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PubMedDate not supplied

Brundtland's World Health Organization: a test case for United Nations reform.

Gro Harlem Brundtland, who became Director General of the World Health Organization in July 1998, has created a small revolution at the WHO headquarters in Geneva. She is in the process of changing how WHO works, how it interacts with other parts of the United Nations system, and how it enlists ministries, whole governments, universities, and other private organizations to improve health in the world. Here, the Editor describes the reorganization, the new people and resources, and prospects for setting a precedent in United Nations reform.

Forecasting↗
PubMed1981

[Cardiovascular risk factors in headquarters staff of the World Health Organization].

Analysis of 2333 medical files of the World Health Organization's headquarters staff in Geneva gives insight into the epidemiology of cardiovascular risk factors in nationals originating from 67 different countries but living in the same environment. The study confirms well established facts such as the prevalence of hypertension (HT) with respect to sex, age, and period of observation, its consequences and interrelation with high cholesterol levels, diabetes, and obesity. The importance of a medical service with emphasis on prevention is stressed. Major differences in relation to geographic origin are noted for men. The highest percentage of HT (32%) is noted for staff members from Germanic countries. There is a concentric decrease according to nationality: 29 to 25% for the other countries of Central, Western, and Southern Europe, 23 to 18% for the USSR, Arab countries and North America, 9 to 6% for South East and Eastern Asia and African countries south of the Sahara (p less than 0.05 between the extremes). India and Australia do not fit the pattern of concentric decrease, since a high percentage of men in those countries have HT. As the number of files available was insufficient to carry out the same analysis for women or to determine other factors of cardiovascular risk, the study will be extended to cover the staff of other International Organizations in Geneva.

Age Factors↗
PubMed2003

Whither the World Health Organization?

The outgoing Director-General of the World Health Organization, Gro Harlem Brundtland, has successfully returned health issues to the international arena. The new Director-General will have to cope with reduced control over funding, debate over WHO's mandate, and the relationships between WHO and other organisations. Despite the broad role described in WHO's constitution, many groups see WHO's mandate as narrowly directed at disease eradication. The method of choice for funding health programs has become public-private partnerships. These have the advantages of bringing private money, management expertise and research knowledge to bear on health problems, but rarely consider the health system as a whole, focusing instead on specific diseases. This has the potential to distort resource allocation and priorities. The international community needs to work to strengthen WHO and maintain its broad mandate to achieve the highest possible level of health for all people.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The role of the World Health Organization in the control of rickettsial diseases.

The World Health Organization (WHO) pays great attention to the problem of rickettsial diseases. A network exists of Collaborating Centres for Rickettsial Reference and Research, which are designated by WHO. A WHO Consultation on the Laboratory Diagnosis of Rickettsial Diseases was held in 1987. In accordance with the recommendations of this consultative group, WHO first established The Project on Global Surveillance System for Rickettsial Diseases, with the immediate objective of obtaining reliable data on the global prevalence and distribution of rickettsial diseases. This information should contribute directly to the principal objective of reducing morbidity and mortality due to rickettsial diseases. An additional objective is to identify and characterize strains of pathogenic rickettsiae from various localities throughout the world. The final objective of the above study is to transfer the existing diagnostic technology to laboratories in developing countries. Under the auspices of this Project a diagnostic kit was developed for identification of antibodies with antigens of R. prowazekii and R. conorii in the indirect immunofluorescence test. About 20 laboratories in various countries are participating in this Project. Training courses have been organized for participants from countries in Africa and South-East Asia. The first stage of the Project will be evaluated in 1991 and, depending on the outcome of the first stage, a larger programme would be considered for subsequent years.

Antibodies, Bacterial↗
PubMed2003

Clinical study of primary cutaneous B-cell lymphoma using both the European Organization for Research and Treatment of Cancer and World Health Organization classifications.

Primary cutaneous B-cell lymphoma (PCBCL) is rare, with few series reported in the literature. Its classification and treatment remain controversial. Biopsy specimens of 13 patients with PCBCL were classified according to both the European Organization for Research and Treatment of Cancer (EORTC) and the new World Health Organization (WHO) classifications. Treatment and clinical outcomes were documented. Using the EORTC classification there were seven men and six women aged 32-85 years (mean = 51 years) with follicle centre cell (FCC) lymphoma (nine), immunocytoma (two) and primary cutaneous large B-cell lymphoma of the leg (PCLBCL-leg) (two). When the WHO classification was used, the nine patients with FCC were reclassified as follicle centre (five) and diffuse large B-cell lymphoma (four). Most patients had localized disease (12). Initial treatment consisted of radiotherapy alone (seven), combination chemotherapy alone (one), combined chemoradiotherapy (three) and surgery (two). Twelve patients achieved complete remission (median follow up 28 months, range 10-167 months). One patient with PCLBCL-leg died from progressive cutaneous disease. Most localized PCBCL lesions (except PCLBCL-leg) have a favourable prognosis. We recommend that clinicians be familiar with the important differences in the EORTC and WHO classifications. Further large prospective studies comparing the WHO and EORTC classifications are required to more clearly delineate the outcomes of the increasing number of patients who are classified as DLBCL by the WHO system.

Adult↗
PubMed2002

The World Health Organization (WHO) classification of the myeloid neoplasms.

A World Health Organization (WHO) classification of hematopoietic and lymphoid neoplasms has recently been published. This classification was developed through the collaborative efforts of the Society for Hematopathology, the European Association of Hematopathologists, and more than 100 clinical hematologists and scientists who are internationally recognized for their expertise in hematopoietic neoplasms. For the lymphoid neoplasms, this classification provides a refinement of the entities described in the Revised European-American Lymphoma (REAL) Classification-a system that is now used worldwide. To date, however, there has been no published explanation or rationale given for the WHO classification of the myeloid neoplasms. The purpose of this communication is to outline briefly the WHO classification of malignant myeloid diseases, to draw attention to major differences between it and antecedent classification schemes, and to provide the rationale for those differences.

Humans↗
PubMed1997

Progress toward poliomyelitis eradication in the Eastern Mediterranean Region of the World Health Organization.

The Eastern Mediterranean Region (EMR) of the World Health Organization has made substantial progress toward eradicating poliomyelitis. From 1988 to 1995, the number of confirmed cases of polio decreased 66%, from 2342 to 789. National immunization days were conducted in 18 (78%) of the 23 countries in 1995, representing 88% of the regional population. By 1995, 20 countries (87%) in the EMR had established systems for reporting acute flaccid paralysis (AFP), 20 (87%) were investigating AFP or polio cases epidemiologically, 18 (78%) had initiated follow-up at 60 days to confirm or discard suspected polio cases, 7 (30%) had achieved nonpolio AFP rates of > or = 1.0/100,000 children <15 years of age (a measure of the sensitivity of surveillance), and 16 (70%) had made laboratory investigations of polio cases for 1281 (74%) of the 1715 AFP cases reported in the EMR. Despite significant progress, the success of the polio eradication initiative in the EMR will depend on finding solutions to a number of technical, managerial, political, and financial challenges.

Adolescent↗
PubMed1975

World Health Organization classification and nomenclature of ovarian cancer.

A World Health Organization (WHO) committee of representatives from seven nations published a histologic typing of ovarian tumors in 1973. Their typing of common epithelial tumor was based largely on the classification by the International Federation of Gynaecology and Obstetrics (FIGO), and the single most important concept to emerge from the FIGO and WHO classifications was the distinction among common epithelial tumors between tumors of borderline malignancy and carcinomas. A second general category of ovarian tumors, some of which are clinically malignant, was designated by the WHO committee as sex cord-stromal tumors (neoplasms containing granulosa, theca, collagen-producing stromal, Sertoli, and/or Leydig cells). The WHO classification of germ cell tumors emphasized the necessity of careful examination of the gross specimen with jucicious sampling for microscopic evaluation. The classification and nomenclature used within an institution should be the one most conductive to mutual understanding and optimal patient care; however, when that nomenclature has to be translated into one with more widespread acceptance, the WHO classification, based on the earlier and widely adopted classification of FIGO, is presently the most deserving of universal usage.

Female↗
PubMed2006

[Clinical and functional aspects of the World Health Organization histologic classification of thymic epithelial tumors].

The World Health Organization (WHO) histologic classification was presented by the international committee to provide a universal system for clinicians and researchers in 1999 and was further modified in 2004. This classification is mainly based on Müller-Hermelink et al.'s system and six distinct types were defined. Thymomas were classified into type A, AB, B1, B2, and B3 tumors, according to the shape and atypia of epithelial cells and also the abundance of lymphocytes. Another type of tumor is thymic carcinomas, which have apparent atypia of neoplastic cells. Neuroendocrine tumor (carcinoid) of the thymus was categorized as thymic carcinoma because of the resemblance of genetic aberrations. Several studies have shown that the WHO histologic type is correlated with the proportion of invasive tumors and is an independent prognostic factor along with Masaoka stage. Furthermore, association with myasthenia gravis, ability to induce CD4+CD8+T cells and express HLA-DR molecules, and chromosomal imbalances such as loss of heterogeneity were found to be correlated with the WHO histologic type. Thus, the WHO histologic classification system reflects the oncologic, immunologic, and genetic characteristics of thymic epithelial tumors. The clinical application of this classification system is expected.

Carcinoma↗
PubMed1989

Evaluation and simplification of the World Health Organization clinical case definition for paediatric AIDS.

The World Health Organization (WHO) clinical case definition for paediatric AIDS was tested during a 1-month period on 221 consecutive hospitalized children in Kigali, Rwanda. Relevant clinical features not included in the WHO case definition were also evaluated. Thirty-four out of the 221 children (15.4%) were HIV seropositive. Although the specificity of the WHO case definition was high (92%), the sensitivity and the positive predictive value (PPV) were low (41 and 48%, respectively). The following individual signs had a PPV at least equal to the complete WHO case definition: chronic diarrhoea (47%), respiratory distress secondary to lower respiratory tract infection (50%), oral candidiasis (53%), parotitis (67%), generalized lymphadenopathy (88%), and herpes zoster infection (100%). When logistic regression analysis was done on the nine variables included in the WHO case definition, confirmed maternal infection was the best predictive variable for HIV seropositivity in children (P less than 10(-5). We further excluded the serological status of the mother from the analysis and performed a stepwise logistic regression analysis on the 18 clinical signs and symptoms for which information had been collected. Those signs and symptoms contributing the most to the regression were: respiratory distress, chronic diarrhoea and generalized lymphadenopathy. Based on these findings, we propose a simplified clinical case definition for paediatric AIDS in Africa with better sensitivity, specificity and PPV than the WHO case definition. Further work is needed using this approach to develop case definitions useful for epidemiological surveillance and for case management.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than 5 years of age for prevention of pneumonia: updated analysis using World Health Organization standardized interpretation of chest radiographs.

BACKGROUND: A World Health Organization (WHO) working group in 2001 developed a method for standardizing interpretation of chest radiographs in children for epidemiologic purposes. We reevaluated radiographs from the Kaiser Permanente Pneumococcal Efficacy trial using this method. METHODS: Seven-valent pneumococcal conjugate vaccine was evaluated in a randomized, controlled study including 37,868 infants. Effectiveness against pneumonia was previously evaluated using the original treating radiologist reading. There were 2841 sets of radiographs from this trial and all available radiographs were scanned and read blindly by 2 WHO crosstrained readers (A and B); discordance between the 2 primary readers was resolved through a consensus reading by an adjudicating panel of 2 radiologists. RESULTS: Of the 2841 radiographs, 2446 were available for scanning and were reviewed using WHO-defined descriptive categories. Two hundred fifty of the 2446 radiographs were read as positive by both readers. An additional 129 were read as positive by reader A only and 142 by reader B only for a total of 521 radiographs that were read as positive by one or both of the reviewers. The concordance rate between the 2 reviewers was 250 of 521 (48%). Of the 271 discordant radiographs, 45 of 129 (34.9%) of reader A and 66 of 142 (46.5%) for reader B were finalized as positive by the adjudicating panel. Overall, 361 radiographs were finalized as positive (12.7%). With these 361 images as the standard, the sensitivity and specificity of reader A were 82% and 97%, respectively, and for reader B, 88% and 97%, respectively. Kappa between the 2 readers was 0.58. Of 25 control radiographs read as positive by both A and B, 80% were also read as positive by the panel and all 25 control negative radiographs were read as negative by the panel. Using original readings by point-of-care radiologists, efficacy against first episode of radiograph confirmed pneumonia was 17.7% (95% confidence interval [CI] = 4.8-28.9%) in intent-to-treat and 20.5% (95% CI = 4.4-34%) in per protocol. Using the WHO method, the efficacy against first episode of radiograph confirmed pneumonia adjusting for age, gender and year of vaccination of 25.5% (95% CI = 6.5-40.7%, P = 0.011) for intent-to-treat and 30.3% (95% CI = 10.7-45.7%, P = 0.0043) for per protocol. CONCLUSION: Using WHO criteria for reading of radiographs increased point estimates of vaccine efficacy presumably as a result of improved specificity.

Child, Preschool↗
PubMed1998

[The World Health Organization is 50 years old].

In celebration of the World Health Organization's 50th anniversary, this article features WHO's contribution to the world by examining its current activities in the areas of health, human rights, and development. It briefly summarizes events leading to its establishment over the period from 1851 to 1948, which marks the year when WHO assumed its role as a specialized body of the United Nations. Quoting from various articles in WHO's Constitution, it illustrates the principles that prompt its actions and that have led nations to become aware of their potential goals, thus steering them toward a brighter future. A brief overview of the last 20 years ends with the introduction of WHO's new Director General, Dr. Gro Harlem Brundtland.

History, 20th Century↗
PubMed2002

Primary cutaneous lymphomas: applicability of current classification schemes (European Organization for Research and Treatment of Cancer, World Health Organization) based on clinicopathologic features observed in a large group of patients.

Classification of primary cutaneous lymphomas (PCLs) is the subject of ongoing controversy. Based on a series of 556 patients, the applicability of the European Organization for Research and Treatment of Cancer (EORTC) classification for PCLs was assessed and compared to the proposed World Health Organization (WHO) classification of hematologic malignancies. The large majority of patients could be properly classified according to the scheme proposed by the EORTC. Comparison of estimated 5-year survival for specific diagnostic categories of PCLs demonstrated nearly complete concordance of the present results with those of the EORTC study for most of the indolent cutaneous T-cell lymphomas and cutaneous B-cell lymphomas, whereas differences were found for mycosis fungoides-associated follicular mucinosis and Sezary syndrome. A few patients with newly described entities (CD8(+) epidermotropic cytotoxic T-cell lymphoma, primary cutaneous natural killer/T-cell lymphoma) could not be classified according to the EORTC scheme. Comparison of the EORTC with the WHO classification showed that the EORTC scheme allows a more precise categorization of the patients, especially for cutaneous B-cell lymphoma. In conclusion, the study confirmed that the EORTC classification allows a better management of patients with PCL. Small amendments to that classification should be carried out to account for recently described entities and to unify some of the diagnostic categories.

Adolescent↗
PubMedDate not supplied

The public versus the World Health Organization on health system performance.

The World Health Organization (WHO) ranked health systems in 191 countries based on measures developed by public health experts. This paper compares the WHO rankings for seventeen industrialized countries with the perceptions of their citizens. The results show little relationship between WHO rankings and the satisfaction of the citizens who experience these health systems. The health systems of some top WHO performers are rated poorly by their citizens, including the low-income and elderly. The two rated most highly by the public rank at the bottom of the WHO ratings. These findings suggest that both public and expert views should be considered in international rankings.

Consumer Behavior↗