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The Expanded Programme on Immunization of the World Health Organization.

In the developing world today, less than 20% of children are immunized against diphtheria, pertussis, tetanus, tuberculosis, measles, and poliomyelitis. Consequently, these diseases kill 10 children and disable 10 more each minute. To address this problem, the World Health Organization created the Expanded Programme on Immunization (EPI), with the goal of reducing morbidity and mortality by making immunization services available for all children of the world by 1990. This goal will be difficult to achieve. Information systems and immunization services themselves need to be strengthened. This goal will require commitments by the developing countries of human resources and commitments by developing and developed countries of financial support. Commitment is also needed by parents, who need to be informed that death and disability from these diseases can disappear if their children are immunized. Can these commitments be obtained? There is no choice but to try, for few appeals can be made as powerfully. The EPI cannot be permitted to fail.

Community Health Services↗

World Health Organization (WHO) and the World Heart Federation (WHF) Pathobiological Determinants of Atherosclerosis in Youth Study (WHO/WHF PBDAY Study) 1986-1996. An overview and general considerations.

This paper is an overview of the PBDAY Study--a ten-year multinational collaborative study. It provides condensed information on the background, objectives and methods of the study, as well as a summary of its most significant results and recommendations for further morphometric and special studies.

Adolescent↗

World Health Organization (WHO) and the World Heart Federation (WHF) Pathobiological Determinants of Atherosclerosis in Youth (PBDAY) Study. Lipid and raised lesion distribution in the right coronary artery of young people.

BACKGROUND AND AIM: As part of the WHO-WHF PBDAY Study, we examined the proximal segment of the right coronary artery (RCA) (n = 469) of 5-34 yr-old otherwise healthy trauma victims from 15 countries to establish the topographical relation of atherosclerotic lesions to age, sex and geographical location. METHODS AND RESULTS: Topography and extent of lesions were analyzed by image processing and probability-of-occurrence maps of lipid lesions (mostly fatty streaks) and raised lesions on the intimal surface of the RCA were produced. Extension of lesions varied considerably between the groups and between individuals in the same group. The prevalence of lipid lesions was 68% (319/469) compared with 100% in the aorta. The prevalence of raised lesions was 22% (102/469) compared with 7% and 26% in the thoracic and abdominal aorta. Females had more lipid lesions, whereas raised lesions prevailed in males. Lipid lesion extent increased with age in both sexes. CONCLUSIONS: High probability-of-occurrence areas for lipid and raised lesions prevailed in the proximal 5 cm of the intimal surface of the RCA (myocardial side) and were greatly overlapping. Regression analysis between lipid and raised lesion extent in the thoracic or abdominal aorta and the RCA showed no correlations between the lipid lesion extent, whereas significant correlations were found between the raised lesion extent in the RCA and the thoracic aorta only, showing that the two types of lesion behave differently in different anatomical locations.

Adolescent↗

Nursing in the 40 years of the World Health Organization.

In the celebration of the 40 years of the World Health Organization's existence, the International Council of Nurses, spokesman for the world's nurses, wants to be present with the enthusiasm of a friend, with the pride to be an associate in providing health care and with due respect of the professionals who recognize the leading role and authority of WHO in the health field.

Education, Nursing↗

A theoretical model for preventing osteoarthritis-related disability.

Osteoarthritis (OA) affects many aspects of life for affected individuals. Effective interventions to prevent and restore function must be based upon an understanding of what contributes to OA and its associated disabilities. A hypothetical OA disability model built upon the previous work of Nagi (1991), Verbrugge and Jette (1994), the International Classification of Functioning of World Health Organization (World Health Organization, 2001), and other scientific findings is proposed. The model includes a main disease pathway, which describes the sequence of events from OA-associated impairments to disabilities. Contextual factors influencing the process include individual characteristics, psychological state, coping style, comorbidities, social support, and physical environment. The model provides a useful conceptual framework for understanding the OA disability process from a biopsychosocial perspective and for guiding rehabilitation nursing interventions in OA care.

Activities of Daily Living↗

Asbestos: toxicology and risk assessment for the general population in The Netherlands.

Within the scope of the preparation of Integrated Criteria Documents for priority compounds in The Netherlands, the possible health effects of oral and inhalatory exposure to asbestos for the general population were evaluated. It was concluded from the results of experiments in animals that exposure to asbestos by the oral route is not carcinogenic and is not expected to present a health risk to the general population. Inhaled asbestos, however, is distinctly carcinogenic to man, giving rise to lung tumours, and mesotheliomas of the pleura and peritoneum. Chrysotile asbestos appears to be less potent in inducing mesotheliomas than the amphiboles, but all types of asbestos appear to have a similar potency for inducing lung cancer. The risk of mesothelioma is not expected to be influenced by smoking, whereas the risk of lung cancer is expected to be ten times higher in smokers than in non-smokers exposed to the same asbestos concentrations. Risk-assessment models for the inhalatory route, for the general population, are based on linear non-threshold extrapolation of occupational exposure to much lower environmental concentrations. These models give only a rough approximation of the risk of environmental exposure to asbestos. In accordance with the Air Quality Guidelines of the World Health Organization (World Health Organization, 1987), it was estimated that an extra risk of lung cancer of one in 10(6) (in the general population, with 30% smokers) may be presented by lifetime exposure to asbestos fibres longer than 5 microns, measured by electron microscopy, at concentrations of 100-1000/m3. It was further estimated that an extra risk of mesothelioma of one in 10(6) may be presented by lifetime exposure to 10-100 amphibole fibres/m3 or to a range of 100-10000 chrysotile fibres/m3 (fibres longer than 5 microns). From the current asbestos concentrations, the risk of mesothelioma for the general population in The Netherlands appears to be negligible; the extra risk of lung cancer is expected to be higher than 1 in 10(6) near asbestos sources, whereas it appears to be negligible in background areas and in most large cities and industrial areas. However, it must be borne in mind that the validity of the risk figures given is difficult to judge.

Asbestos↗

Oligozoospermia and heat-shock protein expression in ejaculated spermatozoa.

BACKGROUND: Heat-shock protein A2 (HspA2) is correlated with sperm maturity, function and fertility, and a dysfunctional expression of such a gene results in abnormal spermatogenesis. The purpose of this study was to compare HspA2 gene expression in spermatozoa from oligozoospermic men and normozoospermic controls. METHODS: Semen was obtained and analysed according to World Health Organization (World Health Organization, 1999) guidelines, morphology by Kruger's strict criteria. Seventeen patients with oligozoospermia and 21 fertile controls were studied. Total RNA was extracted from ejaculated and Percoll density-gradient-separated spermatozoa followed by semiquantitative RT-PCR analysis. The relative expression level of HspA2 was analysed according to the expression level of the housekeeping beta-actin gene. Serum hormonal profiles (FSH, LH and testosterone) and a peripheral karyotype were also performed. RESULTS: All patients possessed normal karyotype, and no significant hormonal differences were found between the two groups. The study group had significantly lower sperm concentration and normal morphology than the controls. Semiquantitative RT-PCR analysis of HspA2 showed significantly lower expression levels in the oligoteratozoospermic men when compared to controls (P=0.0021). CONCLUSIONS: The HspA2 gene was down-regulated in sperm from infertile men with idiopathic oligoteratozoospermia, suggesting that such anomalies of gene expression might be associated with pathogenesis in some subtypes of male infertility.

Actins↗

The impact of the World Health Organization classification and clonality assessment of posttransplant lymphoproliferative disorders on disease management.

CONTEXT: The World Health Organization classification of posttransplant lymphoproliferative disorders divides them into 4 main categories. OBJECTIVE: To classify cases of posttransplant lymphoproliferative disorders diagnosed in our institution according to the World Health Organization scheme and correlate the classification and clonality with clinical data. DESIGN: Cases of posttransplant lymphoproliferative disorders were reviewed. They were classified according to the World Health Organization scheme. Clonality was determined by flow cytometry and/or polymerase chain reaction. Patients' charts were reviewed. RESULTS: Thirty-one cases were identified. Median age was 33 years. There were 19 cases of kidney, 8 cases of liver, and 4 cases of bone marrow transplant. Immunosuppression consisted of cyclosporin A and prednisone (N = 24) or FK506 and prednisone (N = 7). Twenty cases (63%) were World Health Organization type 3, 7 cases (23%) type 2, 3 cases (6.4%) type 1, and 1 case type 4 posttransplant lymphoproliferative disorder. Ten patients received chemotherapy, 20 patients had reduction of immunosuppression, and 1 had no treatment. Follow-up was available on 25 patients. Seven (43.75%) of 16 with type 3 lesions with available follow-up died of their disease. Five of these patients received reduction of immunosuppression alone. Only 2 of 9 patients with type 3 disease who received chemotherapy died of disease. Two patients with type 2 disease died of unrelated causes. One patient is alive with disease; the remaining patients with types 1 and 2 disease are alive with no disease. CONCLUSIONS: The World Health Organization classification of posttransplant lymphoproliferative disorders is valuable in the identification of subtypes. It helps identify early lesions (1 and 2) requiring reduction of immunosuppression and type 3 disease, which requires chemotherapy from the outset.

Adolescent↗

WHO/CONRAD technical consultation on nonoxynol-9, World Health Organization, Geneva, 9-10 October 2001: summary report.

This report summarises the evidence presented to a technical consultation on the safety of N-9 and its effectiveness for protection against pregnancy, sexually transmitted infections and HIV, organized by the World Health Organization Department of Reproductive Health and Research with CONRAD in October 2001. Key conclusions from the meeting include: 1. Although Nonoxynol-9 has been shown to increase the risk of HIV infection when used frequently by women at high risk of infection, it remains a contraceptive option for women at low risk. 2. Nonoxynol-9 offers no protection against sexually transmitted infections such as gonorrhoea or chlamydia. 3. There is no evidence that condoms lubricated with nonoxynol-9 are any more effective in preventing pregnancy or infection than condoms lubricated with silicone, and such condoms should no longer be promoted. However, it is better to use a nonoxynol-9 lubricated condom than no condom at all. 4. Nonoxynol-9 should not be used rectally.

Animals↗

Validation of the United States' version of the World Health Organization Quality of Life (WHOQOL) instrument.

In 1991, the World Health Organization initiated a project to simultaneously develop a quality of life (QOL) instrument in 15 countries: The World Health Organization Quality of Life (WHOQOL) instrument. This was intended as a generic QOL tool for use with patients across varying disease types, severities of illness, and cultural subgroups. The objective of the current study was to evaluate the WHOQOL-100 in the U.S., one of the original 15 participating countries. The WHOQOL is a 100-item self-report instrument consisting of 24 subscales within six domains: Physical, Psychological, Independence, Social, Environment, and Spiritual. Four additional items pertain to overall QOL/health. We tested the WHOQOL-100 (U.S. version) in a sample of 443 adults (n = 251 chronically ill, n = 128 healthy, and n = 64 childbearing) in the U.S. to test its reliability (internal consistency, test-retest), construct validity (convergent, discriminant), responsiveness, and factor structure. The WHOQOL-100 (U.S. version) has acceptable internal consistency (alpha range: 0.82-0.95 across domains) and reproducibility (ICC range: 0.83-0.96 at 2-week retest interval). It is responsive to change in clinical conditions, as evidenced by predicted score change (effect size) in women after childbirth. Construct validity was demonstrated by (1) its correlation with the Short Form-36 and Subjective Quality of Life Profile, and (2) its ability to discriminate between the diverse samples in this study. The conceptual structure was confirmed exactly with the exception of four facets that did not correlate most highly with the domains to which they were originally assigned, but these differences were minor. The WHOQOL measurement system is suitable for evaluating the QOL of adults in the U.S. The psychometric properties will be continually evaluated as more data become available in the U.S.

Adult↗

Psychiatric assessment instruments developed by the World Health Organization.

Over the past 30 years the World Health Organization (WHO) has produced a number of assessment instruments intended for national and cross-cultural psychiatric research. WHO instruments have been tested and used in many collaborative studies involving more than 100 centres in different parts of the world. This article reviews the main WHO instruments for the assessment of (a) psychopathology, (b) disability, quality of life and satisfaction, (c) services, and (d) environment, and risks to mental health. The principles used in the development of WHO instruments, their translation and their use across cultures and settings are discussed.

Cross-Cultural Comparison↗

The role of the World Health Organization in the study of influenza.

The World Health Organization (W.H.O.), since its inception in 1947, has given close attention to influenza. In its early years W.H.O. laid the foundations of its present network of over 100 national influenza centres and collaborating laboratories which today constitute the backbone of its influenza activities. The activities of the network include the isolation and characterization of influenza strains and the early notification of any changes in surface antigens, the preparation of reference reagents, standardization of diagnostic procedures, formulation of requirements for vaccines, training, and collaboration in research. The efficacy of the network has been proved in the 1957, 1968 and 1977 epidemics. Collaborative research organized by W.H.O. has made important contributions to our understanding of the epidemiology of influenza, including the possible role of lower animals as the origin of some pandemic strains. The latter subject is briefly discussed.

Animals↗

Medically unexplained somatic symptoms in different cultures. A preliminary report from phase I of the World Health Organization International Study of Somatoform Disorders.

The World Health Organization has recently launched an international study of somatoform disorders in different cultures. Five centres representing distinct cultures participated in phase I of the project, the main objective of which was to test the cross-cultural applicability and reliability of instruments for the assessment of somatoform disorders. The analysis of the assessed somatic symptoms showed that various aches and pains in different parts of the body represented cross-culturally the most frequent symptoms for which there was no medical explanation. Such symptoms may indicate the presence of an underlying mental disorder but can also represent a means for culture-specific expression of psychosocial distress. This bears particular significance for health professionals in primary and general medical care, who are most likely to encounter patients presenting with multiple, persistent and medically unexplained somatic symptoms.

Adult↗

Considerations on methodology used in the World Health Organization 2000 Report.

The article analyzes the World Health Organization Report for 2000, with emphasis placed on the methodology used to analyze the indicators utilized to compare and classify the performance of the health systems of the 191 member countries. The Report's contribution was the compromise of monitoring the performance of the health systems of member countries, but because of the inconsistent way it was elaborated, and the utilization of questionable scientific evaluation methodologies, the Report fails to give a clear picture. A criterion-based methodology revision is imposed. The main problems in evidence are the choice of individual indicators of disparity in health that discount the population profile, the inadequate control of the impact of social disparities over the performance of the systems, the evaluation of the responsibility of systems that are only partially articulated to the right of the citizens, the lack of data for a great number of countries, consequently having inconsistent estimations, and the lack of transparency in the methodological procedures in the calculation of some indicators. The article suggests a wide methodological revision of the Report.

Annual Reports as Topic↗

Clinical value of sperm morphology for in-vivo fertility: comparison between World Health Organization criteria of 1987 and 1992.

The World Health Organization (WHO, 1992) has suggested new criteria for scoring sperm morphology. This study compares the clinical value of the new criteria, i.e. classification of a man as fertile or infertile, to those previously established by the WHO (1987). Papanicolaou-stained semen smears from 166 men attending our infertility clinic, whose fertility status was known, were scored using both methods. Using logistic discriminant analysis for compositional data, no difference between these two sets of criteria with respect to predicting pregnancy outcome was observed. The categorization of the abnormalities (head, midpiece, tail) provides no extra clarification. The WHO (1992) cut-off point of 30% for normal forms is not appropriate, as approximately half of the men in the fertile group had a normal sperm morphology below this limit. In conclusion, the present WHO (1992) classification of sperm morphology is of no additional clinical value. Studies on sperm morphology should concentrate on obtaining biological data on, and measurements of, spermatozoa which are functionally active. Only then can the definition of normal be achieved and clinically useful criteria be adopted.

Discriminant Analysis↗

Appraisal of the World Health Organization classification of lung tumours.

The 1967 World Health Organization (WHO) classification of the histologic types of lung tumours has been examined in relation to 303 tumours of patients admitted to a national trial of the treatment of lung cancer. In 63 instances (20%) there was disagreement between the diagnoses of the local pathologist and the reference pathologist. The slides for these 63 tumours were reviewed by two other pathologists, and the slides for 60 tumours for which there was agreement between the local and reference pathologists were reviewed by one of the other pathologists. The main disagreement was in the diagnosis of epidermoid (squamous) tumours. It is apparent that many pathologists do not adhere to the strict criterion of the presence of keratinization or intercellular prickles or both for the diagnosis of epidermoid carcinoma. In addition, there was substantial variation in the use of subtypes within the WHO classification. Use of the revised classification proposed by the WHO would have removed a small amount of the variation from these findings but would not have affected the main discrepancy. Stricter attention to the definition of types is required for a uniform approach to the histologic classification of lung tumours.

Carcinoma, Squamous Cell↗

Respiratory tract infection in HIV-1-infected adults in Nairobi, Kenya: evaluation of risk factors and the world health organization treatment algorithm.

To evaluate the WHO (World Health Organization) algorithm for management of respiratory tract infection (RTI) in HIV-1-infected adults and determine risk factors associated with RTI, we enrolled a cohort of 380 HIV-1-seropositive adults prospectively followed for incident RTI at an outpatient clinic in Nairobi, Kenya. RTI was diagnosed when patients presented with history of worsening or persistent cough. Patients were treated with ampicillin, or antituberculosis therapy when clinically indicated, as first-line therapy and with trimethoprim/sulfamethoxazole as second-line therapy. Five hundred ninety-seven episodes of RTI were diagnosed: 177 of pneumonia and 420 of bronchitis. The WHO RTI algorithm was used for 401 (95%) episodes of bronchitis and 151 (85%) episodes of pneumonia (p <.001). Three percent of bronchitis cases versus 32% of pneumonia cases failed to respond to first-or second-line treatment (p <.0001). Being widowed (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.0-4.4), less than 8 years of education (adjusted OR = 2.5, CI: 1.5 - 4.1), and CD4 count < 200 cells/microl (adjusted OR = 2.4, CI: 1.4-3.9) were risk factors for pneumonia. A high percentage of patients (32%) with pneumonia required a change in treatment from that recommended by the WHO guidelines. Randomized trials should be performed to determine more appropriate treatment strategies in HIV-1-infected individuals.

AIDS-Related Opportunistic Infections↗