Showing papers by "World Health Organization published in 1997"

Alcohol Consumption and Mortality among Middle-Aged and Elderly U.S. Adults

Abstract: Background Alcohol consumption has both adverse and beneficial effects on survival. We examined the balance of these in a large prospective study of mortality among U.S. adults. Methods Of 490,000 men and women (mean age, 56 years; range, 30 to 104) who reported their alcohol and tobacco use in 1982, 46,000 died during nine years of follow-up. We compared cause-specific death rates and rates of death from all causes across categories of base-line alcohol consumption, adjusting for other risk factors, and related drinking and smoking habits to the cumulative probability of dying between the ages of 35 and 69 years. Results Causes of death associated with drinking were cirrhosis and alcoholism; cancers of the mouth, esophagus, pharynx, larynx, and liver combined; breast cancer in women; and injuries and other external causes in men. The mortality from breast cancer was 30 percent higher among women reporting at least one drink daily than among nondrinkers (relative risk, 1.3; 95 percent confidence interval,...

Strategies and tools for the control/elimination of lymphatic filariasis.

Abstract: Lymphatic filariasis infects 120 million people in 73 countries worldwide and continues to be a worsening problem, especially in Africa and the Indian subcontinent. Elephantiasis, lymphoedema, and genital pathology afflict 44 million men, women and children; another 76 million have parasites in their blood and hidden internal damage to their lymphatic and renal systems. In the past, tools and strategies for the control of the condition were inadequate, but over the last 10 years dramatic research advances have led to new understanding about the severity and impact of the disease, new diagnostic and monitoring tools, and, most importantly, new treatment tools and control strategies. The new strategy aims both at transmission control through community-wide (mass) treatment programmes and at disease control through individual patient management. Annual single-dose co-administration of two drugs (ivermectin + diethylcarbamazine (DEC) or albendazole) reduces blood microfilariae by 99% for a full year; even a single dose of one drug (ivermectin or DEC) administered annually can result in 90% reductions; field studies confirm that such reduction of microfilarial loads and prevalence can interrupt transmission. New approaches to disease control, based on preventing bacterial superinfection, can now halt or even reverse the lymphoedema and elephantiasis sequelae of filarial infection. Recognizing these remarkable technical advances, the successes of recent control programmes, and the biological factors favouring elimination of this infection, the Fiftieth World Health Assembly recently called on WHO and its Member States to establish as a priority the global elimination of lymphatic filariasis as a public health problem.

Behavioral and Psychological Signs and Symptoms of Dementia: A Consensus Statement on Current Knowledge and Implications for Research and Treatment

Abstract: The behavioral (e.g., repetitive questioning, hitting) and psychological (e.g., delusions, anxieties) signs and symptoms of dementia can result in suffering, premature institutionalization, increased costs of care, and significant loss in the quality of life for the patient and his or her family and caregivers.

Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child.

Abstract: About 12 million children under age 5 years die annually in developing countries 70% of which are due to pneumonia diarrhea malaria measles and malnutrition and 75% of children who seek health care at health facilities do so in response to morbidity from one of these conditions. Potentially fatal illnesses are often brought to the attention of health workers at first-level health facilities. This paper describes the technical basis of the guidelines for the integrated management of childhood illness (IMCI) approach presented in the WHO/UNICEF training course on IMCI for outpatient health workers at such first-level facilities in developing countries. These guidelines include the most important case management and preventive interventions against pneumonia diarrhea malaria measles and malnutrition. The training course enables health workers who use the guidelines to make informed correct decisions upon the management of sick children. The guidelines have been shaped through research studies and field-testing in the Gambia Ethiopia Kenya and Tanzania as well as in studies on the clinical signs of anemia and malnutrition. These studies as well as two others from Uganda and Bangladesh are presented.

Ribosomal RNA sequencing reveals differences between the genotypes of Giardia isolates recovered from humans and dogs living in the same locality.

Abstract: A polymerase chain reaction-based method for genotyping Giardia duodenalis isolates using a polymorphic region near the 5' end of the small subunit ribosomal (SSU) RNA gene is described. Analysis was performed using Giardia cysts purified directly from feces. Isolates were collected from humans and dogs living in isolated Aboriginal communities where Giardia infections are highly endemic. This is the first report of the genetic characterization of Giardia from dogs and humans living in the same locality. Comparison of the SSU-rRNA sequences from 13 human and 9 dog isolates revealed 4 different genetic groups. Groups 1 and 2 contained all of the human isolates, whereas groups 3 and 4 consisted entirely of Giardia samples recovered from dogs. One dog sample contained templates from both groups 2 and 3. These results suggest that zoonotic transmission of Giardia infections between humans and dogs does not occur frequently in these communities. The dog-associated SSU-rRNA sequences have not been reported before, suggesting a new G. duodenalis subgroup. A genetic basis for the differences observed between the groups was supported by sequence analysis of 9 in vitro cultured isolates that were placed into the same genetic groups established by enzyme electrophoresis.

Drug-Resistant Tuberculosis: Review of the Worldwide Situation and the WHO/IUATLD Global Surveillance Project

Abstract: The emergence of strains of Mycobacterium tuberculosis that are resistant to antimycobacterial agents is a worldwide problem whose global magnitude is not well described. We reviewed and tabulated 63 surveys of resistance to antituberculous drugs that were performed between 1985 and 1994. Rates of primary resistance to isoniazid, administered as a single agent, ranged from 0 to 16.9% (median rate, 4.1%); to streptomycin, 0.1%-23.5% (median, 3.5%); to rifampin, 0-3.0% (median, 0.2%); and to ethambutol, 0-4.2% (median, 0.1%). The rates of acquired resistance to these agents, which were higher than those of primary resistance, were as follows: isoniazid, 4.0%-53.7% (median rate, 10.6%); streptomycin, 0-19.4% (median, 4.9%); rifampin 0-14.5% (median, 2.4%); and ethambutol, 0-13.7% (median, 1.8%). The highest rates of multidrug-resistant tuberculosis have been reported in Nepal (48.0%), Gujarat, India (33.8%), New York City, (30.1%), Bolivia (15.3%), and Korea (14.5%). The WHO (World Health Organization) and the IUATLD (International Union Against Tuberculosis and Lung Disease) have established a global project of drug resistance surveillance that is based on standard epidemiological methods and quality control through an extensive network of reference laboratories. Accurate drug resistance surveillance data can be used to assess and improve national tuberculosis programs.

Socioeconomic and Demographic Factors Are Associated with Worldwide Patterns of Stunting and Wasting of Children

Abstract: We estimated the variability among nations in the prevalence of stunting and wasting, evaluated which national factors are associated with stunting and wasting and examined the relationship of stunting with wasting. The World Health Organization Global Database on Child Growth, a comprehensive conceptual model and a database of national factors were used with variance components and regression analyses. There was substantial variability among nations and among provinces within nations. Most national variability for stunting (76%) and wasting (66%) was explained by national factors and geographic region. Higher energy availability, female literacy and gross product were the most important factors associated with lower prevalence of stunting. The association of health expenditures and stunting differed by region. Higher immunization rate and, for Asia only, energy availability were the most important factors associated with lower prevalence of wasting. Regional differences in the relationship between stunting and wasting were accounted for by national factors. Some factors associated with stunting and wasting differ at the national level. Child malnutrition within a household is greatly influenced by issues at national and provincial levels, and intervention should be considered at all three levels.

Total Volatile Organic Compounds (TVOC) in Indoor Air Quality Investigations

Abstract: The amount of volatile organic compounds (VOCs) in indoor air, usually called TVOC (total volatile organic compounds), has been measured using different definitions and techniques which yield different results. This report recommends a definition of TVOC referring to a specified range of VOCs and it proposes a method for the measurement of this TVOC entity. Within the specified range, the measured concentrations of identified VOCs (including 64 target compounds) are summed up, concentrations of non-identified compounds in toluene equivalents are added and, together with the identified VOCs, they give the TVOC value. The report reviews the TVOC concept with respect to its usefulness for exposure assessment and control and for the prediction of health or comfort effects. Although the report concludes that at present it is not possible to use TVOC as an effect predictor, it affirms the usefulness of TVOC for characterizing indoor pollution and for improving source control as required from the points of view of health, comfort, energy efficiency and sustainability.

Scientific basis for the content of routine antenatal care I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes

Abstract: Background. Scope and content of antenatal care programs are ritualistic rather than evidence-based. We wanted to identify elements of antenatal care which are of proven benefit in preventing or ameliorating specific adverse outcomes in the mother: bleeding, anemia, preeclampsia, sepsis and genito-urinary infection and obstructed labor. Methods. Review of recent literature, especially randomized controlled trials. Results and conclusions. Recent trials indicate that fewer routine visits for low-risk women do not put pregnancies at increased risk but may lessen patient satisfaction. Bleeding in pregnancy has many causes, none of which can be eliminated through antenatal care. Risk factors can be identified by history-taking. Counselling and advice on what to do is the best option. Anemia in pregnancy is common, especially in developing countries. Routine iron supplementation is not necessary in well-nourished populations, but iron and folate should be provided for every pregnant woman in areas of high anem...

Foodborne disease control: a transnational challenge.

Abstract: In the globalized political economy of the late 20th century, increasing social, political, and economic interdependence is occurring as a result of the rapid movement of people, images, values, and financial transactions across national borders. Another consequence of the increase in transnational trade, travel, and migration is the greater risk of cross-border transmission of infectious diseases. As the world becomes more interconnected, diseases spread more rapidly and effectively. With more than one million people crossing international borders every day, and with the globalization of food production, manufacturing, and marketing, the risk of infectious disease transmission is greater. Economic globalization has also increased the need for governmental budget austerity, and consequent national preparedness has been eroded. The emergence of new infectious diseases, as well as the reemergence of old ones, thus represents a crucial transnational policy issue. These problems cannot be resolved by national governments alone; they require international cooperation. This article analyzes the role of foodborne disease surveillance programs, nationally and internationally, in the control of foodborne diseases.

Population-based case-control study of teratogenic potential of corticosteroids.

Abstract: The teratogenic potential of oral and topical corticosteroid treatment during pregnancy was evaluated in the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1994. Corticosteroid tablet pregnancy exposure was 1.55% among 20,830 malformed cases and 1.41% among 35,727 healthy control births (P = 0.2). Corticosteroid ointment pregnancy exposure was 0.35% among malformed and 0.33% among control births (P = 0.7). The absolute risk of oral and ointment corticosteroid treatment was low in pregnancy and particularly in the second and third months of gestation, i.e., in the critical period for major congenital abnormalities. The adjusted odds ratio and the analysis of case-control pairs did not show any association between the rate of different congenital abnormalities and the corticosteroid treatment in the second and third months of gestation. Thus, treatments with corticosteroids in pregnancy do not appear to noticeably increase the risk of congenital abnormalities in humans.

Studying Knowledge, Culture, and Behavior in Applied Medical Anthropology

Abstract: In this article we argue that the concept ofknowledge, as utilized bypublic health professionals, is best regarded as cultural belief, as defined in anthropology. The implications of this position are explored, particularly as it relates to the development of a decision-making approach to the understanding and analysis of health care behavior. The methodological challenges posed by the new theoretical perspective that has emerged from the emphasis on decision making is discussed from the perspective of applied research. The role offocused ethnographic studies is examined and contrasted with ethnomedicine and survey approaches. Some main features of focused ethnographic methods are described and illustrated with a case example of acute respiratory infection (ARI) in Gambia. [knowledge and cultural beliefs, decision-making approaches, health behavior, focused ethnographic studies] ur purposes in this article are threefold: (1) to critically examine the twin concepts of cultural knowledge and cultural beliefs with respect to people's behaviors; (2) to place these concepts in a theoretical model of health-seeking behaviors; and (3) to outline an approach to empirical data gathering that can produce systematic data concerning cultural beliefs and knowledge that can be directly useful in health care programs.

DNA immunization circumvents deficient induction of T helper type 1 and cytotoxic T lymphocyte responses in neonates and during early life.

Abstract: The relative deficiency of T helper type 1 (Th1) and cytotoxic T lymphocyte (CTL) responses in early life is associated with an increased susceptibility to infections by intracellular microorganisms. This is likely to reflect a preferential polarization of immature CD4 T cells toward a Th2 rather than a Th1 pattern upon immunization with conventional vaccines. In this report, it is shown that a single immunization within the first week of life with DNA plasmids encoding viral (measles virus hemagglutinin, Sendai virus nucleoprotein) or bacterial (C fragment of tetanus toxin) vaccine antigens can induce adult-like Th1 or mixed Th1/Th2 responses indicated by production of IgG2a vaccine-specific antibodies and preferential secretion of interferon-γ (IFN-γ) compared with interleukin (IL)-5 by antigen-specific T cells, as well as significant CTL responses. However, in spite of this potent Th1-driving capacity, subsequent DNA immunization was not capable of reverting the Th2-biased responses induced after early priming with a recombinant measles canarypox vector. Thus, DNA vaccination represents a novel strategy capable of inducing Th1 or mixed Th1/Th2 and CTL responses in neonates and early life, providing it is performed prior to exposure to Th2-driving conventional vaccine antigens.

Tuberculosis and HIV: current status in Africa.

Abstract: Having radically and permanently altered the face of tuberculosis (TB) in Africa HIV/AIDS is the major threat to TB control programs in Africa. As HIV prevalence rises so will TB rates. TB rates will plateau once HIV infection does. The control of TB therefore partly depends upon the control of HIV transmission. The current epidemiological situation is described with regard to TB case notification incidence estimates and projections; TB and HIV co-infection; and evidence of the interaction between TB and HIV. The impact of HIV upon the clinical management of TB with regard to diagnostic obstacles and treatment complications is considered followed by an examination of the threats and opportunities for National Tuberculosis Program activities in Africa in the context of HIV/AIDS. Community-based TB care approaches and the role of isoniazid preventive therapy in HIV-infected people are also considered.

Control of rubella and congenital rubella syndrome (CRS) in developing countries, Part 2: Vaccination against rubella.

Abstract: In 1995-96 we conducted a review of rubella immunization strategies. Worldwide, 78 countries (more than one-third) reported a national policy of using rubella vaccine. This was closely related to country economic status. Based on the United Nations country classification, rubella vaccine is used in 92% of industrialized countries, 36% of those with economies-in-transition, and 28% of developing countries. Cases of congenital rubella syndrome (CRS) may be prevented as follows: by providing direct protection to women and/or schoolgirls (a selective vaccination strategy); by vaccinating boys and girls to provide indirect protection by reducing the transmission of rubella virus (a childhood vaccination strategy); or by a combination of these approaches (a combined strategy). A combined strategy was most commonly reported (60% of countries); seven countries (9%) reported a selective strategy; and 24 countries (31%) reported only childhood immunization. Experience has shown that it is essential to include vaccination of women of childbearing age in any rubella control strategy. Childhood vaccination alone may pose a risk of an increase in CRS cases. Although many countries have introduced rubella vaccine, few report any data on the impact of vaccination. Countries using rubella vaccine need to establish surveillance for rubella and CRS and monitor coverage in each of the target groups.

The syndrome of hypochondriasis: a cross-national study in primary care.

Abstract: Background. The nature and correlates of hypochondriasis are still poorly understood, especially in settings other than those in North America and Western Europe.

Health seeking behaviour and the control of sexually transmitted disease.

Abstract: What people do when they have symptoms or suspicion of a sexually transmitted disease (STD) has major implications for transmission and, consequently, for disease control. Delays in seeking and obtaining diagnosis and treatment can allow for continued transmission and the greater probability of adverse sequelae. An understanding of health seeking behaviour is therefore important if STD control programmes are to be effective. However, taboos and stigma related to sex and STD in most cultures mean that gaining a true picture is difficult and requires considerable cultural sensitivity. At the moment relatively little is known about who people turn to for advice, or about how symptoms are perceived, recognized or related to decisions to seek help. It is argued that such knowledge would assist programme planners in the development of more accessible and effective services, that studies of health seeking behaviour need to include a combination of qualitative and quantitative methods, and that studies should include data collection about people who do not present to health care facilities as well as those who do. A pilot protocol for studying STD-related health seeking behaviour in developing countries is briefly presented.