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At least 127 records · Page 7Linked to original sources
PubMed2004

Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI).

An overview is presented of the rationale, design, and analysis plan for the WMH-CIDI clinical calibration studies. As no clinical gold standard assessment is available for the DSM-IV disorders assessed in the WMH-CIDI, we adopted the goal of calibration rather than validation; that is, we asked whether WMH-CIDI diagnoses are 'consistent' with diagnoses based on a state-of-the-art clinical research diagnostic interview (SCID; Structured Clinical Interview for DSM-IV) rather than whether they are 'correct'. Consistency is evaluated both at the aggregate level (consistency of WMH-CIDI and SCID prevalence estimates) and at the individual level (consistency of WMH-CIDI and SCID diagnostic classifications). Although conventional statistics (sensitivity, specificity, Cohen's kappa) are used to describe diagnostic consistency, an argument is made for considering the area under the receiver operator curve (AUC) to be a more useful general-purpose measure of consistency. In addition, more detailed analyses are used to evaluate consistency on a substantive level. These analyses begin by estimating prediction equations in a clinical calibration subsample, with WMH-CIDI symptom-level data used to predict SCID diagnoses, and using the coefficients from these equations to assign predicted probabilities of SCID diagnoses to each respondent in the remainder of the sample. Substantive analyses then investigate whether estimates of prevalence and associations when based on WMH-CIDI diagnoses are consistent with those based on predicted SCID diagnoses. Multiple imputation is used to adjust estimated standard errors for the imprecision introduced by SCID diagnoses being imputed under a model rather than measured directly. A brief illustration of this approach is presented in comparing the precision of SCID and predicted SCID estimates of prevalence and correlates under varying sample designs.

Adult↗
PubMed1998

The World Health Organization Multinational Study of Breast-feeding and Lactational Amenorrhea. I. Description of infant feeding patterns and of the return of menses. World Health Organization Task Force on Methods for the Natural Regulation of Fertility.

OBJECTIVE: To detect differences between populations in both infant feeding practices and the duration of lactational amenorrhea, if they exist. DESIGN: Prospective, nonexperimental, longitudinal follow-up study. SETTING: Five developing and two developed countries. PATIENT(S): Four thousand one hundred eighteen breast-feeding mothers and their infants. INTERVENTION(S): Breast-feeding women collected ongoing information about infant feeding and family planning practices, plus the return of menses. Fortnightly follow-up occurred in the women's homes. MAIN OUTCOME MEASURE(S): Breast-feeding frequency by day (and by night); 24-hour breast-feeding duration, percent of all infant feedings that were milk/milk-based (and solid/semisolid foods); time until the end of full breast-feeding; time until regular supplementation; and time until the end of lactational amenorrhea. RESULT(S): Differences between the centers in the duration of amenorrhea were substantial, ranging from a median of 4 months in New Delhi (India) to 9 months in Chengdu (China). Women in developed countries (but also women in Chengdu) were more likely to delay supplementation (for up to 5 months), whereas women in Santiago (Chile), Guatemala City (Guatemala), and Sagamu (Nigeria) started supplements much earlier, sometimes as early as 1 week after birth. CONCLUSION(S): Both breast-feeding behavior and the duration of lactational amenorrhea vary markedly across settings, indicating that breast-feeding promotion and family planning advice should be site- and culture-specific.

Adult↗
PubMed1998

The World Health Organization Multinational Study of Breast-feeding and Lactational Amenorrhea. II. Factors associated with the length of amenorrhea. World Health Organization Task Force on Methods for the Natural Regulation of Fertility.

OBJECTIVE: To determine the relation between infant feeding practices (and other factors) and the duration of postpartum amenorrhea, and to establish whether there are real differences in the duration of postpartum amenorrhea for similar breast-feeding practices in different populations. DESIGN: Prospective, nonexperimental, longitudinal follow-up study. SETTING: Five developing and two developed countries. PATIENT(S): Four thousand one hundred eighteen breast-feeding mothers and their infants. INTERVENTION(S): Breast-feeding women collected ongoing information about infant feeding and family planning practices, plus the return of menses. Fortnightly follow-up occurred in the women's homes. MAIN OUTCOME MEASURE(S): A multivariate analysis explored the association between the risk of menses return and 16 infant feeding variables and 11 other characteristics. RESULT(S): Ten factors (in addition to center effects) were significantly related to the duration of amenorrhea. Seven of these were infant feeding characteristics and the remaining three were high parity, low body mass index, and a higher frequency of infant illness. CONCLUSION(S): The breast-feeding stimulus is strongly linked to the duration of postpartum amenorrhea. Cross-cultural effects also are extremely important and may have caused the variations in feeding, the variation in amenorrhea, or both.

Adult↗
PubMed1999

The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. Pregnancy during breast-feeding. World Health Organization Task Force on Methods for the Natural Regulation of Fertility.

OBJECTIVE: To determine the risk of pregnancy during lactational amenorrhea relative to infant feeding status. DESIGN: Prospective longitudinal study. SETTING: Five developing and two developed countries. PATIENT(S): Four thousand one hundred eighteen breast-feeding mother-infant pairs. INTERVENTION(S): Infant feeding practices, menstrual status, and pregnancy were measured. MAIN OUTCOME MEASURE(S): Life-table rates of pregnancy. RESULT(S): In the first 6 months after childbirth, cumulative pregnancy rates during amenorrhea, depending on how the end of amenorrhea was defined, ranged from 0.9% (95% confidence interval [CI] = 0%-2%) to 1.2% (95% CI = 0%-2.4%) during full breast-feeding, and from 0.7% (95% CI = 0.1%-1.3%) to 0.8% (95% CI = 0.2%-1.4%) up to the end of partial breast-feeding. At 12 months, the rates ranged from 6.6% (95% CI = 1.9%-11.2%) to 7.4% (95% CI = 2.5%-12.3%) during full breast-feeding, and from 3.7% (95% CI = 1.9%-5.5%) to 5.2% (95% CI = 3.1%-7.4%) up to the end of partial breast-feeding. CONCLUSION(S): These results support the Bellagio Consensus on the use of lactational amenorrhea for family planning, and confirm that the lactational amenorrhea method is a viable approach to postpartum contraception.

Adult↗
PubMed1997

Diagnosis of Alzheimer's disease. Report of an International Psychogeriatric Association Special Meeting Work Group under the cosponsorship of Alzheimer's Disease International, the European Federation of Neurological Societies, the World Health Organization, and the World Psychiatric Association.

Current knowledge with respect to the diagnosis of Alzheimer's disease (AD) is reviewed. There is agreement that AD is a characteristic clinicopathologic entity that is amenable to diagnosis. The diagnosis of AD should no longer be considered one of exclusion. Rather, the diagnostic process is one of recognition of the characteristic features of AD and of conditions that can have an impact on presentation or mimic aspects of the clinicopathologic picture. The present availability of improved prognosis, management, and treatment strategies makes the proper, and state-of-the-art, diagnosis of AD a clinical imperative in all medical settings. Concurrently, information regarding the relevance and applicability of current diagnostic procedures in diverse cultural settings must continue to accrue.

Aged↗