Showing papers by "World Health Organization published in 1989"

Perinatal transmission of the human immunodeficiency virus type 1 to infants of seropositive women in Zaire.

Abstract: To examine perinatal transmission of the human immunodeficiency virus type 1 (HIV-1) in Zaire, we screened 8108 women who gave birth at one of two Kinshasa hospitals that serve populations of markedly different socioeconomic status. For up to one year, we followed the 475 infants of the 466 seropositive women (5.8 percent of those screened) and the 616 infants of 606 seronegative women matched for age, parity, and hospital. On the basis of clinical criteria, 85 of the seropositive women (18 percent) had the acquired immunodeficiency syndrome (AIDS). The infants of seropositive mothers, as compared with those of seronegative mothers, were more frequently premature, had lower birth weights, and had a higher death rate in the first 28 days (6.2 vs. 1.2 percent; P less than 0.0001). The patterns were similar at the two hospitals. Twenty-one percent of the cultures for HIV-1 of 92 randomly selected cord-blood samples from infants of seropositive women were positive. T4-cell counts were performed in 37 seropositive women, and cord blood from their infants was cultured. The cultures were positive in the infants of 6 of the 18 women with antepartum T4 counts of 400 or fewer cells per cubic millimeter, as compared with none of the infants of the 19 women with more than 400 T4 cells per cubic millimeter (P = 0.02). One year later, 21 percent of the infants of the seropositive mothers had died as compared with 3.8 percent of the control infants (P less than 0.001), and 7.9 percent of their surviving infants had AIDS. We conclude that the mortality rates among children of seropositive mothers are high regardless of socioeconomic status, and that perinatal transmission of HIV-1 has a major adverse effect on infant survival in Kinshasa.

Suicide and the attempted suicide: an international perspective.

Abstract: This article reviews the scope of suicide and attempted suicide as public health problems from an interntional perspective. Socio-demographic trends are analyzed and explanatory theories for interntional differences proposed. Suicide and attempted suicide can be prevented, but the development and evaluation of effective large-scale prevention programs is still in its infancy. Inadequacies in current programs across the world has promoted the establishment of national Task Forces on Suicide Prevention in the United States, Canada and The Netherlands, as well as a WHO strategy on suicide prevention. These groups have formulated comprehensive strategies for the prevention of suicide. The main components of these strategies are: - Design and implementation of national research programs; - The improvement of services; - The provision of information and training on suicide prevention to relevant professional groups, organizations and the general public; and - Formulation of strategies and techniques to deal with special risk groups. The added recommendations are seen as important steps in translating a comprehensive national plan to prevent suicide into clinical and research programs that can be effectively implemented to prevent these tragedies around the world.

WHO MONICA Project: objectives and design.

Abstract: The WHO MONICA Project is a multicentre international collaborative project coordinated by the World Health Organization. Its objective is to measure trends in cardiovascular mortality and morbidity and to assess the extent to which these trends are related to changes in risk factor levels and/or medical care, measured at the same time in defined communities in different countries. Thirty-nine collaborating centres from 26 countries of Europe, North America, and the Western Pacific collaborate in this project, using a standardized protocol and covering a population of approximately 10 million men and women aged 35-64. The WHO MONICA Project is directed by the Council of Principal Investigators and a Steering Committee, and it is managed by a Management Centre, Data Centre, Quality Control Centres (for event registration, ECG coding and lipid determinations) and Reference Centres (for optional studies). The MONICA methodology is increasingly used as a measurement tool for cardiovascular and non-communicable diseases prevention and control programmes by centres within and outside the project.

Prevalence and risk factors for micro- and macroalbuminuria in diabetic subjects and entire population of Nauru.

Abstract: Rates of elevated urinary albumin concentration, defined as microalbuminuria (30-299 micrograms/ml) and macroalbuminuria (greater than or equal to 300 micrograms/ml), were determined on random morning urine specimens in the population of Nauru, which has a high prevalence of non-insulin-dependent diabetes mellitus. The prevalence of elevated urinary albumin levels in the total Nauruan population was very high: 26 and 30% of men and women, respectively, had microalbuminuria, whereas 13% of both sexes had macroalbuminuria. Of the subjects with macroalbuminuria, 66% had diabetes. The prevalence increased with worsening glucose tolerance; 26% of subjects with normal glucose tolerance had either micro- or macroalbuminuria, increasing to 43% of subjects with impaired glucose tolerance, 63% of newly diagnosed diabetic subjects, and 75% of previously diagnosed diabetic subjects. Associations between elevated urinary albumin concentration and putative risk factors were assessed for both the total population (n = 1184) and the diabetic subgroup alone (n = 318). Fasting plasma glucose and hypertension were the most important independent correlates for the whole population, whereas plasma creatinine was also important in diabetic subjects. Age at onset and duration of diabetes were not found to be significantly associated with elevated albumin concentration. In subjects with normal glucose tolerance, hypertension and hyperuricemia were the most important associated factors. These results suggest that blood glucose, blood pressure, and possibly obesity and plasma uric acid are important modifiable risk factors for both micro- and macroalbuminuria in this population.

Multiple infections in cases of cervical cancer from a high-incidence area in tropical Africa.

Abstract: The presence of several infections was determined in tissue and serum samples from 34 cases and 23 controls seen in 1984-85 at Mulago Hospital in Kampala, Uganda. When assessing single infections, association with cervical cancer could be shown for 5 agents, namely by Southern blot assay for human papillomavirus types 16 and 18 (HPV), and by serological tests at varying levels of antibody titres, for herpes simplex virus type I and/or 2 (HSV), cytomegalovirus (CMV), Epstein-Barr virus, viral capsid antigen (EBV-VCA), and Chlamydia trachomatis (CLT). Due to interaction, HSV and CMV were associated with cervical cancer only when infection by both of these agents was demonstrable. In the assessment of the simultaneous presence of these 5 infections, moderately high antibody titres were taken as the cut-off point for infection by HSV, CMV, EBV-VCA, and CLT. This showed that 3 and 4 infections at a time were seen in the majority of the cases in contrast to the controls with essentially no more than 2 such infections. A linear trend in the rise of risk for cervical cancer was noted with increasing number of infections.

Comparative field evaluation of the fluorescent-antibody test, virus isolation from tissue culture, and enzyme immunodiagnosis for rapid laboratory diagnosis of rabies.

Abstract: The rabies tissue culture infection test (RTCIT) and rapid rabies enzyme immunodiagnosis (RREID) were compared to the fluorescent-antibody test (FAT) with field specimens. At the French National Reference Center for Rabies, 15,248 specimens were analyzed by FAT and RTCIT, and 2,290 of those specimens were also tested by RREID; 818 other specimens were tested by FAT and RREID in 12 laboratories located in Africa, Asia, and Latin America. The sensitivities and specificities of RREID and RTCIT were comparable. This study showed that both tests can be used as backup procedures to confirm FAT. RREID is also strongly recommended for epidemiological studies and for laboratories which are not equipped for performing FAT.

Hemorrhagic Fever with Renal Syndrome in Korea

Abstract: Several clinical variants of hemorrhagic fever with renal syndrome (HFRS) are caused by Hantaan and related viruses. Since 1951, 500-900 patients with HFRS have been hospitalized annually in Korea. Although HFRS is associated primarily with rural areas, it is now being recognized as an urban problem and a particular hazard to laboratory staff using rodents for research. Recently, epidemic outbreaks of leptospirosis and scrub typhus have occurred during the HFRS season, leading to confusion in diagnosis. Serologic diagnosis of HFRS is based on the demonstration of IgM antibodies to Hantaviruses by the indirect fluorescent antibody technique or enzyme-linked immunosorbent assay. The specific Hantavirus causing infection can be identified on the basis of titers of plaque-reduction neutralizing antibody. Results of studies with monoclonal antibodies suggest that viral subtypes exist for each Hantaviral serotype presently recognized. While infection with Hantaviruses is known to be a problem of worldwide dimensions, present evidence indicates that it occurs over a wider area than previously recognized. Vertical transmission of Hantaan virus in a pregnant woman has been documented.

WHO collaborative study on alcohol education and young people: Outcomes of a four-country pilot study

Abstract: In 1985 the Division of Mental Health, World Health Organization, Geneva, convened a group of investigators from centers in four countries-Australia, Chile, Norway, Swaziland-to participate in a pilot study on the efficacy of school-based alcohol education. The goal of the educational program was to delay onset and minimize involvement of alcohol use among 13- to 14-year-old adolescents. Twenty-five schools in the four countries, representing middle- and lower-class populations, were randomly assigned to peer-led education, teacher-led education, or a control condition. The educational program was derived from social-psychological theory and etiological research on adolescent alcohol use. The program focused on the social and environmental influences to drink alcohol and skills to resist those influences. It consisted of five lessons over 2 months. Baseline and posttest data measured alcohol use knowledge, attitudes, skills, and friends' drinking patterns. Data were collected immediately prior to and 2 mo...

Combined oral contraceptives and liver cancer

Abstract: A multi-national, hospital-based, case-control study was conducted to evaluate the possible relationships of steroid contraceptives to 6 neoplasms. Based on data from 122 newly diagnosed cases of primary liver cancer and 802 matched controls, the relative risk of liver cancer in women who had ever used combined oral contraceptives was estimated to be 0.71 (95% Cl 0.4–1.2). No consistent trend in risk with months of use or time since first or last use was observed. Separate analyses also revealed no association between use of combined oral contraceptives and hepatocellular carcinoma (RR = 0.60) or cholangiocarcinoma (RR = 1.22). Most women in this study came from areas in which hepatitis B is endemic and rates of liver cancer are relatively high, and in most cases use of oral contraceptives was of short duration. These results provide no evidence that short-term use of oral contraceptives enhances risk of liver cancer in countries where the determinants of this disease are similar to those observed in the countries where this study was conducted.

1989 Guidelines for the management of mild hypertension: Memorandum from a WHO/ISH meeting

Abstract: The present guidelines were prepared by a subcommittee of the WHO/ISH (International Society of Hypertension) Mild Hypertension Liaison Committee, and wee finalized after discussion at the Fifth WHO/ISH Mild Hypertension Conference. They include the definition of mild hypertension, and describe blood pressure measurement, factors influencing the decision to begin treatment, methods of treatment, and follow-up. These guidelines are a revision of those published in 1986; they are based on the best available scientific evidence, and will be updated in the future to keep abreast of further developments in this field.

Control of morbidity due to Schistosoma haematobium on Pemba island; selective population chemotherapy of schoolchildren with haematuria to identify high-risk localities

Abstract: In Pemba, Tanzania, 2 sequential surveys were made of the prevalence of haematuria in children (aged 5–19 years) in 52 schools, using direct observation of gross haematuria (bloody urine) and chemical reagent strips as indicators of Schistosoma haematobium infection 24 462 children were examined in the first survey and 25 575 in the second, 6 months later The prevalence of gross haematuria was initially 15·8% (3876 cases); 6 months later, after a single dose of praziquantel (40 mg/kg), it was only 2·4% (613 cases), a reduction of 84·9% The total number of cases of haematuria (gross or otherwise) dropped similarly, from 13 920 (54%) to 6638 (26%), a 52·2% reduction In towns the degree of reduction was positively correlated with the standard of water supply and sanitation available, and the initial prevalence of gross and total haematuria in schools was positively correlated with the prevalence 6 months later The cost per person reduced from US$ 0·83 in the first survey to US$ 0·48 in the second (excluding field staff wages paid in local currency), the reduction being due to the reduced number of positive persons This study has demonstrated the feasibility of using indirect techniques on a large scale for the diagnosis of S haematobium infection to identify schoolchildren requiring treatment, and to monitor its impact on clinical morbidity in a highly endemic area

WHO drinking water quality guidelines for selected herbicides.

Abstract: Following the successful introduction of its Guidelines for Drinking-Water Quality in 1984, the WHO Regional Office for Europe was approached by the Government of Italy to develop, as a matter of urgency, recommendations for guidelines levels of certain herbicides found in drinking water supplies. Realizing the extent of the problem, the Regional Office for Europe organized two consultations to develop drinking water quality guidelines for the following 11 herbicides most commonly used in Italy: alachlor, metolachlor, pyridate, atrazine, molinate, simazine, bentazon, pendimethalin, trifluralin, MCPA and propanil. The presence of these and other herbicides in ground and surface water has been reported in several countries. Although the main purpose of these guidelines is to provide guidance to the Government of Italy in making risk management decisions, the information given was also intended to assist the other countries of the European Region in setting standards or in developing alternative control procedures where the implementation of standards is not feasible. The purpose of this paper is to review the process of health risk assessment used in the development of the WHO drinking water quality guidelines for selected herbicides. It will also reveal the major dilemmas and concerns expressed by the participating experts during the process of scientific deliberations, in the interests of understanding the complex issues involved in reaching the bare figures of the recommended guidelines.

International travel and sexually transmitted diseases.

Abstract: Sexually transmitted diseases (STDs) are a group of communicable diseases transferred mainly by sexual contact. Population movements are undoubtedly a major contributing factor in the spread of STDs. Owing to the ease of modern travel, larger numbers of people are moving around than ever before in peacetime. Travellers may both import and export infection, and the importance of their role in the transmission of STDs is demonstrated by the rapid worldwide spread of penicillinase-producing strains of N. gonorrhoeae (PPNG) and AIDS. While in most industrialized countries the incidence of the classic STDs (syphilis, gonorrhoea, chancroid) has decreased during the last decade, they remain hyperendemic in many developing countries due to poorly developed STD services. In many industrialized countries, the incidence of genital C. trachomatis infection now exceeds that of gonococcal infection. Chlamydial infections were previously thought to be infrequent in developing countries, but recent research has made it clear that this infection is at least as frequent as gonorrhoea. Incidence of genital herpes and genital human papilloma-virus infections (HPV) has increased dramatically during the last 20 years. Now that international travel takes place increasingly by air, it is more likely than previously for a traveller to return home within the incubation period of many STDs. Moreover, people behave differently when they travel. Tourists travel to seek adventure and new experiences, including sex. In countries where a good notification system exists, up to 30% of new cases of syphilis were found to be acquired abroad. Since PPNG appeared in 1976, these strains have spread to almost all areas of the world. During the first five years of the epidemic, most cases in Europe and the United States of America were imported. Measures for preventing STDs are the same whether the individual is travelling or not. Abstinence or sexual intercourse between two mutually-faithful uninfected partners exclusively are the only totally effective prevention strategies. The risk of infection can also be significantly reduced by adopting safe sexual practices such as the use of condoms. Prophylactic use of an antibiotic is not recommended, however.

Inhibition of cryoprecipitation of murine IgG3 anti-dinitrophenyl (DNP) monoclonal-antibodies by anionic DNP-amino acid conjugates.

Abstract: Previously we have demonstrated that eight out of nine IgG3 monoclonal antibodies (mAb) obtained from autoimmune MRL-lpr/lpr mice were able to self-associate and to precipitate in the cold (Gyotoku et al., J. Immunol. 1987. 138:3785). To determine whether the cryoprecipitation of IgG3 mAb is enhanced or inhibited in the presence of specific ligand, we have established eight IgG3 mAb reactive with 2,4-dinitrophenol (DNP) hapten: four mAb were obtained from fusion of spleen cells of C57BL/6 mice immunized with 2,4,6-trinitrophenylated keyhole limpet hemocyanin, three from 129/Sv and one from BALB/c immunized with DNP-lipopolysaccharide. Five of them induced cryoglobulins composed exclusively of the IgG3 mAb. The binding of negatively charged monomeric DNP-amino acid conjugates completely inhibited the cryoprecipitation of all the five cryoprecipitating anti-DNP IgG3 mAb, while the incubation with positively charged or neutral DNP-amino acid conjugates had variable effects: increase, inhibition or no change of the cryoprecipitation. In addition, positively charged DNP-amino acid conjugates were able to induce the cryoprecipitation of one of the non-cryoprecipitating anti-DNP IgG3 mAb. Our data showed that (a) IgG3 mAb derived from non-autoimmune strains of mice, similar to IgG3 mAb derived from an autoimmune MRL-lpr/lpr strain, possessed the unique property to self-associate and were able to form cryoglobulins in most cases; (b) although the Fc-Fc interactions of IgG3 mAb play a decisive role in IgG3 cold solubility, IgG3 cryoprecipitation was markedly influenced after interacting with their specific ligand, depending on the charge of the hapten-amino acid conjugate. This suggested that even minor interferences with the electrostatic equilibrium of the IgG3 by the binding of charged hapten molecules induced dramatic changes in the solubility of the IgG3 mAb at low temperature.

Semisolid blood-free selective-motility medium for the isolation of campylobacters from stool specimens.

Abstract: Isolation of Campylobacter jejuni and C. coli from stool specimens is done by growing campylobacter colonies on solid selective media with or without blood. However, recognition of these colonies can be difficult. Therefore, we decided to evaluate an isolation procedure based on the swarming of campylobacters through a semisolid medium. We developed a semisolid blood-free selective motility (SSM) medium which is composed of Mueller-Hinton broth with 0.4% agar and supplemented with cefoperazone (30 micrograms/ml) and trimethoprim (50 micrograms/ml). The SSM medium was compared with our previously described Butzler Medium Virion (Goossens et al., J. Clin. Microbiol. 24:840-843, 1986) and blood-free medium (Bolton and Coates, J. Appl. Bacteriol. 54:115-125, 1983) with cefoperazone (32 micrograms/ml) (Bolton et al., J. Clin. Pathol. 37:956-957, 1986). Of 1,890 routine stool specimens tested, 100 were found to be positive for campylobacters: 95 were recovered with the SSM medium, 94 with the Virion medium, and 90 with the blood-free medium. The SSM medium performed equally well whether it was incubated in the special incubator or the candle jar. Only 4.4 and 7.3% of the plates grew contaminating fecal flora when incubated in the special incubator and the candle jar, respectively. Clearly the SSM medium is easy, quick, cheap, sensitive, and more selective than any other medium which has been developed so far and does not require the addition of blood. We believe that this medium has a future in the routine microbiology laboratory in developed as well as in developing countries. Images

Antibiotics in the Management of Shigellosis in Children: What Role for the Quinolones?

Abstract: In the last 20 years, epidemic bacillary dysentery due to Shigella dysenteriae type 1 has become an important cause of serious morbidity and death in children less than 5 years of age in a number of developing countries; in many instances the infecting strains have been resistant to many or all of the usually recommended antibiotics. Moreover, an increasing proportion of Shigella strains of other serotypes isolated in all parts of the world are now resistant to the most commonly used antibiotics. The new fluoroquinolones have been shown to be active against Shigella in vitro and effective for the treatment of shigellosis in adults, but concern about the safety of quinolones has so far prevented the evaluation of these agents for the treatment of shigellosis in young children. Two observations, however, have led a Scientific Working Group of the World Health Organization to suggest that such studies would be appropriate for the following reasons: a one- or two-dose treatment is likely to be effective, and if so the amount of drug given would be far below the doses that have been determined to be toxic in animals; and nalidixic acid, which shares all the toxicity of the fluoroquinolones, is widely recommended--and in some areas routinely used--for the treatment of shigellosis in young children without reports of significant adverse effects. In the Group's view there is an urgent need to perform carefully conducted research to determine the safety and efficacy of fluoroquinolones for the treatment of shigellosis in children.

Recent research on impregnated mosquito nets.

Abstract: The present status of impregnated mosquito nets and other impregnated materials is discussed. Research projects which have produced most of the publications on this subject were conducted in areas in Africa with relatively high endemicity of malaria. In these areas, usage of impregnated mosquito nets caused substantial reductions in the sporozoite inoculation rates and some reduction in incidence of malaria attacks. However, there was little or no reduction in parasite rates in the human population. In several countries in Asia and the Pacific, vector control with impregnated mosquito nets has been introduced on a large scale, thus proving its affordability and compatibility with local customs in these countries. Substantial reductions in malaria parasite rates have been obtained in areas with low levels of malaria transmission. In order to develop the vector control method which is most appropriate for each area, much more research is needed on the technical and organizational aspects of vector control with impregnated mosquito nets. Examples are given of data already available as well as an indication of gaps in knowledge which still exist and will need more attention.