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Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics / WHO international growth reference: implications for child health programmes.
Public Health Nutrition. 2006 Oct; 9(7):942-947.The objectives were to compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards ('the WHO standards') and the National Center for Health Statistics (NCHS)/WHO international growth reference ('the NCHS reference'), and discuss implications for child health programmes. Design: Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives. Settings: Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe. Subjects: Respectively 4787, 10 381 and 226 infants and children. Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%. The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations. (author's)
[The practice guideline 'Hormonal contraception' (second revision) from the Dutch College of General Practitioners; a response from the perspective of obstetrics and gynecology] De standaard 'Hormonale anticonceptie' (tweede herziening) van het Nederlands Huisartsen Genootschap; reactie vanuit de verloskunde-gynaecologie.
Nederlands Tijdschrift voor Geneeskunde. 2004 Jun 26; 148(26):1274-1275.The Dutch College of General Practitioners' (NHG) guideline on hormonal contraception does not follow the WHO criteria for the use of oral contraceptives in contrast to the guideline of the Dutch Society of Obstetrics and Gynaecology. Contrary to the WHO criteria, the NHG guideline considers a blood-pressure measurement before starting with an oral contraceptive to be unnecessary. It also considers no form of migraine to be contraindication for oral contraceptives. The NHG guideline further disclaims the (slightly) increased risk of developing breast cancer in women using oral contraceptives. It advises initiation of oral-contraceptive use two weeks postpartum in non-breast-feeding women and six weeks postpartum in breastfeeding women, instead of the three weeks and six months, respectively, indicated in the WHO guideline. Lastly, the NHG guideline is too optimistic as to the reliability of oral-contraceptive use, as no distinction is made between efficacy and effectiveness. Such discrepancies between two Dutch guidelines can be detrimental to women's health care. The WHO criteria for contraceptive use may be a valuable tool to overcome differences of opinion to as to achieve a badly needed full consensus. (author's)
Comparison of patient evaluations of health care quality in relation to WHO measures of achievement in 12 European countries.
Bulletin of the World Health Organization. 2004 Feb; 82(2):106-114.To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. Patient evaluations were derived from a series of Quote (QUality of care Through patients’ Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intra-class correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 — Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. Intra–class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients’ problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider’s understanding of patients’ problems and responsiveness according to WHO. Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO’s performance measures of health care systems. (author's)
Adverse events after immunisation with aluminium-containing DTP vaccines: systematic review of the evidence.
Lancet Infectious Diseases. 2004 Feb 1; 4(2):84-90.We have reviewed evidence of adverse events after exposure to aluminium-containing vaccines against diphtheria, tetanus, and pertussis (DTP), alone or in combination, compared with identical vaccines, either without aluminium or containing aluminium in different concentrations. The study is a systematic review with metaanalysis. We searched the Cochrane Vaccines Field Register, the Cochrane Library, Medline, Embase, Biological Abstracts, Science Citation Index, and the Vaccine Adverse Event Reporting System website for relevant studies. Reference lists of retrieved articles were scanned for further studies. We included randomised and semi-randomised trials and comparative cohort studies if the report gave sufficient information for us to extract aluminium concentration, vaccine composition, and safety outcomes. Two reviewers extracted data in a standard way from all included studies and assessed the methodological quality of the studies. We identified 35 reports of studies and included three randomised trials, four semi-randomised trials, and one cohort study. We did a meta-analysis of data from five studies around two main comparisons (vaccines containing aluminium hydroxide vs no adjuvant in children aged up to 18 months and vaccines containing different types of aluminium vs no adjuvants in children aged 10–16 years). In young children, vaccines with aluminium hydroxide caused significantly more erythema and induration than plain vaccines (odds ratio 1·87 [95% CI 1·57–2·24]) and significantly fewer reactions of all types (0·21 [0·15–0·28]). The frequencies of local reactions of all types, collapse or convulsions, and persistent crying or screaming did not differ between the two cohorts of the trials. In older children, there was no association between exposure to aluminiumcontaining vaccines and onset of (local) induration, swelling, or a raised temperature, but there was an association with local pain lasting up to 14 days (2·05 [1·25–3·38]). We found no evidence that aluminium salts in vaccines cause any serious or long-lasting adverse events. Despite a lack of good-quality evidence we do not recommend that any further research on this topic is undertaken. (excerpt)
Is a 2 : 1 ratio of standard WHO ORS to plain water effective in the treatment of moderate dehydration.
Journal of Tropical Pediatrics. 2003 Oct; 49(5):291-294.Increased amounts of plain water have been recommended ad libitum during rehydration treatment with oral rehydration solutions (ORS) in moderately dehydrated cases in order to decrease the hypertonicity of ORS. However, we could not encounter any study demonstrating its effectiveness objectively. In this study, moderately dehydrated children admitted to Hacettepe University Ihsan Dogramaci Children’s Hospital Diarrheal Disease Training and Treatment Unit were administered either standard WHO ORS treatment or two parts of standard WHO ORS and one part of plain water alternately at a dose of 100 ml/kg, according to the period they were admitted to the center. The frequency of vomiting, stool purging rate, and unscheduled intravenous treatment rate of the two different regimens were compared. There were 51 children in the standard ORS group and 79 children in the 2 : 1 ratio ORS group. The admission characteristics of the children were similar. The children with a stool purging rate over one per hour during treatment was higher in the standard ORS group (29.4 vs. 15.2 per cent, p = 0.051), as well as the children with vomiting (56 vs. 30 per cent, p = 0.007). The children who required unscheduled intravenous treatment was also higher in the standard ORS group (20 vs. 14 per cent, p = 0.2). A regimen of two parts of WHO ORS and one part of plain water may be an alternative treatment for moderately dehydrated children with non-cholera diarrhea in areas where hypotonic ORS is not yet available. (author's)
The safety and feasibility of female condom reuse: report of a WHO consultation, 28-29 January 2002, Geneva.
Geneva, Switzerland, WHO, 2002. , 15 p.According to the recommendations of the first consultation, this second meeting (January 2002) was planned to review the resulting data and to develop further guidance on the safety of reuse of the female condom. The specific objectives and anticipated outcomes of this second consultation were to: Review the results and evaluate the implications of the recently completed microbiology and structural integrity experiments and the human use study; Develop a protocol or set of instructions for disinfecting and cleaning used female condoms safely; Outline future research areas and related issues for programme managers to consider when determining the balance of risks and benefits of female condom reuse in various contexts and settings. (excerpt)
Comparative performances, under laboratory conditions, of seven pyrethroid insecticides used for impregnation of mosquito nets. [Performances comparées, dans des conditions de laboratoire, de sept insecticides à base de pyréthroïde utilisés pour l'imprégnation des moustiquaires]
Bulletin of the World Health Organization. 2003 May; 81(5):324-333.Objective: To compare the efficacy of seven pyrethroid insecticides for impregnation of mosquito nets, six currently recommended by WHO and one candidate (bifenthrin), under laboratory conditions. Methods: Tests were conducted using pyrethroid-susceptible and pyrethroid-resistant strains of Anopheles gambiae and Culex quinquefasciatus. Knock-down effect, irritancy and mortality were measured using standard WHO cone tests. Mortality and bloodfeeding inhibition were also measured using a baited tunnel device. Findings: For susceptible A. gambiae, alpha-cypermethrin had the fastest knock-down effect. For resistant A. gambiae, the knockdown effect was slightly slower with alpha-cypermethrin and much reduced following exposure to the other insecticides, particularly bifenthrin and permethrin. For susceptible C. quinquefasciatus, the knock-down effect was significantly slower than in A. gambiae, particularly with bifenthrin, and no knock-down effect was observed with any of the pyrethroids against the resistant strain. Bifenthrin was significantly less irritant than the other pyrethroids to susceptible and resistant A. gambiaebut there was no clear ranking of pyrethroid irritancy against C. quinquefasciatus. In tunnels, all insecticides were less toxic against C. quinquefasciatusthan against A. gambiaefor susceptible strains. For resistant strains, mortality was significant with all the pyrethroids with A. gambiaebut not with C. quinquefasciatus. Inhibition of blood-feeding was also high for susceptible strains of both species and for resistant A. gambiaebut lower for resistant C. quinquefasciatus; bifenthrin had the greatest impact. Conclusions: Efficacy for impregnation of mosquito nets against A. gambiae was greatest with alpha-cypermethrin. Bifenthrin is likely to have a significant comparative advantage over other pyrethroids in areas with pyrethroid resistance because of its much stronger impact on the nuisance mosquito, C. quinquefasciatus, despite its slower knock-down effect and irritancy. Selection of pyrethroids for mosquito vector control and personal protection should take into account the different effects of these insecticides, the status of pyrethroid resistance in the target area, and the importance of nuisance mosquitoes, such as C. quinquefasciatus. (author's)
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(2):193-231.In 1983, the number of malaria cases reported was 5.5 million, compared with 6.5 million in 1982 and 7.8 million in 1981, excluding figures from Africa. Of a total world population of 4676 million, some 1307 million (28%) live in areas where malaria never existed or from where it disappeared without specific antimalaria measures. About 753 million people (16%) live in areas where the disease has been eliminated during recent years by successful antimalarial activities. Almost 50% of the world's population live in areas where antimalaria activities are carried out. About 389 million people (8%) inhabit areas where no specific measures are undertaken to control malaria transmission and where the prevalence of infection has hardly changed. Over the years, malaria has invaded large areas of countries. This paper examines the malaria situation in the following regions of the world: Africa north of the Sahara; Africa south of the Sahara; the Americas; North America; Middle America; South America; Asia west of India; Middle South Asia; Eastern Asia and Oceania; and Europe, including Turkey and the USSR. Among the factors recognized as determining the malaria situation are technical problems that have grown in magnitude and present major obstacles and a real threat to the successful implementation of antimalaria measures. Tables provide statistics on number of malaria cases reported, 1973-1983, by region; epidemiological indicators in 1983 (examination rate, slide positivity rate, number of cases, % by p. falciparum) by country; malaria situation by large epidemiological areas, 1983 (incidence, areas under attact, freed areas, interrupted transmission areas); WHO official register of areas where eradication has been achieved; semestrial follow-up of registration of malaria eradication; and summary of semi-annual reports on vigilance. Also tabulated are malaria cases imported into malaria-free countries and areas; and areas where resistance of p. falciparum to chloroquine is reported. Epidemiological assessment is also given in map form for 1983.
Contraception. 1984 Dec; 30(6):505-22.The World Health Organization (WHO) conducted a randomized comparative trail of th effects of hormonal contrception on milk volume and infant growth. The 341 study participants, drawn from 3 obstetric centers in Hungary and Thailand, were 20-35 years of age with 2-4 live births and previous successful experience with breastfeeding. Subjects who chose oral contraception (OC) were randomly allocated to a combined preparation containing 150 mcg levonorgestrel and 30 mcg ethinyl estradiol (N=86) or to a progestin-only minipill containing 75 mcg dl-norgestrel (N=8). 59 Thai women receiving 150 mg depot medroxyprogesterone (DPMA) intramuscularly every 3 months were also studied. An additional 111 women who were using nonhormonal methods of contraception or no contraception served as controls. Milk volume was determined by breast pump expression. No significant differences in average milk volume were noted between treatment groups at the 6 week baseline visit. However, between the 6th and 24th weeks, average milk volume in the combined OC group declined by 41.9%, which was significantly greater than the declines of 12.0% noted in the progestin-only group, 6.1% among DMPA users, and 16.7% among controls. The lower expressed milk volume among combined OC users did not impair infant growth. No significant differences were observed between treatment groups in terms of average infant body weight or rate or weight gain. Users of combined OCs may have compensated for their decreased milk volume by providing more extensive supplementary feeding or more prolonged suckling episodes. These results suggest that the estrogen content of combined OCs adversely affects the capacity of the breast to produce milk; thus, family planning programs should make nonestrogen-containing methods available to breastfeeding mothers. Although no effects on infant growth were noted in this study, the possibility of such efects cannot be excluded in populations where infant growth largely depends on the adequacy of unsupplemente d lactation.
[Sexually abusive behavior. IPPF's Daphne project] Comportamiento sexual abusivo. Proyecto Daphne de IPPF.
DIALOGOS. 2000 Jul-Sep; 44(24):21-4.A 1999 joint study by the Family Planning Associations of Italy, Estonia, and the Flemish region of Belgium in collaboration with the Department of Criminology of the University of Louvain to determine the prevalence and nature of sexually abusive behavior in youth residences and develop protective strategies is described. The Daphne Initiative was created in 1996 by the European Parliament to promote participation by nongovernmental organizations and private associations in prevention of sexual violence against children, adolescents, and women. In this context, the European Network of the International Planned Parenthood Federation (IPPF) in 1999 initiated a study of sexual abuse in residences for youth. Its objective was to explore the possibility of developing strategies oriented to educators and directors for prevention of sexually abusive behavior in residences. Several experimental studies in Europe have indicated that 15 to 20% of sexual aggressors had spent part of their youth in residential institutions. The report describes the activities and philosophy behind the joint study. The work began with an analysis of related legislation in each of the three countries and interviews with directors and educators at residences. The work ends by discussing several elements of secondary prevention that should be included in a plan of action: training in sexuality and sexually abusive behavior, selection of residents, selection of residence personnel, development of the plan of action by parents and institutional personnel as well as residents, sharing information, respect for the victim and the accused, identification of all the parties involved, team decision making, the juridical principle of reparation, and adequate contact with police and other authorities.
Growth of the Czech child population 0-18 years compared to the World Health Organization growth reference.
American Journal of Human Biology. 1997; 9(4):459-68.A comparison of the findings of nationwide anthropometric surveys carried out in the Czech Republic at 10-year intervals in 1951-91 with World Health Organization (WHO) growth references identified an ongoing secular trend in the height of Czech children of both sexes and a decrease in weight, especially among older girls. Compared to the WHO reference data, Czech infants demonstrated a growth acceleration in the first 6 months of life. Mean weight values for Czech infants aged 0-2 years were insignificantly above the reference curve in all 5 surveys. The 1971 curve for height in boys 12-18 years and girls 11-18 years most closely mirrored the WHO reference. In 1991, in 17-year-old males, height increased an average of 3.8 cm compared to 1971 and 7.1 cm compared to 1951; in females, these average increases were 2.9 cm and 4.7 cm, respectively. As in other developed countries, overweight and obesity were more significant problems than malnutrition. Since the Czech Republic is still undergoing socioeconomic changes with the potential to increase population diversity, it is recommended that factors such as education, income, and occupation per household head be monitored to detect any trends that could have an adverse effect on the nutritional and health status of Czech children.
Washington, D.C., Futures Group, Gender in Economic and Social Systems Project [GENESYS], 1994 Oct. , 48 p. (GENESYS Special Study No. 17; USAID Contract No. PDC-0100-Z-00-9044-00)In order to reveal essential lessons learned about the process undertaken by major bilateral and multilateral donor agencies to institutionalize gender awareness in their organizational structure and programs and to define the scope of the remaining work in this area, this paper compares strategies of major agencies and assesses the degree to which these strategies have allowed the agencies to meet stated objectives. The first main section of the paper provides background information on the following issues: 1) the importance of recognizing women's dual productive and reproductive roles and of the concept of mainstreaming in the development of policies and plans of action; 2) the key structures and processes that enhance capacity for institutionalizing gender, including a commitment to raising awareness, the presence of a Women in Development (WID) office and/or staff, and WID training and research; 3) the process of incorporating gender issues into country programs and project cycles; 4) involving women in all stages of development programming; and 5) strategies for the future. The second section of the paper analyzes the institutionalization of gender issues into the development process funded by the bilateral donors (Australia, Canada, Denmark, Japan, Norway, Sweden, the UK and the US). Each analysis includes a look at the content and scope of the country's policy and plan of action, at organizational commitment to raising awareness, at efforts to build a knowledge base, at how gender issues are incorporated into programs and project cycles, and at efforts to bring women into the process. The same framework is applied to the consideration of multilateral donors (the African Development Bank, the Asian Development Bank, the Inter-American Development Bank, the World Bank, and the UN Development Programme) contained in the final section of the paper.
AIDS. 1993 Dec; 7(12):1613-5.In 1990, Belgium, physicians enrolled 415 consecutive patients attending HIV reference centers in Antwerp, Brussels, and Ghent in a cross-sectional study designed to evaluate the clinical axis of the WHO staging system with and without the lymphocyte stratification proposed by Montaner el al. (that is, modified WHO staging system) (>1500, 1500- 1000, and <1000 cells x 1 million/l). They filled in a standardized questionnaire with all criteria of the WHO staging system. Laboratory personnel used standard hematology and flow cytometry techniques to determine absolute and CD4 lymphocyte counts. 80% of the patients were Caucasians. 46% of all patients were homosexual and 42% were heterosexual; 79.2% were men. Median CD4 lymphocyte counts fell in both staging systems as the stage of HIV infection increased. There were significant differences in median CD4 counts between stages of each staging system (p < .001). The modified WHO staging system's stage I was more sensitive at identifying patients with CD4 lymphocyte counts of more than 500 cells x 1 million/l than the WHO clinical stage 1 (83% sensitivity vs. 48% sensitivity). The positive predictive value of WHO clinical stage 4 and of the modified WHO staging system's stage IV for identifying people with CD4 lymphocyte counts of less than 200 cells x 1 million/l was quite high (79% and 80%, respectively). The researchers suggested that clinicians use stages 4 and IV as end-points is clinical trials in developing countries. Clinicians completing the questionnaire knew the patients' earlier CD4 lymphocyte count, which may have introduced a bias in the study. For example, they may have more thoroughly examined patients with low CD4 lymphocyte counts than those with normal counts. Nevertheless, the study's results indicated that either one of these systems may be a good alternative in developing countries to the technical equipment-dependent CD4 lymphocyte count-based HIV staging system used in developed countries. Cohort studies in developing countries would evaluate their prognostic value.
AIDS. 1992 Dec; 6(12):1505-13.HIV/AIDS specialists have developed and applied 3 different scenarios to a comprehensive decision analysis model to estimate mortality rates for children of mothers infected with HIV during pregnancy and for children of mothers who were not infected with HIV during delivery. Scenario I represents Central Africa where HIV prevalence and incidence are high. Some scenario I assumptions are HIV prevalence in pregnant women of 30% and proportion of initially uninfected women who become infected after delivery during lactation (d) of 6%. Scenario II is a population where HIV epidemic is rather recent (e.g., some parts of Asia). Its assumptions are HIV prevalence of 5%, and s is 2%. Scenario III symbolizes high-risk populations in North America and Western Europe (HIV prevalence and s = 1%). The scenarios also consider child mortality rates and relative risks (RRs) of mortality of breast fed children and those who were not breast fed. Universal breast feeding would effect equal or higher mortality than non-breast feeding, when the RR of mortality is no more than 1.5 and HIV prevalence/incidence is high (high prevalence = > 10% and high incidence = > 5%). In developing countries, where the RR of mortality is high if children are not breast fed (RR > 3), breast fed children have almost always lower child mortality than those who are not breast fed, regardless of HIV infection status. The decision to breast feed when the HIV status is known depends greatly on the degree of an additional mortality risk if an infant is not breast fed. The model substantiates WHO and CDC recommendations: HIV-positive women in the UK and the US should not breast feed, while those in developing countries with high RR of child mortality should breast feed. Additional research would define the range of HIV transmission rates from breast feeding and increase specific assessments of RRs for various parts of the world.
CONTRACEPTION. 1992 Apr; 45(4):363-8.Researchers analyzed interview and physician records' data on 45 women with breast cancer (cases) admitted to the Central Institute of Cancer Research in Berlin, East Germany between November 1982-June 1986 and born in 1983 or later and 194 women (controls) admitted to the Klinikum Berlin-Buch also in East Germany for conditions other than breast cancer to compare recall accuracy in women who had ever used an IUD. These women were drawn from case control study of the relationship between breast cancer and oral contraceptive use was part of the WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Agreement between patient recall and physician records was exceptional for duration of IUD use (p<.001), number of IUD episodes (kappa=0.79), time since 1st IUD and time since last IUD use (p<.001). Agreement rates did not differ between cases and controls. 75% of the women could not name the IUD brand used so the researcher could not examine agreement of brand name. Thus, other than brand name, this study showed that validity of information on IUD use obtained from interviews is significant. In fact, it also pointed out that case control studies probably yield sound relative risk estimates.
Progesterone-releasing vaginal rings for use in postpartum contraception. I. In vitro release rates of progesterone from core-loaded rings.
CONTRACEPTION. 1992 Apr; 45(4):329-41.Chemists from London, England and a chemist from WHO in Geneva, Switzerland compared release rates of progesterone from vaginal rings with cores of different diameters (4, 5, 6, 6.7, and 7.24 mm). The manufacturer loaded each core with 25% w/w progesterone. The technique used to dissolve the progesterone from the silicone rubber core consisted of placing the rings in continuously flowing baths of isotonic saline at 37 degrees Celsius. The learned that a membrane diffusion controlled process, modified by the development of a gradually increasing zone of depletion at the core surface, did indeed release the progesterone. The used the UV absorption method to measure the amount of progesterone released in 24 hour periods for as much as 128 days. The vaginal ring with the 6 mm core released 3.6-5.5 mg progesterone/day in a 90 day period. The daily range of maximum and minimum values for each set of rings demonstrated good reproducibility. Progesterone release was inversely related to diffusion distance (between core surface and ring surface) for each day. Since, in their clinical trials in postpartum women, WHO wanted to use vaginal rings which initially released 5 mg progesterone/day and declines by about 0.5 mg/month under conditions of membrane limited diffusion as the depletion zone grew thicker, the study showed that the rings with a 6 mm core met the criteria. The chemists found that these rings and 4 sterile batches of these rings have highly consistent and reproducible rates in vitro drug delivery. They also compared the vaginal rings with a 6 mm core with rings with at homogeneous dispersion of progesterone throughout the polymer. The homogenous rings 1st released much progesterone then fell quickly from 10->20 mg/day during the 1st week to a gradual release of about 6 mg/day during the end of the 90 days.
Population et Societes. 1991 Dec; (263):1-3.This work contrasts 2 world population atlases published in 1991, 1 the work of a demographer and the other of a geographer. Both works synthesize the concepts of demography as it is currently practiced. The work by the geography, Daniel Noin, (Atlas of World Population) has a more detailed bibliography and glossary and concentrates on the contemporary population situation. The other work (The Population of the World. From Antiquity to 2050), by Jean-Claude Chesnais, takes a historic approach. The 2 works are complementary and neither raises ecological alarms. They stress different issues in their conclusions, Chesnais asking whether the nations of Europe can compensate for their loss of demographic and economic power by regrouping into an entity large enough to maintain influence, Noin identifying fertility decline in the poor countries as the major current demographic challenge. Both authors use the same analytical instrument and rely on UN statistics. The UN, since its origin, has been the site of a confrontation between 2 schools of demographic thought, the American which is preoccupied with rapid population growth in the poor countries, and the French, which stresses fertility decline and demographic aging in the developed countries. The analytical instrument in both cases is the theory of demographic transition, on which both authors have already written. The 2 authors classify the countries differently, 1 identifying 5 stages of transition and the other 3 stages and 8 types of countries. Agreement on the basic phenomenon of the transition is accompanied by some difference of interpretation.
WORLD WATCH. 1990 Sep-Oct; 3(5):29-34.In the early 1950s, the Soviet Union and several of its Eastern European satellites completed their transition from high to low fertility before the US and Western Europe. They did this even though there were not enough modern contraceptives available to meet the needs of its citizens. As late as 1990, the Soviet Union had no factories manufacturing modern contraceptives. A gynecologist in Poland described domestically produced oral contraceptives (OCs) as being good for horses, but not for humans. The Romanian government under Ceaucescu banned all contraceptives and safe abortion services. Therefore, women relied on abortion as their principal means of birth control, even in Catholic Poland. The legal abortion rates in the Soviet Union and Romania stood at 100/1000 (1985) and 91/1000 (1987) as compared to 18/1000 in Denmark and 13/1000 in France. All too often these abortion were prohibited and occurred under unsafe conditions giving rise to complications and death. Further, the lack of contraceptives in the region precipitated and increase in AIDS and other sexually transmitted diseases. On the other hand, abortion rates were minimalized in Czechoslovakia, East Germany, and Hungary due to the availability of modern contraceptives and reproductive health services. Hungary and East Germany even manufactured OCs. OC use in these 2 nations rated as among the world's highest. East Germany also treated infertility and sexually transmitted diseases. The region experienced a political opening in latecomer 1989. In 1989, IPPF gave approximately 15 million condoms and 3000 monthly OC packets to the Soviet Union to ease the transition. More international assistance for contraceptive supplies and equipment and training to modernize abortion practices is necessary.
Improving comparability of international migration statistics: contributions by the Conference of European Statisticians from 1971 to date.
INTERNATIONAL MIGRATION REVIEW. 1987 Winter; 21(4):1017-37.This article summarizes the 3 main types of interrelated activities which the Conference of European Statisticians has worked on to improve the measurement and international comparability of international migration flows. The work has encompassed collaborating with the UN Statistical Commission on the preparation and implementation of the revised international recommendations on statistics of international migration, organizing a regular exchange of data on immigration and emigration flows among the UN Economic Commission for Europe countries and selected countries in other regions, and conducting bilateral studies on international migration within the framework of the Conference's program of work in this field of statistics. The bulk of the work which has been carried out to date by the conference has been conducted rather anonymously and even unobtrusively by the staff of national statistical offices in Economic Commission for Europe countries; they have achieved a modest but important amount of progress during the past 15 years. There is reason to expect that further progress will be made over the next decade, particularly if national statistical offices in the region continue to undertake bilateral studies and endeavor to improve their migration statistics. However, more substantial progress could be achieved if additional countries and organizations established projects aimed at achieving these ends (author's modified).
Bangkok, Thailand, U.N. Economic and Social Commission for Asia and the Pacific, 1986. v, 148 p. (Asian Population Studies Series No. 79.)The research reports and statements by government representives contained in this volume were presented at the Policy Workshop on International Migration in Asia and the Pacific held at Bangkok from 15-21 October 1985. The workshop was the final activity of a 2-year Economic and Social Commission for Asia and the Pacific (ESCAP) project on international migration policy in Asia and the Pacific, funded by the UN Fund for Population Activities. The 2nd phase of the project includes the studies reported in this volume, which were intended to be exploratory. They were meant to assess the current state of knowledge regarding return migration and to identify critical issues that would require further investigation. 5 of the studies are concerned with return migration from temporary employment, primarily in the Middle East. Because many of the labor-sending countries of the Mediterranean basin experienced a rapid expansion of labor emigration (largely to northern and western Europe) and a contraction of the flow and increase in return migration prior to current trends in Asian labor migration, it was felt that a background paper on that experience would be value to policy makers in the ESCAP region. Migration from the Pacific sub-region of ESCAP is both of more variable duration and less heavily labor-oriented than temporary migration from Asian countries to the Middle East. The workshop's objectives were 1) to bring together researchers and policy makers to review carefully the results of the 7 studies carried out as part of the project, 2) to relate the research findings to feasible government policies for the reintegration of returning labor migrants, and 3) to make and disseminate policy recommendations to governments in the ESCAP region.
WORLD HEALTH FORUM. 1986; 7(4):391-8.Between 1841 and 1901 infant mortality in England and Wales hovered around 150/1000 live births. In the 1st 30 years of the present century it plummeted to about 60/1000, and between 1931 and 1981 it fell to about 10/1000. This article shows how a broadly based social movement starting around the turn of the century brought about a child health revolution using the slogan, "Save the babies." Baby clinics were opened, milk depots were set up, and, most important of all, mothers were educated in child care. Concomitantly, social and economic progress was achieved, women's rights were improved, female literacy became the norm, and family planning became widespread. The situation is very different in developing countries. Here the infant mortality rate ranges between 50 and 230/1000 live births. In 1982, the United Nations Children's Fund launched a campaign to bring infant mortality below 50/1000 in every developing country by the year 2000. The main factors hindering a child survival revolution are social and political, not technical. The medical technology to bring about a dramatic reduction in infant mortality in developing countries is already at hand. Now needed, above all, is sustained, broad-based campaigning to convince the decision-makers of the world that a child survival revolution is indeed possible.
["Census" in the twentieth century: on the indispensability of the census] Zensus im 20. Jahrhundert: uber die Unverzichtbarkeit einer Volkszahlung
Wirtschaftswissenschaftliches Studium. 1984 May; 13(5):253-7.This article focuses on the uses and limits of a population census from a scientific statistical viewpoint, with a geographic emphasis on the Federal Republic of Germany. Comparisons are made among the minimum census program recommended by the United Nations and the U.S. and German census programs. The role of the census in relation to population registers and surveys is also discussed. Finally, the indispensability of the census for economic and social policy is noted. (ANNOTATION)
Mothers and Children. 1985 Nov-Dec; 5(1):5, 7.Currently standards from industrialized countries are used to assess the growth patterns of breastfed infants in developing countries. Infant growth faltering is interpreted as an indicator of insufficient lactational capacity on the mother's part. 2 recent articles suggest the need for a critical reappraisal of current growth standards and their use for evaluating the adequacy of infant feeding practices. The most commonly used standards to evaluate infant growth are derived from the US National Center for Health Statistics based on anthropometric data collected in the US population 3-month intervals up to the age of 3. During this period, infant feeding practices varied greatly. Many babies were bottle-fed and given supplemental feedings early in life. No large sample of exclusively breastfed infants has been studied from birth on, and thus a standard for breastfed infants is not available. A study of fully breastfed infants was done in England and suggests that there are differences in growth rates. Among a population of 48 exclusively breastfed boys and girls, for the 1st 3 to 4 months of life, growth of breastfed infants was greater than National Center for Health Statistics Standards, while after 4 months growth velocity decelerated more quickly than the standard. The growth of infants studied in Kenya, New Guinea and the Gambia appears to falter at 2-3 months of age using the NCHS standard. Findings suggest that current FAO/WHO recommended energy intakes may be excessive. Recent studies in the US support this assertion. The adequacy of the milk production for the infants in this US study done in Texas was illustrated by their growth rates. Length for age percentiles were higher than the NCHS standards throughout the study though at birth they did not differ significantly. 1 reason these breastfed infants were able to maintain growth despite less than recommended energy intakes is that the ratio of weight gain/100 calories of milk consumed was 10-30% higher among the breastfed infants compared to formula fed infants, suggesting a more efficient use of breastmilk than formula. There is a need for studies of exclusively breastfed infants with larger samples to determine what growth pattern should be considered the norm.
Proceedings of the International Collaborative Effort on Perinatal and Infant Mortality, Vol. 1. Papers presented at the International Symposium on Perinatal and Infant Mortality, 1984; Bethesda, Maryland; sponsored by National Center for Health Statistics
Hyattsville, Md, United States. National Center for Health Statistics [NCHS], 1985. xv,  p.These are the proceedings of an international symposium held in August 1984 in Bethesda, Maryland. The objective of the symposium was to improve coordination between the U.S. National Center for Health Statistics [NCHS] and other institutions in developed countries working in the area of perinatal and infant mortality. Emphasis was placed on how to develop programs and activities designed to improve infant health and to remove the disparities that exist among racial, ethnic, and socioeconomic groups in the United States. A series of papers is included on recent trends in perinatal and infant mortality in the United Kingdom, the Federal Republic of Germany, Japan, the United States, Israel, Norway, and Sweden, together with a comparative overview. A second group of papers describes health care systems in the countries concerned. A third section deals with current research into perinatal and infant mortality in these countries. The proceedings conclude with working group and discussant reports.
Multinational comparative clinical trial of long-acting injectable contraceptives: norethisterone enanthate given in two dosage regimens and depot-medroxyprogesterone acetate. A preliminary report.
Contraception. 1982 Jan; 25(1):1-11.A multicenter phase 3 clinical trial compared norethisterone enanthate (NET-EN) given by 2 different treatment regimens and depot-medroxyprogesterone acetate (DMPA). After 18 months of observation, preliminary findings are reported for 790 women who received NET-EN 200 mg every 60 days; for 796 women who recieved NET-EN every 60 days (200 mg) for 6 months, then 200 mg every 84 days, and for 1589 women who received DMPA 150 mg every 90 days. Overall discontinuation rates and discontinuation for bleeding and personal reasons were similar for all 3 groups after 18 months observation (61.8-63.5/100 women). Terminations due to amenorrhea were significantly higher among DMPA users (12.1 and 17.4/100 women at 12 and 18 months) than among both NET-EN groups (6.8-8.2/100 women at 12 months and 10.4-10.9/100 women at 18 months). The only significant difference in pregnancy rates observed among the 3 groups was a higher rate at 18 months among NET-EN (84 days) users (1.6/100 women), than among DMPA users (0.2/100 women). There was no overall significant difference between the 2 NET-EN groups, although between the 6 and 18 month follow-ups when the 2 NET-EN regimens diverged, the NET-EN (84 days) users' pregnancy rates rose significantly, whereas in the NET-EN (60 days) group, the pregnancy rate did not change. Weight gain was significantly higher in those subjects using NET-EN at 60 day intervals than at 84-day intervals. (author's modified)