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The World Health Organization has played a major part in the development, surveillance and distribution of attenuated poliovirus vaccines. At a time when most of the United States' efforts concerned the introduction of Salk-type vaccines, WHO initiated studies that set standards and permitted the large scale trials of Sabin and other attenuated vaccines. Independent expert review validated studies in countries such as the U.S.S.R. which helped lead to the adoption of Sabin vaccines for worldwide usage. Surveillance by WHO Collaborative Centres established the safety of Sabin vaccines and identified issues of reversion primarily concerning type 3 viruses, initiating studies which have elucidated the molecular mechanism of reversion. Efforts by the Biological Unit of the World Health Organization have ensured worldwide acceptable standards to control the safety and manufacture of vaccines. Revision of neurovirulence test methods has ensured adequate safety testing of vaccine lots, reduced the costs of such studies and the numbers of primates needed, important ethical and conservation issues. Finally, the World Health Organization has played a major part in the worldwide supply of vaccines at affordable prices and has been the repository of, and had the exclusive license, to Sabin vaccines since 1972.
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The World Health Organization established official recommendations for managing pain in cancer patients. Since then, this stepladder approach has been widely adopted as a conceptual framework to treat all types of pain. However, those guidelines have not been critically evaluated for use in patients with renal insufficiency. In these patients, the questions of drug dosage adjustment and renal toxicity must be considered. This article reviews the pharmacokinetics of major analgesic drugs and data on their use and/or behavior in renal failure and considers their potential nephrotoxicity. Finally, according to available data in the international literature on pharmacokinetics, recommendations for dosage adjustment in patients with renal failure, and their potential nephrotoxicity, the World Health Organization three-step ladder for the treatment of pain was modified and adapted for patients with impaired renal function. Perspective This well-known treatment strategy now adapted for use in patients with renal insufficiency should secure and rationalize pain treatment in those patients.
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During a two-year study, 670 girls (aged 11-15 years) submitted menstrual diaries that started at the onset of their first menstrual bleeding (Group I), and 802 girls (aged 11-15 years) who had already experienced menarche prior to the study (Group II) kept similar diaries. The two groups were recruited in three centers: Colombo (urban), Peradeniya (rural), both in Sri Lanka, and Hong Kong. The mean duration of bleeding episodes was 4.7 days (SD 1.8) in Group I and 4.9 days (SD 1.4) in Group II. The median length of the first cycle after menarche was 34 days, with 38.3% of the cycles being longer than 40 days. By the 5th cycle the median length was 31 days, similar to that of Group II. The establishment of cycle regularity was defined by three successive cycles within the range of 10 days with none of the three cycles shorter than 20 or longer than 40 days. This regularity was achieved by 19% of the Group I girls in the first three cycles and by 67% of these girls during the entire study period, compared to 89% in Group II.
The World Health Organization Western Pacific Region Gonococcal Antimicrobial Surveillance Programme examined over 11,000 isolates of Neisseria gonorrhoeae from 13 countries for resistance to antibiotics in 2003. Very high rates of resistance to penicillins and quinolones were again present in most centres, but little resistance to spectinomycin was detected. Several centres once more reported the presence of gonococci with decreased susceptibility to third generation cephalosporins. Treatment options for gonococcal disease acquired in the Region are increasingly limited.
The World Health Organization (WHO) is the specialized agency of the UN on public health. It gives worldwide guidance in the field of health, sets global standards for health, cooperates with governments to strengthen national health care programs, and develops and transfers appropriate health technology, information, and standards. Within the WHO European region, health status and health expenditures vary greatly. In this paper, disparities between health status, health services, and health care expenditures between countries of the WHO European region are presented. The objectives, performance, and dilemmas facing health care systems are discussed, including the recent performance ranking published by the WHO. The paper focuses particularly on access to medicines, their appropriate use, and rising drug expenditures. Strategies used by European countries to improve drug use and contain health care expenditures are outlined. Finally, the future of pharmaceuticals and public health is explored.
The World Health Organization Regional Office for Europe has adopted the viewpoint that it is necessary to attempt to evaluate potential human carcinogens in such a way so that the risk they present can be compared and used in general consideration of protecting the public from toxic substances found in various environments. In order to demonstrate this process, the evaluations for a number of criteria air pollutants as presented in the volume Air Quality Guidelines for Europe are summarized and reviewed. The basic method used is that involving the estimation of risk based on lifetime exposures to airborne carcinogens by a linear extrapolation from known data using no threshold, with the carcinogenic potency expressed as the incremental unit risk estimate. This unit risk is defined as the average expected for a hypothetical population exposed for a lifetime to a concentration of one microgram per cubic meter of the agent in the air they breathe. The advantages and disadvantages of the method are reviewed, and background information for actual environmental conditions and risks leading up to the consensus guidelines adopted are presented for those 17 of the initial 28 criteria air pollutants treated which have IARC classifications of carcinogenicity.
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