World Health Organization

About: World Health Organization is a government organization based out in Islamabad, Pakistan. It is known for research contribution in the topics: Population & Public health. The organization has 13330 authors who have published 22232 publications receiving 1322023 citations. The organization is also known as: World Health Organisation & WHO.

The Impact of Endocrine Disruption: A Consensus Statement on the State of the Science

Abstract: Perspectives | Editorial The Impact of Endocrine Disruption: A Consensus Statement on the State of the Science doi:101289/ehp1205448 Ake Bergman, 1 Jerrold J Heindel, 2,a Tim Kasten, 3,b Karen A Kidd, 4 Susan Jobling, 5 Maria Neira, 6,c R Thomas Zoeller, 7 Georg Becher, 8 Poul Bjerregaard, 9 Riana Bornman, 10 Ingvar Brandt, 11 Andreas Kortenkamp, 5 Derek Muir, 12 Marie-Noel Brune Drisse, 6,c Roseline Ochieng, 13 Niels E Skakkebaek, 14 Agneta Sunden Bylehn, 3,b Taisen Iguchi, 15 Jorma Toppari, 16 and Tracey J Woodruff 17 1 Department of Materials and Environmental Chemistry, Stockholm University, Stockholm, Sweden; 2 National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA; 3 United Nations Environment Programme (UNEP), Geneva, Switzerland; 4 Department of Biology & Canadian Rivers Institute, University of New Brunswick, Saint John, New Brunswick, Canada; 5 Institute for the Environment, Brunel University, Uxbridge, Middlesex, United Kingdom; 6 Department of Public Health and Environment, World Health Organization, Geneva, Switzerland; 7 Biology Department, Morrill Science Center, University of Massachusetts, Amherst, Massachusetts, USA; 8 Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway; 9 Institute of Biology, University of Southern Denmark, Odense, Denmark; 10 Department of Urology, School of Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa; 11 Department of Environmental Toxicology, Uppsala University, Uppsala, Sweden; 12 Aquatic Ecosystems Protection Research Division, Water Science & Technology Directorate, Environment Canada, Burlington, Ontario, Canada; 13 Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya; 14 University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark; 15 Department of Bioenvironmental Science, Okazaki Institute for Integrative Bioscience, National Institute for Basic Biology, National Institutes of Natural Sciences, Okazaki Aichi, Japan; 16 Departments of Physiology and Paediatrics, University of Turku, Turku, Finland; 17 Department of Obstetrics, Gynecology and Reproductive Sciences, Institute for Health Policy Studies, University of California San Francisco, Oakland, California, USA In 2002, the joint International Programme on Chemical Safety (IPCS) of the World Health Organization (WHO), the United Nations Environment Programme (UNEP), and the International Labour Organisation (ILO) published a report titled Global Assessment of the State-of-the-Science of Endocrine Disruptors (http://wwwwhoint/ ipcs/publications/new_issues/endocrine_disruptors/en/) Since 2002, intense scientific work has improved our understanding of the impacts of endocrine-disrupting chemicals (EDCs) on human and wildlife health, such that in 2012, the UNEP and WHO, in collaboration with international experts, have produced an updated document on EDCs, State of the Science of Endocrine Disrupting Chemicals - 2012 (http:// wwwwhoint/ceh/publications/endocrine/en/indexhtml) that includes scientific information on human and wildlife impacts and lists key concerns for decision makers and others concerned about the future of human and wildlife health The basis for these key concerns is described in the State of the Science of Endocrine Disrupting Chemicals - 2012 (http://wwwwho int/ceh/publications/endocrine/en/indexhtml) and includes extensive references to the science behind the concerns A shorter summary, primarily for decision makers, elabo­rates on the key concerns listed below and and also on suggested considerations related to EDCs (State of the Science of Endocrine Disrupting Chemicals - 2012: Summary for Decision-Makers; http://wwwwhoint/ceh/publications/endocrine/en/ indexhtml) The key concerns noted in the State of the Science of Endocrine Disrupting Chemicals - 2012 (http://wwwwhoint/ceh/publications/ endocrine/en/indexhtml) are as follows: • Human and wildlife health depends on the ability to reproduce and develop normally This is not possible without a healthy endocrine system • Three strands of evidence fuel concerns over endocrine disruptors: ǹ ǹ The high incidence and the increasing trends of many endocrine- related disorders in humans; ǹ ǹ Observations of endocrine-related effects in wildlife populations; ǹ ǹ The identification of chemicals with endocrine disrupting proper- ties linked to disease outcomes in laboratory studies • Many endocrine-related diseases and disorders are on the rise ǹ ǹ Large proportions (up to 40%) of young men in some countries have low semen quality, which reduces their ability to father children ǹ ǹ The incidence of genital malformations, such as non-descending testes (cryptorchidisms) and penile malformations (hypospadias), in baby boys has increased over time or levelled off at unfavour- ably high rates ǹ ǹ The incidence of adverse pregnancy outcomes, such as preterm birth and low birth weight, has increased in many countries ǹ ǹ Neurobehavioural disorders associated with thyroid disruption affect a high proportion of children in some countries and have increased over past decades ǹ ǹ Global rates of endocrine-related cancers (breast, endometrial, ovarian, prostate, testicular and thyroid) have been increasing over the past 40–50 years ǹ ǹ There is a trend towards earlier onset of breast development in young girls in all countries where this has been studied This is a risk factor for breast cancer ǹ ǹ The prevalence of obesity and type 2 diabetes has dramatically increased worldwide over the last 40 years WHO estimates that 15 billion adults worldwide are overweight or obese and that the number with type 2 diabetes increased from 153 million to 347 million between 1980 and 2008 • Close to 800 chemicals are known or suspected to be capable of inter- fering with hormone receptors, hormone synthesis or hormone con- version However, only a small fraction of these chemicals have been investigated in tests capable of identifying overt endocrine effects in intact organisms ǹ ǹ The vast majority of chemicals in current commercial use have not been tested at all ǹ ǹ This lack of data introduces significant uncertainties about the true extent of risks from chemicals that potentially could disrupt the endocrine system • Human and wildlife populations all over the world are exposed to EDCs ǹ ǹ There is global transport of many known and potential EDCs through natural processes as well as through commerce, leading to worldwide exposure ǹ ǹ Unlike 10 years ago, we now know that humans and wildlife are exposed to far more EDCs than just those that are POPs [persis- tent organic pollutants] ǹ ǹ Levels of some newer POPs in humans and wildlife are still increasing, and there is also exposure to less persistent and less bioaccumulative, but ubiquitous, chemicals Address correspondence to A Bergman, Department of Materials and Environmental Chemistry, Stockholm University, SE-10691 Stockholm, Sweden E-mail: akebergman@mmksuse United Nations Environment Programme (UNEP) address: 13 chemin des Anemones, CH-1219 Chatelaine, Geneva, Switzerland a The author is an employee of the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH); any statements, opinions, or conclusions contained herein do not necessar- ily represent the statements, opinions, or conclusions of the NIEHS, NIH, or the US government b The authors are staff members of the United Nations Environment Programme (ASB is now retired) The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions or policies of the United Nations Environment Programme c The authors are staff mem- bers of the World Health Organization (WHO) The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the views, decisions, or policies of the WHO This article should not be reproduced for use in association with the promotion of commercial products, services, or any legal entity The WHO does not endorse any specific organization or products Any reproduction of this article cannot include the use of the WHO logo The authors declare they have no actual or potential competing ­financial interests A 104 Environmental Health Perspectives volume 121 | number 4 | April 2013 •

Genetic Diversity of Plasmodium falciparum Histidine-Rich Protein 2 (PfHRP2) and Its Effect on the Performance of PfHRP2-Based Rapid Diagnostic Tests

Abstract: Rising costs of antimalarial agents are increasing the demand for accurate diagnosis of malaria. Rapid diagnostic tests (RDTs) offer great potential to improve the diagnosis of malaria, particularly in remote areas. Many RDTs are based on the detection of Plasmodium falciparum histidine-rich protein (PfHRP) 2, but reports from field tests have questioned their sensitivity and reliability. We hypothesize that the variability in the results of PfHRP2-based RDTs is related to the variability in the target antigen. We tested this hypothesis by examining the genetic diversity of PfHRP2, which includes numerous amino acid repeats, in 75 P. falciparum lines and isolates originating from 19 countries and testing a subset of parasites by use of 2 PfHRP2-based RDTs. We observed extensive diversity in PfHRP2 sequences, both within and between countries. Logistic regression analysis indicated that 2 types of repeats were predictive of RDT detection sensitivity (87.5% accuracy), with predictions suggesting that only 84% of P. falciparum parasites in the Asia-Pacific region are likely to be detected at densities ≤250 parasites/μL. Our data also indicated that PfHRP3 may play a role in the performance of PfHRP2-based RDTs. These findings provide an alternative explanation for the variable sensitivity in field tests of malaria RDTs that is not due to the quality of the RDTs.

Recommendations for surveillance of transmitted HIV drug resistance in countries scaling up antiretroviral treatment

Abstract: Background: The World Health Organization (WHO) HIV drug resistance (HIVDR) threshold survey method was developed for surveillance of transmitted HIVDR in resource-limited countries. The method is being implemented with minimal resources as a routine public health activity to produce comparable results in multiple countries and areas within countries. Transmitted drug resistant HIV strains will be seen first in cities or health districts where antiretroviral treatment (ART) has been widely available for years. WHO recommends countries begin surveillance in these areas. Methods: Each survey requires ≤47 specimens from individuals consecutively diagnosed with HIV to categorize resistance to each relevant drug class as 15%. Use of routinely collected information and remnant specimens is recommended to minimize costs. Site and individual eligibility criteria are designed to minimize inclusion of ARV-experienced individuals and individuals infected before ART was available. Results: Surveys have been implemented in 21 countries. In this supplement, seven countries report results of <5% transmitted HIVDR in areas where ART has been available for the longest time period. The main challenges in implementation are acquiring sufficient numbers of eligible specimens and optimizing specimen handling. Conclusion: The WHO HIVDR threshold survey method is feasible in resource-limited countries and produces information relevant to ART and drug resistance prevention planning.

WHO study on Prevention of REcurrences of Myocardial Infarction and StrokE (WHO-PREMISE)

Abstract: OBJECTIVE: To determine the extent of secondary prevention of coronary heart disease (CHD) and cerebrovascular disease (CVD) in low- and middle-income countries. METHODS: A descriptive cross-sectional survey of a sample of 10 000 CHD (85.2%) and CVD (14.8%) patients (6252 men; 3748 women) was conducted over 6 months in geographically defined areas. The mean age was 59.2 years (standard deviation (SD), 10.8). Consecutive patients were recruited from a stratified random sample of primary, secondary and tertiary care facilities in defined areas in 10 countries (Brazil, Egypt, India, Indonesia, Islamic Republic of Iran, Pakistan, Russian Federation, Sri Lanka, Tunisia and Turkey). The main outcome measures were levels of lifestyle and physiological risk factors, and the use of drugs for secondary prevention of CHD and CVD. FINDINGS: Approximately 82%, 89% and 77% of patients were aware of the cardiovascular benefits of quitting smoking, a heart-healthy diet and regular physical activity, respectively. About half (52.5%) engaged in less than 30 minutes of physical activity per day, 35% did not follow a heart-healthy diet and 12.5 % were current tobacco users. Blood pressure had been measured in 93.8% (range 71-100%), blood cholesterol in 85.5% (range 29-97%) and blood sugar in 75.5% (range 65-99%) in the preceding 12 months. The proportions who had received medications among CHD and CVD patients were: aspirin, 81.2%, 70.6%; beta-blockers, 48.1%, 22.8%; angiotensin-converting enzyme inhibitor, 39.8%, 37.8%; statins, 29.8%, 14.1%, respectively. About one-fifth of patients with CHD had undergone revascularization. CONCLUSION: A significant proportion of patients did not receive appropriate medications. About 47% of patients had at least two or more modifiable risk factors (smoking, physical inactivity, hypertension, diabetes or hypercholesterolaemia). There are considerable missed opportunities for prevention of recurrences in those with established CVD in low- and middle-income countries.