Showing papers by "World Health Organization published in 1994"

The International Personality Disorder Examination: The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration International Pilot Study of Personality Disorders

Abstract: Background: One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision , and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. Methods: The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. Results: The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. Conclusion: It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.

Peak bone mass.

Abstract: Peak bone mass, which can be defined as the amount of bony tissue present at the end of the skeletal maturation, is an important determinant of osteoporotic fracture risk.Measurement of bone mass development. The bone mass of a given part of the skeleton is directly dependent upon both its volume or size and the density of the mineralized tissue contained within the periosteal envelope. The techniques of single-1 and dual-energy photon or X-ray absorptiometry measure the so-called ‘areal’ or ‘surface’ bone mineral density (BMD), a variable which has been shown to be directly related to bone strength.Bone mass gain during puberty. During puberty the gender difference in bone mass becomes expressed. This difference appears to be essentially due to a more prolonged bone maturation period in males than in females, with a larger increase in bone size and cortical thickness. Puberty affects bone size much more than the volumetric mineral density. There is no significant sex difference in the volumetric trabecular density at the end of pubertal maturation. During puberty, the accumulation rate in areal BMD at both the lumbar spine and femoral neck levels increases to four- to sixfold over a 3-and 4-year period in females and males, respectively. Change in bone mass accumulation rate is less marked in long bone diaphyses. There is an asynchrony between the gain in statural height and bone mass growth. This phenomenon may be responsible for the occurrence of a transient period of a relative increase in bone fragility that may account for the pattern of fracture incidence during adolescence.Variance in peak bone mass. At the beginning of the third decade there is a large variability in the normal values of areal BMD in the axial and appendicular skeleton. This large variance, which is observed at sites particularly susceptible to osteoporotic fractures such as lumbar spine and femoral neck, is barely reduced after correction for statural height, and does not appear to increase substantially during adult life. The height-independent broad variance in bone mass develops during puberty at sites such as lumbar spine and femoral neck, where the accretion rate is markedly increased.Time of peak bone mass attainment. Despite the fact that a majority of studies did not indicate that bone mass continues to accumulate significantly during the third and fourth decades, it has been generally accepted that peak bone mass at any skeletal site is attained in both sexes during the mid-thirties. However, recent studies indicate that in healthy Caucasian females with apparently adequate intakes of energy and calcium, bone mass accumulation can virtually be completed before the end of the second decade, for both lumbar spine and femoral neck. It is possible that both genetic and environmental factors could influence the time of peak bone mass achievement.Determinants of peaks bone mass. Several variables, more or less independent, are supposed to influence bone mass accumulation during growth; heredity, sex, dietary components, endocrine factors, mechanical forces, and exposure to risk factors. Quantitatively, the most prominent factor appears to be the genetic determinant, as estimated by studies comparing monozygotic and dizygotic twins. That heredity is not to be the only determinant of peak bone mass is of practical interest, since environmental factors can be modified. With respect to nutrition, the quantitative importance of calcium intake in bone mass accumulation during growth, particularly at sites prone to osteoporotic fractures, remains to be clearly determined. The same can be said for the impact of physical activity. Finally, the crucial years when these external factors will be particularly effective on bone mass accumulation remain to be determined by longitudinal prospective studies in order to produce credible and well targeted recommendations for the setting up of osteoporosis prevention programs aimed at maximizing peak bone mass.

Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients

Abstract: The efficacy of calcium (Ca) in reducing bone loss is debated. In a randomized placebo-controlled double-masked study, we investigated the effects of oral Ca supplements on femoral shaft (FS), femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD), and on the incidence of vertebral fracture in vitamin-D-replete elderly. Ninety-three healthy subjects (72.1±0.6 years) were randomly allocated to three groups receiving 800 mg/day Ca in two different forms or a placebo for 18 months. Sixty-three patients (78.4±1.0 years) with a recent hip fracture were allocated to two groups receiving the two forms of Ca without placebo. FS BMD changes in Ca-supplemented non-fractured women were significantly different from those in the placebo group (+0.6±0.5% v −1.2±0.7%,p<0.05). There was no difference in effect between the two forms of Ca. The changes of +0.7±0.8% v −1.7±1.6% in FN BMD of Ca-supplemented women and the placebo group did not reach statistical significance. In fractured patients, FS, FN and LS BMD changes were −1.3±0.8, +0.3±1.6 and +3.1±1.2% (p<0.05 for the last). The rate of new vertebral fractures was 74.3 and 106.2 fractures per 1000 patient-years in Ca-supplemented non-fractured subjects and in the placebo group, respectively, and 144.0 in Ca-supplemented fractured patients. Thus, oral Ca supplements prevented a femoral BMD decrease and lowered vertebral fracture rate in the elderly.

At least one in seven cases of cancer is caused by smoking. Global estimates for 1985

Abstract: Tobacco smoking is accepted as a major cause of cancers of the lung, larynx, oral cavity and pharynx, oesophagus, pancreas, kidney and bladder. The proportions of these cancers that are due to smoking were estimated for the year 1985 for 24 areas of the world. Fifteen percent--1.1 million new cases per year--of all cancer cases are attributed to cigarette smoking, 25% in men and 4% in women. In developed countries, the tobacco burden is estimated at 16% of all annual incident cases. In developing countries, the corresponding figure is 10%. In total, 85% of the 676,000 cases of lung cancer in men are attributable to tobacco smoking. The highest attributable fractions (AF: 90-93%) are estimated in areas where the habit of cigarette smoking in men has been longest established: North America, Europe, Australia/New Zealand and the former USSR. Among the other 6 cancer sites considered in this analysis, those with the largest fractions of tobacco-related cases are the larynx, mouth and pharynx (excluding nasopharynx) and oesophagus. In regions where males have smoked for several decades, 30 to 40% of all cancers in this sex are attributable to tobacco. Unless tobacco-control efforts in developing countries are strengthened, the massive rise in cigarette consumption over the last few decades will produce a comparable rise in cancer in these countries within the next 20 to 30 years.

Vaccination against typhoid fever: present status

Abstract: Typhoid fever remains an underestimated important health problem in many developing countries, causing more than 600,000 deaths annually in the world. Because of the reactogenicity of the parenteral, killed whole-cell vaccine, research has been oriented towards vaccination orally using live organisms and purified antigen. Live vaccine Ty21a, given by the oral route, has been extensively tested in several studies in developing countries. Its liquid formulation was the most effective, providing more than 60% protection after 7 years of follow-up. A Vi polysaccharide vaccine has been elaborated and provided more than 65% protection; after 3 years of follow-up the Vi antibody level was still at a high level. These two vaccines are therefore candidates for use in public health control programmes. Before such use, however, they need further evaluation for safety and protective efficacy when administered to the EPI-targeted age groups. The question of whether typhoid fever vaccines interfere with the response to simultaneously administered measles vaccine must also be studied. New live vaccines, given by the oral route in one dose, have been constructed through genetic engineering. The first results are promising, but they must be improved before use in a large-scale study. These strains could be used as live vector to deliver foreign antigens to the intestinal mucosa.

Infectious disease surveillance: a crumbling foundation.

Abstract: O u r ability to detect and monitor infectious disease threats to health is in jeopardy. False perceptions that such threats had dwindled or disappeared led to complacency and decreased vigilance regarding infectious diseases, resulting in a weakening of surveillance--the foundation for control of infectious diseases (1). However, such infectious diseases as acquired immunodeficiency syndrome (AIDS), influenza, and pneumonia are leading causes of death i,n the United States and the world. As microorganisms adapt to dramatic changes in our society and environment, we remain vulnerable to a wide array of new threats in the form of emerging, resurgent, and drug-resistant infections (Table 1) (2, 3). Surveillance has served as the basis for important public health responses to new threats: identifying contaminated food or other products, determining the influenza virus strains to include in each year's vaccine, and monitoring the safety of our blood supply. Improved surveillance, including strengthened laboratories, is needed to assess the extent of illness and death associated with infectious diseases so that priorities can be assigned to control efforts. Surveillance is also critical in assessing the effectiveness of regulatory and advisory veillance has encompassed not only the reporting and investigation of cases but also the submission of clinical specimens, when needed, for testing at local, state, or federal public health laboratories. This network has constituted the foundation for guiding communicable disease prevention and control activities. The system breaks down if any one step, such as appropriate diagnostic testing, reporting by physicians to public health agencies, or follow-up investigation, is not accomplished. During the past decade, state and local support for infectious disease surveillance has diminished as a result of budget restrictions. In 12 states, for example, no personnel are dedicated to foodborne disease surveillance despite dramatic evidence that the spectrum of disease caused by microbiaOlOgically contaminated food is expanding nd that foodborne disease outbreaks in this country may be increasing (5, 6). Moreover, there has been nO Federal financial support to states for the notifiable disease surveillance system and many state health laboratories receive no federal support (7). Targeted federal programs for prevention and control of AIDS, tuberculosis (TB), sexually transmitted diseases, and childhood vaccine-preventable diseases measures designed to safeguard public have been unable to rely on data from this health, such as drinking water standards and guidelines for the prevention of infectious diseases in child care facilities. Infectious disease surveillance in the UnitedStates relies heavily upon a national notifiable disease system. The legal authority for disease reporting rests with the states, which determine diseases or conditions to be reported by all physicians, laboratories, or others to local or state public health authorities (4). In turn, the states voluntarily report cases of more than 40 infectious diseases to the Centers for Disease Control and Prevention (CDC). Sur-

A randomized controlled trial comparing mebendazole and albendazole against Ascaris, Trichuris and hookworm infections

Abstract: The efficacies and side effects of single dose treatments with 500 mg mebendazole (Janssen Pharmaceutica) and 400 mg albendazole (SmithKline Beecham) against intestinal nematodes were compared in a single-blind, randomized controlled trial among 2294 children aged 6 to 12 years on Pemba Island, Zanzibar, among whom infections with Ascaris, hookworms and Trichuris were highly prevalent. Both drugs were highly effective against Ascaris, with cure rates of over 97%. The cure rates for Trichuris were low, but mebendazole was significantly better than albendazole and produced a greater reduction in the geometric mean egg count. Mebendazole was inferior to albendazole in curing hookworm infections and in reducing the geometric mean egg count. There was no difference in the frequency of side effects reported by heavily infected children treated with either drug. In a trial on 402 children, 500 mg mebendazole (Janssen) was compared with a generic version of the drug, 500 mg mebendazole (Pharmamed). No difference was apparent in the efficacies of the 2 treatments against any of the 3 parasites studied.

Rheumatic diseases in China: ILAR-China study comparing the prevalence of rheumatic symptoms in northern and southern rural populations.

Abstract: Objective To determine the prevalence of rheumatic diseases in Han Chinese in north and south China. Methods Samples of 4192 adults in the Beijing (north) and 5057 in the Shantou (south) areas, based on village administration registers, were studied. The same questionnaire was administered by doctors who then examined those with rheumatic symptoms. One observer (QYZ) took part in both studies. Results The prevalence of definite rheumatoid arthritis (RA) was 0.34% (95% CI; 0.20-0.51) in the north and 0.32% (0.16-0.47) in the south. Ankylosing spondylitis (AS) was noted in 0.26% of both samples (95% CI; 0.11-0.42 north and 0.14-0.40 south). Only 3 cases of systemic lupus erythematosus (SLE) in the north and one in the south were identified. General rheumatic pain was reported more frequently in the north. Lumbar problems were recorded on examination 5 times more frequently in the north than in the south [men, 25%:5.3%; women 38%:6.5%] and knee problems 10 times more frequently [men, 24%:1.8%; women, 36%:3.4%] in the north. The difference was greatest in the 55 to 64 year age group. Conclusion The prevalence of RA was similar to that in other rural populations and Japan, but only half that reported from other industrialized communities. The prevalence of AS was similar to that in most Caucasian populations. SLE was too infrequent to establish a prevalence with confidence, but did not differ from that in other populations. A study is planned in the south to assess the contribution of interobserver error and/or differences in cultural response to the north/south differences observed in the prevalence of general rheumatic symptoms and back pain.

Risking everything ? Risk behavior, behavior change, and AIDS

Abstract: Inquiry into the determinants of risk-related sexual behavior is important for the development of interventions to reduce the incidence of new cases of human immunodeficiency virus infection. Recent social and behavioral research has revealed much about the individual and social factors influencing risk-taking. Findings from these studies have been important in the development of new educational and community-based interventions for communities at risk in the developed and developing worlds.

Gender-related differences in the impact of tropical diseases on women: what do we know?

Abstract: This paper explores the importance of gender differences in the impact of tropical diseases on women. Malaria and schistosomiasis are used as examples but most of the observations also apply to other diseases endemic to developing countries. The distinction between sex and gender is discussed and evidence of sex and gender differences in the determinants and consequences of malaria and schistosomiasis, particularly their economic, social and personal dimensions, is reviewed. Issues on which research and intervention studies are needed are identified.

New versions of World Health Organization instruments for the assessment of mental disorders

Abstract: Over the past 3 decades, the development of reliable and cross-culturally applicable diagnostic criteria and instruments for the assessment of mental disorders has been one of the major goals of the WHO mental health programme. The most important step in this endeavour of WHO was the production of the ICD-10 Classification of Mental and Behavioural Disorders and the following instruments: Composite International Diagnostic Interview (CIDI), Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and International Personality Disorder Examination (IPDE). This article outlines the basic characteristics of the latest editions of CIDI, SCAN and IPDE and provides descriptions of their newly developed versions and modules.

Congenital abnormalities associated with limb deficiency defects: a population study based on cases from the Hungarian Congenital Malformation Registry (1975-1984).

Abstract: Limb deficiency defects (LD) occurring among 1,575,904 births in Hungary during 1975-1984 were reviewed. The overall birth prevalence of LD was 1 in 1,816. This paper discusses the nature and distribution of the limb and other defects in the 275 (32%) children who had structural malformations in other systems. Two main forms of classification were used: morphologic and causal. Additional malformations were most commonly seen in infants with amelia, rudimentary limb (RL), radial/tibial (RT), intercalary or central axis (CA) LD and rarely in those with terminal transverse (TT) or ulnar/fibular (UF) defects. Upper limbs (81%) were involved significantly more often than lower limbs (42%) and there were more right-sided defects (83% vs. 71%) due to an excess of right arm involvement especially with radial ray and split hand anomalies. Single limb involvement was relatively common with amelia (88%), UF (82%), RT (50%), and TT (50%) defects. With other LD, multimelic involvement was more characteristic. This was usually symmetric with intercalary and RL defects but asymmetric with CA anomalies and digital deficiencies (DD). From a causal perspective, 17% of cases had genetic disorders, 52% had recognized associations, anomalies, sequences, environmental causes or patterns of unknown origin, and 31% had unknown patterns of malformations. The commonest entities were amnion disruption sequence (16% of cases) and VACTERL association (8%). Both of these disorders showed unusual temporal distribution. As anticipated, patterns of malformations differed with the type of LD. Amelia and digital amputations were often seen with body wall defects, atypical anencephaly or encephalocele, and cleft lip reflecting amnion disruption. Rudimentary limb was seen with anencephaly, omphalocele, renal agenesis, aberrant genitalia, and imperforate anus, reflecting defects of blastogenesis including the cloacal exstrophy and caudal regression sequences and Schisis association. Radial/tibial defects were associated with different patterns depending on whether the limb defects were unilateral or bilateral. Unilateral defects occurred with anomalies suggesting VACTERL association or the facio-auriculo-vertebral anomaly, while bilateral defects occurred more often in genetic or potentially genetic disorders including VACTERL with hydrocephalus. Central axis defects showed three main patterns of association: one reflecting the ectrodactyly-ectodermal dysplasia-clefting syndrome; one with tongue anomalies representing a variant of oro-mandibular-limb (Hanhart) anomaly, and the last with hydronephrosis indicating a group of "acro-renal" syndromes. Strong associations with other anomalies were not seen in the groups with TT, UF, or intercalary defects.

Human Immunodeficiency Virus Type 1 Seroconversion in Women with Genital Ulcers

Abstract: Genital ulcers are implicated as a risk factor enhancing susceptibility to human immunodeficiency virus type 1 (HIV-1) infection. A prospective study to determine the incidence of and risk factors associated with acquisition of HIV-1 in women with genital ulcers was done. HIV-1-seronegative women with genital ulcers attending a clinic for sexually transmitted diseases in Nairobi were followed to HIV-1 seroconversion over a 6-month period. Of 81 women 10 seroconverted to HIV-1. The crude 6-month incidence of HIV-1 infection was 12%. Risk factors associated with seroconversion included cervical ectopy (rate ratio [RR] 4.9; 95% confidence interval [CI] 1.5-15.6) and pelvic inflammatory disease (RR 6.3; 95% CI 1.9-20.4). Thus cervical ectopy and pelvic inflammatory disease may increase susceptibility to HIV-1 in women with genital ulcers. (authors)

Expansion of gamma interferon-producing CD8+ T cells following secondary infection of mice immune to Leishmania major.

Abstract: Reinfection of immune mice with Leishmania major elicits a secondary gamma interferon (IFN-gamma) response to which specific CD8+ T cells are essential. We have shown previously that specific CD8+ T cells from reinfected immune mice release substantially higher levels of IFN-gamma, a cytokine essential for the efficient activation of parasitized macrophages to kill intracellular L. major. By using an ELISPOT assay, which allows the detection of IFN-gamma production by individual cells, it is shown here that this elevated IFN-gamma response is the result of an increase of up to 50-fold in the frequency of parasite-specific CD8+ T lymphocytes in the spleens and draining lymph nodes of both immune reinfected CBA and BALB/c mice. This observation is additional evidence of the role that CD8+ T cells play in immunity to reinfection with L. major.

Longitudinal measurement of regional and whole body bone mass in young healthy adults.

Abstract: The so-called peak bone mass (PBM) represents the highest amount of bony tissue achieved during life at a given site of the skeleton. It has been suggested that PBM might be achieved as late as the fourth decade, but recent data have indicated that PBM is already achieved by the end of sexual maturation, namely at the end of the second decade. The solving of this apparent controversy is of interest for a better understanding of bone homeostasis and for defining the cohort of normal subjects to be evaluated in order to establish a PBM reference range--necessary for the diagnosis of osteoporosis and evaluation of the fracture risk. To study bone mass evolution in young healthy adults and to determine whether such a cohort can be used to establish PBM reference values, we measured bone mineral density (BMD) in sixty 20- to 35-year-old young healthy adults by dual-energy X-ray absorptiometry at the levels of the lumbar spine (in both anteroposterior and lateral views), femoral neck, trochanter region, total hip and of Ward's triangle, as well as whole-body BMD and bone mineral content (BMC) in cross-sectional and longitudinal studies. In the cross-sectional analysis, none of the bone mass variables was dependent on age using linear regression analysis. The longitudinal study indicated that the mean changes in lumbar spine, proximal femur and whole body BMD or BMC determined after a 1-year interval were not statistically different from zero in either females or males aged 20-35 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical trials of improved oral rehydration salt formulations: a review.

Abstract: Reviewed are all the published clinical trials of glycine-based oral rehydration salts (ORS), L-alanine-based ORS, L-glutamine-based ORS, maltodextrin-based ORS, and rice-based ORS, as well as the results of several recently completed, but unpublished, studies of these formulations that were supported by WHO. All experimental ORS formulations contained the same concentrations of salts as citrate-based WHO-ORS; all trials were randomized comparisons with WHO-ORS, and all except those with rice-based ORS were double-blind studies. The rate of stool loss and, less frequently, the duration of diarrhoea were used as indicators of clinical performance to compare ORS formulations. The following conclusions were reached concerning the efficacy and use of modified ORS formulations. Rice-based ORS (50 g/l) is superior to WHO-ORS for patients with cholera, and for such patients it can be recommended in any situation where its preparation and use are practical. Rice-based (50 g/l) and WHO-ORS solutions are equally effective for treating children with acute non-cholera diarrhoea, when feeding is resumed promptly following initial rehydration, as has been consistently recommended by WHO. Since rice-based ORS is not superior to WHO-ORS for such children, there is no apparent reason to advise a change from glucose to pre-cooked rice in the recommended formulation for WHO-ORS. Maltodextrin-based ORS formulations (50 g/l) and WHO-ORS appear to be equally effective for treating children with acute non-cholera diarrhoea; there is no reason to advise a change from glucose to maltodextrin in the recommended formulation for WHO-ORS. Amino-acid-containing ORS formulations are not recommended for either non-cholera or cholera diarrhoea, since they are more costly and have no clinical advantage over WHO-ORS for children with acute non-cholera diarrhoea or over rice-based ORS for persons with cholera.

Minor Depression in a Cohort of Young Adults in Israel

Abstract: Background: A diagnosis of minor depression was considered for DSM-IV. Mild depression is thought to be common in primary care settings and in the community, but studies of the validity of minor depression as a separate diagnostic category are few. Methods: Minor depression as defined by Research Diagnostic Criteria was assessed by psychiatrists using a modified Schedule for Affective Disorders and Schizophrenia—Lifetime version in a cohort of 5200 young adults in Israel. Subjects with year-prevalent minor depression were compared with subjects with major depression or generalized anxiety disorder and with controls on aspects of psychopathologic condition, psychosocial functioning, help-seeking behaviors, and demographic correlates. Results: Symptomatically, minor depression appeared to be a mild version of major depression. Minor depression was associated with good teenage and general social functioning, but also with absence from work, separation or divorce, recent impairment in overall functioning, and help-seeking. Conclusions: The results lend support for including minor depression or expanding severity modifiers in future classifications to better capture the phenomenon of subthreshold depression.