Showing papers by "World Health Organization published in 1993"
TL;DR: The AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
Abstract: The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
11,042 citations
TL;DR: Diabetes in adults is now a global health problem, and populations of developing countries, minority groups, and disadvantaged communities in industrialized countries now face the greatest risk.
Abstract: Objective— To assemble standardized estimates of abnormal glucose tolerance in adults in diverse communities worldwide and provide guidelines for the derivation of comparable estimates in future epidemiological studies. Research Design and Methods— The project was limited to population-based investigations that had used current WHO criteria for diagnosis and classification of abnormal glucose tolerance. Raw data were obtained by WHO from surveys conducted during 1976–1991 of over 150,000 persons from 75 communities in 32 countries. Data within the truncated age range of 30–64 yr were adjusted to the standard world population of Segi. Age-specific prevalences also are reported for selected populations. Results— Within the chosen age range, diabetes was absent or rare ( 50% were previously undiagnosed. In both Chinese and Indian migrant populations, relative prevalence was high when compared with indigenous communities. Conclusions— Diabetes in adults is now a global health problem, and populations of developing countries, minority groups, and disadvantaged communities in industrialized countries now face the greatest risk.
994 citations
Journal Article•
TL;DR: The worldwide distribution of protein-energy malnutrition is described, based on nationally representative cross-sectional data gathered between 1980 and 1992 in 79 developing countries in Africa, Asia, Latin America, and Oceania, to confirm that more than a third of the world's children are affected.
Abstract: Using the WHO Global Database on Child Growth, which covers 87% of the total population of under-5-year-olds in developing countries, we describe the worldwide distribution of protein-energy malnutrition, based on nationally representative cross-sectional data gathered between 1980 and 1992 in 79 developing countries in Africa, Asia, Latin America, and Oceania. The findings confirm that more than a third of the world's children are affected. For all the indicators (wasting, stunting, and underweight) the most favourable situation--low or moderate prevalences--occurs in Latin America; in Asia most countries have high or very high prevalences; and in Africa a combination of both these circumstances is found. A total 80% of the children affected live in Asia--mainly in southern Asia--15% in Africa, and 5% in Latin America. Approximately, 43% of children (230 million) in developing countries are stunted. Efforts to accelerate significantly economic development will be unsuccessful until optimal child growth and development are ensured for the majority.
604 citations
TL;DR: Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems.
Abstract: This WHO collaborative project is the first phase of a programme of work aimed at developing techniques for early identification and treatment of persons with hazardous and harmful alcohol consumption. The aim of the present study was to determine the prevalence of hazardous and harmful alcohol use among patients attending primary health care facilities in several countries, and to examine the correlates of drinking behaviour and alcohol-related problems in these culturally diverse populations. The broader purpose was to determine whether there was justification for developing alcohol screening instruments for cross-national use. One thousand, eight hundred and eighty-eight subjects in Australia, Bulgaria, Kenya, Mexico, Norway and the USA underwent a comprehensive assessment of their medical history, alcohol intake, drinking practices, and any physical or psychosocial problems related to alcohol. After non-drinkers and known alcoholics had been excluded, 18% of subjects had a hazardous level of alcohol intake and 23% had experienced at least one alcohol-related problem in the previous year. Intrascale reliability coefficients were uniformly high for the drinking behaviour (dependence) and adverse psychological reactions scales, and moderately high for the alcohol-related problems scales. There were strong correlations between the various alcohol-specific scales, and between these scales and measures of alcohol intake. Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems. These findings strengthen the case for developing international screening instruments for hazardous and harmful alcohol consumption.
487 citations
TL;DR: A large longitudinal multicenter collaborative study that investigated the form, frequency, course, and outcome of psychological problems that were seen in primary health care settings in 15 different sites around the world has produced a database that allows for the exploration of the nature of psychological disorders experienced by patients in general medical care.
Abstract: This article describes a large longitudinal multicenter collaborative study that investigated the form, frequency, course, and outcome of psychological problems that were seen in primary health care settings in 15 different sites around the world. The research employed a two-stage sampling design in which the 12-item General Health Questionnaire was administered to 26422 persons aged 18 to 65 years who were consulting health care services. Of these persons, 5604 were selected for detailed examinations using standardized instruments and were followed up at 3 months and 1 year to provide information on course and outcome. All assessment instruments have been translated into 13 different languages. The project has produced a database that allows for the exploration of the nature of psychological disorders experienced by patients in general medical care and their association with physical illness, illness behavior, and disability over time.
332 citations
TL;DR: A set of drug-use indicators produced and tested in twelve developing countries are presented and described, which include the use of indicators to increase awareness among prescribers in Malawi and Bangladesh, and to identify priorities for action.
315 citations
Journal Article•
TL;DR: In this paper, a review article demonstrates that weaning foods prepared under unhygienic conditions are frequently heavily contaminated with pathogens and thus are a major factor in the cause of diarrhoeal diseases and associated malnutrition.
Abstract: Infections and the malnutrition associated with them are responsible for a significant proportion of the 13 million deaths among infants and children under 5 years of age worldwide each year After respiratory infections, diarrhoeal diseases are the commonest illnesses and have the greatest negative impact upon the growth of infants and young children The causes of diarrhoeal diseases have traditionally been ascribed to water supply and sanitation In attempts to prevent such diseases, efforts by governments and nongovernmental organizations have been focused on and sometimes limited to improving water supply and sanitation as well as promoting and protecting breast-feeding Based on studies reported in the literature, this review article demonstrates that weaning foods prepared under unhygienic conditions are frequently heavily contaminated with pathogens and thus are a major factor in the cause of diarrhoeal diseases and associated malnutrition In the light of the evidence presented, it appears that current efforts are not sufficient to prevent diarrhoeal diseases: education of mothers in food safety principles, particularly weaning food, must also receive high priority Educational programmes based on the hazard-analysis-critical-control-point approach, taking into consideration also sociocultural factors, should be integrated into all national infant feeding or food and nutrition programmes
273 citations
Journal Article•
TL;DR: In Denmark, Netherlands, Norway, Sweden, and Switzerland an increasing number of cases of tuberculosis among foreign-born residents has resulted in a change from the expected downward trend, and there is currently no evidence of its increased transmission among the youngest age groups of the indigenous populations.
Abstract: Deaths due to tuberculosis have decreased uniformly in all countries in Western Europe, and most have occurred among those aged > or = 65 years. In recent years, tuberculosis case notifications have continued to decline in Belgium, Finland, France, Germany, and Spain, and have levelled off in Sweden and the United Kingdom; increases have, however, been recorded in Austria, Denmark, Ireland, Italy, Netherlands, Norway, and Switzerland. In Denmark, Netherlands, Norway, Sweden, and Switzerland an increasing number of cases of tuberculosis among foreign-born residents has resulted in a change from the expected downward trend. Human immunodeficiency virus (HIV) infection appears to contribute only marginally to the overall tuberculosis morbidity; however, it appears to be important in Paris and its surrounding areas, and tuberculosis is very common among HIV-infected persons in Italy and Spain. Despite these recent changes in the incidence of tuberculosis, there is currently no evidence of its increased transmission among the youngest age groups of the indigenous populations. Properly designed disease surveillance systems are critical for monitoring the tuberculosis trends so that each country can identify its own high-risk groups and target interventions to prevent, diagnose, and treat the disease. Tuberculosis remains a global disease and because of increasing human migrations, its elimination in Western Europe cannot be envisaged without concomitant improvements in its control in high-incidence, resource-poor countries.
268 citations
TL;DR: The data obtained suggest that the new neuropsychological tests developed by the WHO/UCLA Auditory Verbal Learning Test and the Color Trails 1 & 2 are more culture fair than others currently used to assess the same functional domains, and that they are sensitive to HIV-1-associated cognitive impairment.
236 citations
01 Jan 1993
TL;DR: Proven agroindustrial technologies should be applied to the cultivation and processing of medicinal plants and the manufacture of herbal medicines.
Abstract: Plant-derived drugs have an important place in both traditional and modern medicine. For this reason a special effort to maintain the great diversity of plant species would undoubtedly help to alleviate human suffering in the long term. Proven agroindustrial technologies should be applied to the cultivation and processing of medicinal plants and the manufacture of herbal medicines.
222 citations
TL;DR: An increase in travel, the Indian and Sudanese epidemics of visceral leishmaniasis, parasite resistance to antimony and the emergence of AIDS-related leish maniasis have all increased the urgency for new drugs, and led to reappraisals of the old ones, as discussed here.
TL;DR: The ICD-10 Symptom Checklist was found to be a reliable diagnostic tool (overall kappa 0.72) within the constraints of the interviewer/observer reliability study design.
Abstract: The ICD-10 Symptom Checklist is a semi-structured diagnostic instrument intended for clinicians' assessment of F0-F6 categories in the ICD-10 Classification of Mental and Behavioural Disorders. The instrument was preliminarily tested at the St. Louis site during its participation in the field trials of the ICD-10 Diagnostic Criteria for Research. The Checklist was found to be a reliable diagnostic tool (overall kappa 0.72) within the constraints of the interviewer/observer reliability study design. More rigorous tests of the psychometric properties of the instrument are necessary.
TL;DR: Prospects of any significant improvement in the sleeping sickness situation would largely depend on the successful mobilization of external resources, and the focus of attention and resources on the AIDS pandemic.
TL;DR: The psychiatry resident users in this project found the Checklist to be a valuable teaching instrument, a way to develop their thinking about symptoms and diagnostic rules, an efficient means of collecting an automated clinical data base, and a stimulus to pursue further research activities.
01 Jan 1993
TL;DR: The present estimate of global mortality caused by cardiovascular diseases is accompanied by a considerable degree of uncertainty, which, in so far as monitoring their emergence in developing countries is concerned, undoubtedly represents one of the major obstacles to effective public health interventions for their control.
Abstract: In this article various approaches to assess the cardiovascular disease burden in [developing] countries will be discussed based on data and information available to WHO....The most promising avenue is that of the progressive implementation of clearly defined mortality surveillance systems that cover all deaths and permit the attribution of probable causes via lay reporting. The reliability of the data largely depends on the specificity and clarity of the verbal autopsy algorithm employed and on the availability of medically trained personnel to validate the returns. (SUMMARY IN FRE) (EXCERPT)
01 Jan 1993-Food Additives and Contaminants Part A-chemistry Analysis Control Exposure & Risk Assessment
TL;DR: Since 1980, systematic efforts have been made by the Joint UNEP/FAO/WHO Food Contamination Monitoring Programme to collect information on dietary intake of various contaminants, exemplified by lead, cadmium and mercury, where highest levels occurred in offal and shellfish and lowest in infants consuming only breast milk.
Abstract: Since 1980, systematic efforts have been made by the Joint UNEP/FAO/WHO Food Contamination Monitoring Programme to collect information on dietary intake of various contaminants, exemplified by lead, cadmium and mercury. In 1980-88, average adult intakes of lead varied from 1 to 63 micrograms/kg bw/week, approaching or exceeding the Provisional Tolerate Weekly Intake (PTWI) of 25 micrograms/kg bw in four countries providing data. Major sources in food and drinking water differed from country to country. A downward trend was observed consequent on reduction in use of lead-soldered cans and of lead in petrol. Few countries provided data on intakes by infants and children (more vulnerable groups) but the mean exceeded the PTWI in three countries, heavily influenced by levels in water and lowest in infants consuming only breast milk. Average adult intakes of cadmium were, with one exception, below the PTWI of 7 micrograms/kg bw; intakes by children were higher on a body weight basis but still within the PTWI in countries supplying data. Highest levels occurred in offal (mean 320 micrograms/kg) and shellfish (200 micrograms/kg) but, because of amounts consumed, reduction of concentrations in cereals, roots and tubers would be most effective. Important sources of contamination included phosphate fertilizer sewage sludge, plated/galvanized equipment, enamels and glazes. For mercury, average intakes were below the PTWI (300 micrograms/person; 200 micrograms/person or 3.3 micrograms/kg bw as methylmercury) for adults and for breast-fed infants. Contributions from fish varied from 20 to 85%; in some countries because of different dietary habits, cereals or meat may contribute similar amounts. Because of inadequate data on food other than fish, intake estimates are biassed and sometimes based solely on typical levels in fish.
TL;DR: It is found that control programmes must be undertaken at the community level to be effective and the search for less expensive, yet effective, control options must continue, and this requires research not only into the costs of the various options, but also into the determinants of community acceptance, compliance and participation.
Journal Article•
TL;DR: Results show that bone marrow-derived macrophages from BALB/c mice, after infection with L.major, have a greatly reduced capacity to present OVA, beta-galactosidase, and L. major-derived Ag to specific T cell hybrids derived from mice immunized with those Ag.
Abstract: Impairment of the Ag-presenting capacity of macrophages harboring intracellular Leishmania might represent one of the several mechanisms by which these parasites can evade host-protective T cell responses. Thus, the present study was designed to investigate the ability of macrophages, parasitized with Leishmania major, to present Ag to relevant T cell hybridomas. Results show that bone marrow-derived macrophages from BALB/c mice, after infection with L. major, have a greatly reduced capacity to present OVA, beta-galactosidase, and L. major-derived Ag to specific T cell hybrids derived from mice immunized with those Ag. In contrast, after pulsing with relevant peptide, macrophages containing L. major have a normal Ag-presenting capacity. The inhibition of presentation of native Ag did not appear to result from decreased endocytosis or catabolism. Inasmuch as the inhibition of presentation could not be attributed to an impaired processing of the Ag or an unavailability of MHC class II molecules on the surface of infected cells, these results could indicate that the presence of L. major interferes with the intracellular loading of MHC class II molecules with antigenic peptides.
TL;DR: Great effort must be made to confront the stigma denial and taboo associated with AIDS and especially accept and understand the fact that children and adolescents are experiencing sexual intercourse at ever younger ages; abstinence is not a viable alternative for most.
Abstract: HIV and AIDS are present in countries around the globe. The incidence of HIV infection increases in Latin America and the Caribbean North Africa and the Middle East eastern Europe and Asia despite the research communitys comparatively extensive knowledge on HIV and the existence of methods of proven efficacy for preventing its transmission. The majority of the estimated 13 million individuals infected with HIV as of mid-1993 acquired it through heterosexual intercourse. Since HIV is essentially a sexually transmitted disease (STD) which can also be transmitted through blood and perinatally slowing its transmission through sexual routes will curb the AIDS pandemic. Vaccines are being developed which may eventually be capable of preventing HIV transmission. A safe and effective vaccine should not however be expected to reach the market until the end of the decade and it will not be 100% effective. A vaccine should thus be considered complementary to other prevention methods. Research must continue in a multidisciplinary multicultural and multinational cooperative fashion toward the development of a vaccine appropriate for the needs of developing countries yet with considerable priority given to the following: development of a vaginal microbicide; improving the understanding of HIV pathogenesis and immune response; improving approaches to the care of STDs; and finding better ways to encourage people to adopt and sustain personally appropriate forms of low-risk behavior. Great effort must also be made to confront the stigma denial and taboo associated with AIDS and especially accept and understand the fact that children and adolescents are experiencing sexual intercourse at ever younger ages; abstinence is not a viable alternative for most. These youths need to know that nonpenetrative sex does not transmit HIV and that condoms significantly reduce the risk of infection. Scientists are well placed to promote this plan of action both domestically and abroad.
TL;DR: The neutralization of IFN-gamma at the time of reinfection reduced the Leishmania-specific delayed-type hypersensitivity response, showing that this cytokine is involved in the recall of immunological memory to L. major in vivo.
Abstract: CD8+ T cells have been shown to contribute to the rapid resolution of secondary lesions developing in immune mice challenged with Leishmania major. In the present study, we assessed directly the participation of specific CD8+ T cells in the memory response induced in immune mice by reinfection. Lymphocyte populations from reinfected immune mice exhibit marked secondary gamma interferon (IFN-gamma) responses. The participation of IFN-gamma-producing CD8+ T cells in the memory response elicited by secondary infectious challenge was demonstrated in both genetically resistant immune CBA mice and genetically susceptible immune BALB/c mice that were rendered resistant by administration of anti-CD4 monoclonal antibody in the early phase of the primary infection. The protective function of CD8+ T cells in experimental murine cutaneous leishmaniasis might thus be explained in part by their ability to secrete IFN-gamma. In this context, the neutralization of IFN-gamma at the time of reinfection reduced the Leishmania-specific delayed-type hypersensitivity response, showing that this cytokine is involved in the recall of immunological memory to L. major in vivo.
TL;DR: Recent food-borne outbreaks of human listeriosis as well as numerous sporadic cases have been mainly caused by Listeria monocytogenes serovar 4b strains and it was of interest to find out whether a certain clone or a certain few clones were responsible for these cases and especially for outbreaks.
Abstract: Recent food-borne outbreaks of human listeriosis as well as numerous sporadic cases have been mainly caused by Listeria monocytogenes serovar 4b strains Thus, it was of interest to find out whethe
TL;DR: The best clinical course (one or two reasonably short episodes of depression with complete remission between episodes) was experienced twice as frequently in patients with a diagnosis of endogenous depression as in those diagnosed as suffering from psychogenic depression.
Abstract: The World Health Organization's study on depressive disorders in different cultures began in 1972. Cohorts of depressed patients were identified in Basle, Montreal, Nagasaki, Teheran and Tokyo. The patients were assessed using standardized measures of social and clinical functioning. Ten-year follow-up data on clinical course, service contact, suicidal acts and social function outcomes were available for 439 (79%) patients. Over one-third (36%) were re-admitted at least once in the follow-up period, half of whom (18%) had very poor clinical outcome. Twenty-four per cent suffered severe social impairment for over half the follow-up period, and over one-fifth (21%) showed no full remissions. The best clinical course (one or two reasonably short episodes of depression with complete remission between episodes) was experienced twice as frequently in patients with a diagnosis of endogenous (65%) as in those diagnosed as suffering from psychogenic depression (29%). Among all patients, a fifth (22%) had at least one episode lasting for more than 1 year, and 10% had an episode lasting over 2 years during follow-up. Death by suicide occurred in 11% of patients, with a further 14% making unsuccessful suicide attempts.
TL;DR: Follow-up of these women and their newborn children for 3-4 years showed no abnormal effect that could be attributed to the YF vaccine, which suggests that vaccination of pregnant women, particularly during a YF epidemic, may not be contraindicated.
Abstract: During an outbreak of yellow fever (YF) in Nigeria in 1986-1987, women at various stages of pregnancy were vaccinated against YF, either because those pregnancies were not known at the time or because they requested vaccination out of fear of acquiring the disease. This offered an opportunity to assess the safety and efficacy of YF vaccine in pregnant women and the effect of this vaccine on their newborn children. Pre-vaccination and post-vaccination serum samples from the vaccinated pregnant women were tested by enzyme-linked immunosorbent assay and by neutralization tests for antibody to YF virus. The results showed that the antibody responses of these pregnant women were much lower than those of YF-vaccinated, non-pregnant women in a comparable control group. Follow-up of these women and their newborn children for 3-4 years showed no abnormal effect that could be attributed to the YF vaccine, which suggests that vaccination of pregnant women, particularly during a YF epidemic, may not be contraindicated.
Journal Article•
TL;DR: The physical, chemical and biological agents considered in the revision process, the procedure used to define the new guidelines, their meaning and their relationships with statutory limits are reported.
Abstract: This paper describes the activity of the World Health Organization in the field of drinking water quality, particularly the revision of the Guidelines for drinking water quality published in 1984. This process will be completed with the publication of new guidelines in 1993. The paper reports the physical, chemical and biological agents considered in the revision process, the procedure used to define the new guidelines, their meaning and their relationships with statutory limits.
TL;DR: It is suggested that the gender relations of health are of considerable significance in explaining the differential consequences of tropical disease on women, men and children.
TL;DR: It is concluded that dual-energy X-ray absorptiometry provides an objective and quantitative assessment of new bone formation during leg lengthening and may decrease the requirements for conventional radiography.
Abstract: We measured the extent and rate of new bone formation over an 18-month period before, during and after the lengthening of ten leg segments in six patients aged between 8 and 18 years, using dual-energy X-ray absorptiometry (DEXA). New bone formation could be identified within one week of the start of distraction. As lengthening proceeded, the bone density of the gap fell, reaching minimum values at the time of maximal distraction. Consolidation of the regenerating bone was started 1 to 2 weeks later in the tibia, and 2.5 to 3.0 weeks later in the femur. The rate of mineral accretion in new bone was significantly greater in the tibia than in the femur (16 +/- 1.86%/month, and 11 +/- 1.1%/month respectively; mean +/- SEM). There was significant osteoporosis distal to the osteotomy, more in the tibia than in the femur, particularly on the side of the fixator. The bone mineral density of the distal segment remained low at the time of fixator removal (44.2 +/- 5.58% and 61.0 +/- 4.2% of the control values at the tibia and femur respectively) and was only partially reversed by subsequent weight-bearing. We conclude that dual-energy X-ray absorptiometry provides an objective and quantitative assessment of new bone formation during leg lengthening. The technique also allows the measurement of the distraction gap and the assessment of leg alignment from the high-resolution images. Its use may decrease the requirements for conventional radiography.
TL;DR: The results of this study do not support the hypothesis of an independent effect of alcohol consumption on the development of NIDDM, but increased alcohol consumption is associated with variation in other cardiovascular disease risk factors in these three populations.
Abstract: The associations of alcohol intake with the prevalence and incidence of non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance were examined in three populations at high risk for NIDDM. Population-based surveys performed in Mauritius in 1987, in Kiribati in 1981, and in Nauru in 1982 and 1987 provided data on alcohol intake, glucose tolerance, and associated risk factors for NIDDM in over 8,700 subjects not previously known to be diabetic. There was no consistent relation of alcohol intake to fasting or 2-hour glucose concentration in either prevalence or prospective studies. Odds ratios for newly diagnosed NIDDM associated with increasing alcohol intake were not significantly different from unity in any population in either prevalence or prospective data. Alcohol consumption was, however, related to other metabolic parameters associated with cardiovascular disease and NIDDM, i.e., increased systolic blood pressure, fasting triglycerides, uric acid, and high density lipoprotein cholesterol and a reduction in 2-hour insulin. The results of this study do not support the hypothesis of an independent effect of alcohol consumption on the development of NIDDM, but increased alcohol consumption is associated with variation in other cardiovascular disease risk factors in these three populations.
TL;DR: The 20-year history of social science research on male contraceptive methods is examined here in terms of the human and method factors related to the acceptability of hypothetical methods and the prevalence of use of existing methods.
Abstract: Globally, men have not shared equally with women the responsibility for fertility regulation. While family planning efforts have been directed almost exclusively toward women, the lack of male involvement may also reflect the limited options available to men. Current methods for men are either coitus-dependent, such as the condom or withdrawal, or permanent, such as vasectomy. The 20-year history of social science research on male contraceptive methods is examined here in terms of the human and method factors related to the acceptability of hypothetical methods and the prevalence of use of existing methods. New male methods, particularly if reversible, may alter men's willingness to accept or share responsibility for the control of fertility. Research opportunities in the areas of gender, decision-making, communication, health education, and service delivery will be enhanced when methods for women and men are comparable.
TL;DR: Schapira et al. as mentioned in this paper investigated the epidemiological factors associated with the development and spread of drug-resistant malaria and proposed a mathematical model to improve the conceptual basis for policy decisions and which has implications for drug development as well as for malaria-control programmes.