developing countries in 1987, and an increasing number of neonatal tetanus deaths is now being prevented by maternal immunization and improved childbirth conditions. Poliomyelitis immunization efforts have been so successful that the Pan American Health Organization is leading a drive to eradicate poliomyelitis from the Americas by 1990. The successes of the Programme represent a major public health achievement, but much remains to be done.(ABSTRACT TRUNCATED AT 250 WORDS)

410 citations


Journal ArticleDOI
TL;DR: The findings support the recommendation of the Global Commission for the Certification of Smallpox Eradication to cease routine smallpox vaccination in monkeypox endemic areas, but to encourage continued epidemiological surveillance.
Abstract: Data on monkeypox in Zaire over the five years 1980-1984 are analysed to assess the protection imparted by past smallpox vaccination and the transmission potential of the virus in unvaccinated communities. Attack rates in individuals with and without vaccination scars indicated that smallpox vaccination (discontinued in 1980) imparted approximately 85% protection against monkeypox. It is predicted that monkeypox virus will continue to be introduced into human communities from animal sources, and that the average magnitude and duration of monkeypox epidemics will increase as vaccine-derived protection declines in the population. On the other hand, current evidence indicates that the virus is appreciably less transmissible than was smallpox, and that it will not persist in human communities, even in the total absence of vaccination. The findings thus support the recommendation of the Global Commission for the Certification of Smallpox Eradication to cease routine smallpox vaccination in monkeypox endemic areas, but to encourage continued epidemiological surveillance.

402 citations


Journal ArticleDOI
TL;DR: Evidence is presented for the effectiveness of a strategy for engaging adolescent drug users and their families in therapy based on strategic, structural, and systems concepts and the identified pattern of interactions that interferes with entry into treatment is restructured.
Abstract: This article presents evidence for the effectiveness of a strategy for engaging adolescent drug users and their families in therapy. The intervention method is based on strategic, structural, and systems concepts. To overcome resistance, the identified pattern of interactions that interferes with entry into treatment is restructured. Subjects were 108 Hispanic families in which an adolescent was suspected of. or was observed, using drugs. Subjects were randomly assigned to a strategic structuralsystems engagement (experimental) condition or to an engagement-as -usual (control) condition. Subjects in the experimental condition were engaged at a rate of 93% compared with subjects in the control condition, who were engaged at a rate of 42%. Seventy-seven percent of subjects in the experimental condition completed treatment compared wiih 25"! of subjects in the control

395 citations


Journal ArticleDOI
TL;DR: Evidence is established that hospital infection is a common and serious problem throughout the world and in children the commonest infections were of the lower respiratory tract, of the skin and gastroenteritis, and in the elderly, urinary-tract infections predominated.

230 citations


Journal ArticleDOI
08 Sep 1988-Nature
TL;DR: It is reported here that clonal deletion of V+β6 cells in Mlsa mice can be prevented by in vivo neonatal administration of monoclonal antibodies directed against CD4 and this subset is an intermediate stage in the differentiation pathway of both CD4+ and CD8+ T-cell lineages.
Abstract: T-cell differentiation in the thymus involves the coordinate expression of genes encoding the alpha and beta chains of the major histocompatibility complex-restricted heterodimeric antigen receptor (TCR) complex, as well as other functionally important molecules such as CD4 and CD8. The repertoire of TCR expressed by T cells is generally thought to be influenced by positive and/or negative selection events occurring when TCRs on developing T cells interact with self-antigens and major histocompatibility complex components. Using a model system in which specific antigen-reactive cells can be monitored by virtue of their preferential expression of certain TCR beta-chain variable (V beta) domains, it has been shown that self-reactive T cells are clonally deleted during development. We report here that clonal deletion of V+ beta 6 cells in Mlsa mice can be prevented by in vivo neonatal administration of monoclonal antibodies directed against CD4. Furthermore, as anti-CD4 monoclonal antibody treatment resulted in the reappearance of V+ beta 6 cells in the mature CD8+ T-cell subset, it is likely that clonal deletion acts on the CD4+CD8+ thymocyte subset and that this subset is an intermediate stage in the differentiation pathway of both CD4+ and CD8+ T-cell lineages.

183 citations


Journal ArticleDOI
TL;DR: A strong renal involvement in the balance of plasma uric acid and may also reflect certain dietary patterns, such as a high intake of protein, fats, and certain local vegetables, which are found in Melanesians and Asian Indians.
Abstract: Plasma uric acid was investigated in a population survey on diabetes and cardiovascular risk factors among Melanesians and Asian Indians in Fiji in 1980. Plasma uric acid levels were elevated in men and women with impaired glucose tolerance in both ethnic groups. The lowest plasma uric acid levels were found in diabetic patients, especially in diabetic men. Even though obesity was positively associated with plasma uric acid, it did not explain the high plasma uric acid level in persons with impaired glucose tolerance. Body mass index had a significant and independent impact on plasma uric acid levels both in nondiabetic and diabetic men and women. The strongest predictor of plasma uric acid in the multiple regression analysis in our study populations was plasma creatinine: it alone explained 9% of the variation in men and 2% in women; and 24% in Melanesians and 5% in Asian Indians. Our findings suggest a strong renal involvement in the balance of plasma uric acid and may also reflect certain dietary patterns, such as a high intake of protein, fats, and certain local vegetables. Although the prevalence of hyperuricemia was high, 27% in both Melanesian men and women, 22% in Asian Indian men, and 11% in Asian Indian women, clinical gout was uncommon. Many predictor variables and their interactions were analyzed along with the reasons for the high plasma uric acid levels in persons with impaired glucose tolerance and for the low plasma uric acid levels in diabetic patients.

169 citations


Journal ArticleDOI
TL;DR: Analysis of seroprevalence data suggests 3 distinct patterns of the AIDS virus, which prevails in areas of Eastern Europe, North Africa, the Middle East, Asia, and most of the Pacific.
Abstract: Although the acquired immunodeficiency syndrome (AIDS) pandemic is still in its early stages and its ultimate dimensions are difficult to gauge it is clear that AIDS represents an unprecedented threat to global health. Over 250000 cases of AIDS have already been reported and another 10 million people are infected with the AIDS virus suggesting that about 1 million new AIDS cases can be expected within the next 5 years. Studies have consistently shown that the human immunodeficiency virus (HIV) is transmitted by anal or vaginal sexual intercourse by the injection or administration of infected blood and from an infected mother to her infant. An analysis of seroprevalence data suggests 3 distinct patterns of the disease. Pattern 1 typical of large industrialized countries such as the US includes a male-to-female sex ratio of reported AIDS cases of about 10-15 to 1 and a concentration of cases among homosexual/bisexual males and intravenous drug users in urban areas. Pattern 2 is presently observed in some areas of central eastern and southern Africa and increasingly in the Caribbean. Most cases in pattern 2 areas occur among heterosexuals and there is a 1 to 1 ratio between infected males and females. Given the high numbers of women affected perinatal transmission is common. Pattern 3 prevails in areas of Eastern Europe North Africa the Middle East Asia and most of the Pacific. In these areas only a small number of AIDS cases have been reported and most of these involve individuals who have travelled to pattern 1 or 2 countries. Africa where all 3 infection patterns can be found has been hardest hit by the AIDS epidemic. From 10-25% of women of childbearing age are infected with HIV implying a 25% increase in child mortality in the years ahead. The cumulative total of AIDS cases in Africa was estimated at over 100000 in mid-1988 and an additional 400000 cases are projected in the next 5 years. Studies in Africa suggest that the presence of other sexually transmitted diseases and an immune system already compromised by chronic diseases increases the risk of HIV infection. The control of AIDS requires a sustained longterm national and international effort.

156 citations


Journal ArticleDOI
TL;DR: A birth control vaccine incorporating a synthetic peptide antigen representing the aminoacid sequence 109-145 of the C-terminal region of the beta subunit of human chorionic gonadotropin (hCG-beta) gave promise of a contraceptive effect of six months' duration.

131 citations


Journal Article
TL;DR: A scientifically valid, relatively inexpensive method suitable for reaching patients at community level does exist and field tests have shown that the right drug in the right dose at the right time relieves 80 to 90% of pain.
Abstract: Cancer pain relief is a ubiquitous but neglected public health problem. Every day more than three and a half million people suffer from cancer pain, but only a fraction receive treatment for it. Relatively simple and inexpensive methods of pain relief are available. Adequate pain relief is not reaching a great number of cancer patients in developed countries. In the developing countries, where more than half the world's cancer patients are and where most are incurable at the time of diagnosis, pain relief (often the only relevant human alternative) by and large is not offered. Obstacles to effective cancer pain relief worldwide include poor drug availability, misguided national drug legislation, lack of education of doctors and nurses, underprescribing and underdosing by the professionals, wrong timing of drugs given, fear of addiction and lack of public awareness that pain can be controlled. A World Health Organization (WHO) method has been developed which provides for drugs to be administered immediately if there is pain, to be given 'by the clock' rather than 'on demand' and to be increased from non-opioids (aspirin or paracetamol) to weak opioids (codeine) and then to strong opioids (morphine) until the patient is free from pain--hence the concept of a three-step ladder for cancer pain relief. Field tests have shown that the right drug in the right dose at the right time relieves 80 to 90% of pain. Thus a scientifically valid, relatively inexpensive method suitable for reaching patients at community level does exist.

Journal ArticleDOI
TL;DR: The reference period method, introduced to avoid the arbitrary rules and definitions required for an analysis based on the concept of a menstrual cycle, is discussed and its limitations presented.


Journal ArticleDOI
TL;DR: During the course of the experimental work a reproducible method of gold labeling immunoglobulins was developed and an extra layer on the cell walls was conspicuous on electron micrographs of both rough and encapsulated pneumococci.
Abstract: The localization of pneumococcal capsular and cell wall antigens was examined by immunoelectron microscopy. C polysaccharide (C-Ps), a common component of all pneumococci, was uniformly distributed on both the inside and outside of the cell walls. The thickness of the C-Ps varied with the strain. Encapsulated strains were covered by varied amounts of capsular polysaccharide concealing the C-Ps of the bacteria so as to render it inaccessible to anti-C-Ps antibodies. In addition to C-Ps, protein antigens were demonstrable on the surface of nonencapsulated pneumococci. The proteins were not masked by the C-Ps layer. An extra layer on the cell walls was conspicuous on electron micrographs of both rough and encapsulated pneumococci. The nature of this extra layer has not been disclosed. F antigen, another common antigen of pneumococci, was uniformly distributed on the surface of the plasma membranes. During the course of the experimental work a reproducible method of gold labeling immunoglobulins was developed.

Journal ArticleDOI
TL;DR: A comparative analysis of women's vaginal bleeding patterns using nine different methods of contraception, one natural and eight hormonal, confirms those of previous studies and shows that the methods of analysis recommended by WHO in 1985 still require substantial refinement.

01 Jan 1988
TL;DR: In spite of the current low prevalence in some countries, the total number of hypertensives in the developing world is high, and a cost assessment of possible antihypertensive drug treatment indicates that developing countries cannot afford the same drug treatment levels as developed countries.
Abstract: Population surveys carried out since the 1970s in 15 developing countries including 23 population groups show that the prevalence of hypertension ranges from as low as 1% in some African countries to over 30% in Brazil. A trend analysis of the mortality statistics for 35-74 year-olds from 16 countries in which data are available shows a downward trend in mortality from hypertension and cerebrovascular diseases in most of these countries. In spite of the current low prevalence in some countries, the total number of hypertensives in the developing world is high, and a cost assessment of possible antihypertensive drug treatment indicates that developing countries cannot afford the same drug treatment levels as developed countries.

Journal ArticleDOI
TL;DR: There is a continuing high prevalence of HIV infection among hospital workers in Kinshasa, Zaire, which appears to be representative of that in the community and not nosocomial.
Abstract: To define the prevalence and course of human immunodeficiency virus (HIV) infection, we examined prospectively a cohort of 2002 adult hospital workers in Kinshasa, Zaire. From 1984 to 1986 the prevalence of HIV infection increased from 6.4 percent to 8.7 percent. Over the two years there was a cumulative incidence of new HIV infection of 3.2 percent. The prevalence was higher among women (16.9 percent) and men (9.3 percent) under the age of 30 than among women (9.0 percent) and men (6.2 percent) over 30. Prevalence rates were similar among physicians (5.6 percent), laboratory workers (2.9 percent), and clerical workers (7.9 percent), but they were higher among female nurses (11.4 percent) and manual workers (11.8 percent). Despite marked differences in the intensity of nosocomial exposure, female nurses had similar infection rates on the female internal medicine ward (9.9 percent), in pediatrics (10.8 percent), and in the delivery room (10.7 percent). The attributable risk of HIV infection from a transfusion was 5.9 percent. Neither medical injections nor scarification was a risk factor for HIV infection. Of the 101 seropositive asymptomatic employees in the 1984 survey, 16 percent had AIDS-related complex, 3 percent had AIDS, and 12 percent had died of AIDS by 1986. Previous studies have revealed a seroprevalence of 8.4 percent among women attending an antenatal clinic near the hospital in 1984 and 1986, and of 5.8 percent (in 1984) and 6.5 percent (in 1986) among men donating blood at the hospital's blood bank. We conclude that there is a continuing high prevalence of HIV infection among hospital workers in Kinshasa, Zaire, which appears to be representative of that in the community and not nosocomial.

Journal ArticleDOI
TL;DR: A housing probability survey in which 9315 women were interviewed was conducted in 1983 to detect the incidence and aetiology of maternal mortality in Addis Ababa, Ethiopia, and selected antenatal care, occupation and income as risk factors for maternal mortality.
Abstract: A housing probability survey in which 9315 women were interviewed was conducted in 1983 to detect the incidence and aetiology of maternal mortality in Addis Ababa, Ethiopia. Maternal mortality for the two-year period from 11 September 1981 was 350/100,000 livebirths (excluding abortions). A logistic regression analysis selected antenatal care, occupation and income as risk factors for maternal mortality, after adjusting for age, parity, education and marital status. Odds ratios were 2.5 for unbooked women compared to those receiving antenatal care, about 3 for students, and maids/janitresses compared to housewives, and between 3 and 5 for those earning less than US$25 monthly, compared to those earning US$150 or more.

Journal Article
Z. Jezek1, Szczeniowski M, K. M. Paluku, M Mutombo, B Grab 
TL;DR: Assessment of the extent of and reasons for clinical diagnostic errors in areas where health staff as well as the general public are aware of human monkeypox shows the presence of lymphadenopathy, pre-eruptive fever and slower maturation of skin lesions are the most important clinical signs supporting correct diagnosis of monkeypox.

Journal ArticleDOI
TL;DR: Women using DMPA tolerated far greater menstrual disruption than subjects using any other method; they had no special difficulty in predicting either the time of onset or the length of their bleeding episodes.

Journal ArticleDOI
09 Dec 1988-JAMA
TL;DR: Findings support the generalizability of the World Health Organization clinical acquired immunodeficiency syndrome definition and its use (especially the modified version) in areas of Uganda without sophisticated facilities.
Abstract: Infections with human immunodeficiency virus are common in areas of the world where laboratory testing and sophisticated diagnostic facilities are unavailable. A World Health Organization clinical case definition for acquired immunodeficiency syndrome was developed in 1985 for use in such areas. In 1987, we tested this definition on 1328 inpatients and outpatients in 15 hospitals throughout Uganda. Five hundred sixty-two patients (42%) were positive by enzyme-linked immunosorbent assay for human immunodeficiency virus antibody. The World Health Organization definition had a sensitivity of 55%, a specificity of 85%, and a positive predictive value of 73%. Modification of the case definition by excluding a known cough from tuberculosis as a minor criteria decreased sensitivity slightly to 52%, but specificity and positive predictive value increased to 92% and 83%, respectively. Amenorrhea, although not specifically asked about, was a symptom noted by many female patients (26% of females who were positive by enzyme-linked immunosorbent assay); as a symptom indicative of human immunodeficiency virus infection, amenorrhea had a specificity of 99%, with a positive predictive value of 89%. These findings support the generalizability of the World Health Organization clinical acquired immunodeficiency syndrome definition and its use (especially the modified version) in areas of Uganda without sophisticated facilities. ( JAMA 1988;260:3286-3289)

01 Jan 1988
TL;DR: The revision of the classification of diabetes mellitus, to differentiate clearly between insulin-dependent (IDDM) and non-insulin-dependentabetes mellitus (NIDDM), and the provision of unambiguous guidelines for diagnosis constitute important recent developments in diabetes epidemiology.
Abstract: The revision of the classification of diabetes mellitus, to differentiate clearly between insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM), and the provision of unambiguous guidelines for diagnosis (1) constitute important recent developments in diabetes epidemiology. However, our knowledge even of the prevalence of NIDDM remains surprisingly incomplete for many areas of the world. Whilst NIDDM may still be uncommon in rural Africa, prevalence has been reported as approximately 10% in blacks in the United States, indicating a need for more information regarding the prevalence of NIDDM in urban Africa. There is also little information with regard to urban communities in Latin America. The highest prevalence of NIDDM is found in certain indigenous North American and Western Pacific societies. In extreme cases approximately one-third of the adult population now suffers from the disease. NIDDM is also common (prevalence approximately 5%) in Europe and in communities of European origin. Data from the United States suggest that approximately one-fifth of white North Americans can expect to develop NIDDM if they live to the seventh decade of life. Of populations of South-East Asian ethnicity, Indians appear to be the most susceptible. Indian migrants to Fiji, South Africa and South America all demonstrate prevalence of NIDDM of 10% or more. Whilst it was formerly believed that Chinese were rarely affected by NIDDM, recent reports cast some doubt on this. Prevalence of NIDDM in the Western Pacific varies widely. However, with the possible exception of certain Melanesian populations, prevalence is high in all communities which have abandoned their traditional lifestyle.(ABSTRACT TRUNCATED AT 250 WORDS)

Journal Article
TL;DR: The results of epidemiological features of 91 monkeypox patients reported in Bumba zone in northern Zaire during the period 1981 to 1985 are presented, indicating its limited public health importance even in a well-known enzootic area.
Abstract: Human monkeypox is a zoonosis that occurs sporadically in the tropical rainforest of western and central Africa. This article presents the results of epidemiological features of 91 monkeypox patients reported in Bumba zone in northern Zaire during the period 1981 to 1985. Their age ranged from 7 months to 29 years (93% below 15 years of age). 11% of patients had visible smallpox vaccination scars. Deaths occurred sporadically; the overall case-fatality rate was 9%. 91 patients arose in 61 separate outbreaks; 42 of them consisted of only a single case. The source of infection was suspected to be animal for 70 cases, and human for the remaining 21 cases. The illness occurred in all months of the year. There was a considerable clustering of cases in the northern part of the zone. The average annual incidence rate in the observed zone was 0.63 cases per 10,000 population with marked differences in age, time and place. The average annual primary attack rate among unvaccinated individuals (1.7/10,000) sharply contrasted with those vaccinated (0.04/10,000). The secondary attack rate for contacts without vaccination scar (4.3%) differed significantly from those who had been vaccinated in past (0.7%). Many unvaccinated contacts living under conditions of maximal exposure to index cases escaped not only the disease but also infection. The low incidence rate of human monkeypox indicates its limited public health importance even in a well-known enzootic area.

Journal ArticleDOI
TL;DR: At the country level, cardiovascular disease prevention and control cannot be considered in isolation and must be related to prevailing national health priorities and competing claims from other sectors of development.
Abstract: Developing countries are subject to the same risks that have contributed to the high incidence of cardiovascular diseases in the already developed countries. Improvements in life expectancy at birth lead to predictable shifts in the cause-of-death structure over time. The stage at which cardiovascular diseases may be considered to be 'actively emerging' corresponds to a life expectancy level between 50 and 60 years and, at this level, cardiovascular disease mortality accounts for 15-25% of all deaths. The average life expectancy at birth in developing countries for the year 2000 is projected to be 60 years or more and it may be expected that by that time cardiovascular diseases would be actively emerging or established in virtually every country. In many developing countries today, life-style pattern that is associated with high rates of coronary heart disease is not yet widespread and it is therefore logical that a strategy of prevention should include efforts to inhibit the entrenchment and spread of unhealthy life-styles in the community (i.e., primordial prevention). At the country level, cardiovascular disease prevention and control cannot be considered in isolation and must be related to prevailing national health priorities and competing claims from other sectors of development. In poorer countries where life expectancy is below 50 years primordial prevention activities are likely to be restricted--perhaps to smoking and hypertension control. In middle-income countries a broader based approach to primordial prevention is feasible and is more likely to be acceptable.

Journal ArticleDOI
TL;DR: It is suggested that the recent attention given to the delivery of 'selective' packages of interventions has often diverted energy and resources from the essential task of developing comprehensive, efficient and effective health services.

01 Jan 1988
TL;DR: Two anthropometric indicators of obesity or overweight are recommended for classifying obesity: the body-mass index is reasonably easy to obtain and correlates well with mortality and morbidity risk and the NCHS value plus two standard deviations.
Abstract: Methods of measuring obesity are briefly reviewed. The more precise methods of measuring the body-fat mass are too complex and expensive for use in regular public health practice or individual screening. Anthropometry can, however, provide useful information. Two anthropometric indicators of obesity or overweight are recommended for classifying obesity. For adults, the body-mass index is reasonably easy to obtain and correlates well with mortality and morbidity risk. For children, "overweight" is indicated by a weight-for-height above the median NCHS value plus two standard deviations. Data compiled by the WHO Nutrition Unit, using these two indicators, are presented for a number of countries worldwide in Table 1 & Fig. 1.

Journal ArticleDOI
TL;DR: In countries that are not poor, diarrhea remains a neglected but substantial problem, lurking in deprived, diseased, and institutionalized populations.
Abstract: Each year, diarrheal diseases kill at least 5 million children before they reach their fifth birthday. For the most part, poor countries bear the brunt of this burden. In many developing nations, it is usual for children to experience three or more serious episodes of diarrhea every year.1 In countries that are not poor, diarrhea remains a neglected but substantial problem, lurking in deprived, diseased, and institutionalized populations. In the United States, diarrhea remains one of the common reasons for the admission of children to hospitals. The elderly, especially in nursing homes, have high rates of diarrhea; its resulting morbidity . . .

Journal ArticleDOI
TL;DR: In this article, the authors present an argument for adhering to a common system of communication in psychiatry, and explain why classifications are such an enchanting conundrum attracting attention, arousing emotion and giving rise to thought.
Abstract: When Renaudin, aghast at the situation in 1856 wrote, “We now see anarchy in the field of classification threatening to split our ranks and robbing us of the victories of our predecessors”, he was not only providing an argument for adhering to a common system of communication in psychiatry, he was also stating why classifications are such an enchanting conundrum attracting attention, arousing emotion and giving rise to thought.

Journal ArticleDOI
TL;DR: During this period there were signs of a gradual increase in drug sensitivity, coinciding with the withdrawal of chloroquine for treatment of falciparum malaria in Thailand.
Abstract: 2 Sensitivity of Thai isolates of Plasmodium falciparum to chloroquine collected over the years 1978–1986 was measured by two methods: (i) by growth of previously cultured isolates for 72 h in presence of drug, and (ii) by the WHO standard in vitro microtest. During this period there were signs of a gradual increase in drug sensitivity, coinciding with the withdrawal of chloroquine for treatment of falciparum malaria in Thailand.

Journal ArticleDOI
TL;DR: BCG vaccination given early in life is very effective in preventing tuberculosis in children under six years of age in an area where coverage is about 55%.
Abstract: A retrospective case-control study was conducted in Argentina to determine the protection conferred by BCG vaccination against tuberculosis in children under six years of age, in an area where coverage is about 55%. A total of 175 tuberculosis patients were included. Five controls selected from patients treated at the same hospital as those under study for reasons other than tuberculosis were matched to each case on the basis of age, socioeconomic origin, nutritional status and place of residence. Information on BCG vaccination status was collected by an independent examiner. Tuberculosis localizations were as follows: 152 pulmonary, pleural and/or miliary; 18 meningitis; 2 lymphadenitis; 2 osteoarticular; and 1 otic. The diagnosis was based on bacteriological and histopathological tests, computerized tomography, radiology, clinical examination, endoscopy, and proved source of infection. The protective effect of BCG among those who were vaccinated was 73.0% with 95% confidence limits of 82% and 62%. According to these results BCG vaccination given early in life is very effective in preventing tuberculosis.