Your search found 51 Results

  1. 1

    Hepatitis B virus: where do we stand and what is the next step for eradication?

    Komatsu H

    World Journal of Gastroenterology. 2014 Jul 21; 20(27):8998-9016.

    Hepatitis B (HB) virus (HBV) infection, which causes liver cirrhosis and hepatocellular carcinoma, is endemic worldwide. Hepatitis B vaccines became commercially available in the 1980s. The World Health Organization recommended the integration of the HB vaccine into the national immunisation programs in all countries. HBV prevention strategies are classified into three groups: (1) universal vaccination alone; (2) universal vaccination with screening of pregnant women plus HB immune globulin (HBIG) at birth; and (3) selective vaccination with screening of pregnant women plus HBIG at birth. Most low-income countries have adopted universal vaccine programs without screening of pregnant women. However, HB vaccines are not widely used in low-income countries. The Global Alliance for Vaccine and Immunization was launched in 2000, and by 2012, the global coverage of a three-dose HB vaccine had increased to 79%. The next challenges are to further increase the coverage rate, close the gap between recommendations and routine practices, approach high-risk individuals, screen and treat chronically infected individuals, and prevent breakthrough infections. To eradicate HBV infections, strenuous efforts are required to overcome socioeconomic barriers to the HB vaccine; this task is expected to take several decades to complete.
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  2. 2
    Peer Reviewed

    Challenges of cancer control in developing countries: current status and future perspective.

    Sharma V; Kerr SH; Kawar Z; Kerr DJ

    Future Oncology. 2011 Oct; 7(10):1213-1222.

    Cancer is a global problem accounting for almost 13% of all deaths worldwide. This equates to over 7 million people a year, more than is caused by HIV/AIDS, TB and malaria combined. Now is the time to strengthen the health systems of developing countries to deal with cancer, to avoid a future crisis similar to the HIV/AIDS pandemic. In this article we discuss the current state of cancer in the developing world, how we need to advocate for a change in cancer control policy with the governments of developing nations/transnational governmental bodies (e.g., the UN and WHO etc) and how we think cancer care could be improved in developing countries. We feel the only way to overcome the growing burden of cancer in the developing world is working in partnership with, nongovernmental organizations, international nongovernmental organizations, transnational governmental bodies and governmental bodies.
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  3. 3
    Peer Reviewed

    Providing paediatric palliative care in Kenya.

    Lancet. 2010 Sep 11; 376(9744):846.

    This article discusses the lack of palliative care and pain treatment for Kenyan children with diseases such as cancer, HIV/AIDS, and sickle-cell anemia. Although WHO and Kenya consider morphine an essential medicine, only seven of 250 public hospitals stock it and healthcare professionals are rarely trained to treat pain and are unaware of the benefits of morphine. It concludes that the Kenyan Government should immediately improve access to oral morphine and draw up a policy and plan of action on how to scale up palliative care.
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  4. 4

    Arsenic drinking water regulations in developing countries with extensive exposure.

    Smith AH; Smith MM

    Toxicology. 2004 May 20; 198(1-3):39-44.

    The United States Public Health Service set an interim standard of 50 mg/l in 1942, but as early as 1962 the US Public Health Service had identified 10 mg/l as a goal which later became the World Health Organization Guideline for drinking water in 1992. Epidemiological studies have shown that about one in 10 people drinking water containing 500 mg/l of arsenic over many years may die from internal cancers attributable to arsenic, with lung cancer being the surprising main contributor. A prudent public health response is to reduce the permissible drinking water arsenic concentrations. However, the appropriate regulatory response in those developing countries with large populations with much higher concentrations of arsenic in drinking water, often exceeding 100 mg/l, is more complex. Malnutrition may increase risks from arsenic. There is mounting evidence that smoking and arsenic act synergistically in causing lung cancer, and smoking raises issues of public health priorities in developing countries that face massive mortality from this product. Also, setting stringent drinking water standards will impede short term solutions such as shallow dugwells. Developing countries with large populations exposed to arsenic in water might reasonably be advised to keep their arsenic drinking water standards at 50 mg/l. (author's)
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  5. 5
    Peer Reviewed

    World Health Organization cancer priorities in developing countries.

    Ngoma T

    Annals of Oncology. 2006; 17 Suppl 8:[6] p..

    The burden of cancer in developing countries is growing and threatens to exact a heavy morbidity, mortality, and economic cost in these countries in the next 20 years. The unfolding global public health dimensions of the cancer pandemic demand a widespread effective international response. The good news is that the majority of cancers in developing countries are preventable, and the efficacy of treatment can be improved with early detection. Currently, the knowledge exists to implement sound, evidence-based practices in cancer prevention, screening/early detection, treatment, and palliation. It is estimated that the information at hand could prevent up to one-third of new cancers and increase survival for another one-third of cancers detected at an early stage. To achieve this, knowledge must be translated into action. To facilitate the call to action in the fight against cancer, the World Health Organization (WHO) has developed a comprehensive approach to cancer control. The WHO has produced many valuable guidelines and resources for the effective implementation of national cancer control programs. Several milestones in the WHO's efforts include the Framework Convention for Tobacco Control, and global strategies for diet and exercise, reproductive health, and cervical cancer. This review examines the strategies and approaches that have successfully resulted into global action to confront the rising global burden of cancer in the developing world. (author's)
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  6. 6
    Peer Reviewed

    The globalisation of cancer.

    Boyle P

    Lancet. 2006 Aug 19; 368(9536):629-630.

    The International Agency for Research on Cancer (IARC) was founded by a Resolution of the World Health Assembly in September, 1965. At that time, although data were sparse, cancer was widely considered to be a disease of developed high-resource countries. Now, the situation has changed dramatically with the majority of the global cancer burden found in low-resource and medium-resource countries. It is estimated that in 2000 almost 11 million new cases of cancer were diagnosed worldwide, 7 million people died from cancer, and 25 million persons were alive with cancer. The continued growth and ageing of the world's population will greatly affect the future cancer burden. By 2030, it could be expected that there will be 27 million incident cases of cancer, 17 million cancer deaths annually, and 75 million persons alive with cancer. The greatest effect of this increase will fall on low-resource and mediumresource countries where, in 2001, almost half of the disease burden was from non-communicable disease. (excerpt)
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  7. 7

    Trends of female mortality from cancer of the breast and cancer of the genital organs.

    Pascua M

    Bulletin of the World Health Organization. 1956; 15:5-41.

    The author reviews that mortality statistics from cancer of the breast in females and from malignant neoplasms of the uterus and of the other female genital organs for nineteen countries over the years 1920-53, first considering the general trend of the mortality series for each group of diseases for all ages and then analysing for each sector of mortality the changes which have occurred in the age-specific death-rates in some pivotal years during the same period. Considerable differences in the levels of total mortality from each group of tumours for various countries are noted. The important variations among age-specific death-rates for cancer of the breast in females and for uterine neoplasms in various countries are examined and their significance is commented upon. (excerpt)
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  8. 8

    Improvement of oral health in Africa in the 21st century -- the role of the WHO Global Oral Health Programme.

    Petersen PE

    African Journal of Oral Health. 2004; 1(1):2-16.

    Chronic diseases and injuries are overtaking communicable diseases as the leading health problems in all but a few parts of the world. This rapidly changing global disease pattern is closely linked to changing lifestyles which include diet rich in sugars, widespread use of tobacco and increased consumption of alcohol. These lifestyle factors also significantly impact oral health, and oral diseases qualify as major public health problems owing to their high prevalence and incidence in all regions of the world. Like all diseases, they affect primarily the disadvantaged and socially marginalized populations, causing severe pain and suffering, impairing functionability and impacting quality of life. Traditional treatment of oral diseases is extremely costly even in industrialized countries and is unaffordable in most low and middle-income countries. The WHO Global Strategy for prevention and control of noncommunicable diseases and the "common risk factor approach" offer new ways of managing the prevention and control of oral diseases. This report outlines major characteristics of the current oral health situation in Africa and development trends as well as WHO strategies and approaches for better oral health in the 21st century. (author's)
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  9. 9

    Reproductive health of women in Thailand: progress and challenges towards attainment of international development goals.

    United Nations Population Fund [UNFPA]. Country Technical Services Team for East and South-East Asia

    Bangkok, Thailand, UNFPA, Country Technical Services Team for East and South-East Asia, 2005 Jul. [59] p.

    The report examines Thailand's progress in the area of women's reproductive health in the context of major international declarations and conventions including CEDAW (1979), ICPD in Cairo (1994), Beijing Declaration (1995), and MDGs (2001). The report is divided into four chapters. Chapter 1 provides an overview of Thai women's status in the economic and political arenas. Chapter 2 deals with reproductive health concerns including maternal mortality STI/HIV/AIDS, adolescent reproductive health, reproductive malignancies, and older person's reproductive health. Primarily the discussion reveals a persistent gender gap in these concerns. Chapter 3 examines how larger issues concerning women's reproductive and sexual rights in the country are addressed. In addition, gender-based violence as a reproductive health and human rights issue is examined owing to the rise in the number of women who are victims of violence. The chapter 3 also details the reproductive health status of women from vulnerable groups such as the ethnic minorities and poor and rural women who engage in low-paid work, which increases their vulnerability to various health risks. The report concludes with chapter 4 that outlines a number of 'quick wins' for ensuring greater equality for women in their access to reproductive health care services in the future. (excerpt)
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  10. 10

    Iraq: reproductive health assessment.

    United Nations Population Fund [UNFPA]

    [New York, New York], UNFPA, 2003 Aug. 35 p.

    This paper provides an overview of the (a) current situation; (b) emerging needs, and (c) areas needing priority action. It is based on data collected from governorates using a standardised data collection guide, an review of available documents and literature, and interviews with Iraqi health specialists. (excerpt)
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  11. 11
    Peer Reviewed

    FIGO and women's health 2000 - 2003.

    Sheth SS

    International Journal of Gynecology and Obstetrics. 2003 Sep; 82(3):357-367.

    The International Federation of Gynecology and Obstetrics – FIGO – has been striving hard to carefully attend to women’s well-being, and respect and implement their rights, the status and their health, which is well beyond the basic obstetric and gynecological requirement. FIGO is deeply involved in acting as a catalyst for the all-round activities of national obstetric and gynecologic societies to mobilise their members to participate in and contribute to, all of their endeavours. FIGO’s committees strengthen these objectives and FIGO’s alliance with WHO provides a springboard. The task is gigantic, but FIGO, through national obstetric and gynecological societies and with the strength of obstetricians and gynecologists as its battalion, can offer to combat and meet the demands. (author's)
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  12. 12
    Peer Reviewed

    A dose escalation study of docetaxel and oxaliplatin combination in patients with metastatic breast and non-small cell lung cancer.

    Kouroussis C; Agelaki S; Mavroudis D; Kakolyris S; Androulakis N

    Anticancer Research. 2003 Jan-Feb; 23(1B):785-791.

    Objectives: To determine the maximum tolerated dose (MTD) and the dose-limiting toxicities (DLTs) of docetaxel in combination with oxaliplatin (L-OHP) as first-line treatment of patients with advanced breast (ABC) and non-small cell lung cancer (NSCLC). Patients and methods: Fifty-two patients (26 with NSCLC and 26 with ABC), who had not received prior chemotherapy for metastatic disease, were enrolled. The patients' median age was 64 years, and 42 (71%) had a performance status (WHO) 0-1. Docetaxel was given as a 1-hour infusion after standard premedication on day 1 and L-OHP as a 2 to 6-hour infusion on day 2 every 3 weeks. Doses were escalated at increments of 10mg/m2. Results: The DLT1 was reached at the doses of docetaxel 75mg/m2 and L-OHP 80mg/m2. The addition of rhG-CSF permitted further dose escalation (DLT2: docetaxel 90mg/m2 and L-OHP 130mg/m2). The dose-limiting events were grade 4 neutropenia, febrile neutropenia, grades 3 or 4 diarrhea and grade 3 fatigue. Out of 239 delivered cycles, grades 3 or 4 neutropenia occurred in 22 (9%) cycles with 5 (2%) neutropenic febrile episodes. There was one septic death. Grades 3 or 4 fatigue was observed in seven (13%) patients and grades 3-4 diarrhea in five (10%). Out of 42 patients evaluable for response, seven (27%) patients with ABC and five (19%) patients with NSCLC experienced a partial response. Conclusion: The combination of docetaxel and oxaliplatin is a feasible and well-tolerated regimen. The recommended doses for future phase II studies are 75mg/m2 for docetaxel on day 1 and 70mg/m2 for L-OHP on day 2 without rhG-CSF support and 85mg/m2 and 130mg/m2, respectively, with rhG-CSF support. (author's)
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  13. 13

    Arsenic poisoning in Bangladesh: a geographic analysis.

    Paul BK; De S

    Journal of the American Water Resources Association. 2000 Aug; 36(4):799-809.

    Drinking of arsenic-contaminated tubewell water has become a serious health threat in Bangladesh. Arsenic contaminated tubewells are believed to be responsible for poisoning nearly two-thirds of this country's population. If proper actions are not taken immediately, many people in Bangladesh will die from arsenic poisoning in just a few years. Causes and consequences of arsenic poisoning, the extent of area affected by it, and local knowledge and beliefs about the arsenic problem - including solutions and international responses to the problem - are analyzed. Although no one knows precisely how the arsenic is released into the ground water, several contradictory theories exist to account for its release. Initial symptoms of the poisoning consist of a dryness and throat constriction, difficulty in swallowing, and acute epigastric pain. Long-term exposure leads to skin, lung, or bladder cancer. Both government and nongovernmental organizations (NGOs) in Bangladesh, foreign governments, and international agencies are now involved in mitigating the effects of the arsenic poisoning, as well as developing cost-effective remedial measures that are affordable by the rural people. (author's)
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  14. 14

    Research on the menopause.

    World Health Organization. Scientific Group

    World Health Organization Technical Report Series. 1981; (670):1-120.

    This report includes the collective views of a World Health Organization (WHO) Scientific Group on Research on the Menopause that met in Geneva during December 1980. It includes information on the following: 1) the endocrinology of the menopause and the postmenopausal period (changes in gonadotropins and estrogens immediately prior to the menopause and changes in gonadotropin and steroid hormone levels after the menopause); 2) the age distribution of the menopause (determining the age at menopause, factors influencing the age at menopause, and the range of ages at menopause and the definition of premature and delayed menopause); 3) sociocultural significance of the menopause in different settings; 4) symptoms associated with the menopause (vasomotor symptoms, psychological symptoms, disturbances of sexuality, and insomnia); 5) disorders resulting from, or possibly accelerated by, the menopause (osteoporosis, atherosclerotic cardiovascular disease, and arthritic disorders); 6) risks, with particular reference to neoplasia, of therapeutic estrogens and progestins given to peri- and postmenopausal women (endometrial cancer, breast cancer, and gallbladder disease); 7) fertility regulating methods for women approaching the menopause (fertility and the need for family planning in women approaching the menopause, problems of family planning in perimenopausal women, and considerations with regard to individual methods of family planning in women approaching the menopause); and 8) estrogen and the health care management of perimenopausal and postmenopausal women. At this time some controversy exists as to whether there is a menopausal syndrome of somatic and psychological symptoms and illness. There are virtually no data on the age distribution of the menopause and no information on its sociocultural significance in the developing countries. The subject of risks and benefits of estrogen therapy in peri- and postmenopausal women is of much importance in view of the large number of prescriptions issued for this medication in developed countries, which indicates their frequrnt use, and the different interpretations and opinions among epidemiologists and clinicians on both past and current studies on this subject. Specific recommendations made by the Scientific Group appear at the end of each section of the report. The following were among the general recommendations made: WHO sponsored research should be undertaken to determine the impact on health service needs of the rapidly increasing numbers of postmenopausal women in developing countries; uniform terminology should be adopted by health care workers with regard to the menopause; uniform endocrine standards should be developed which can be applied to the description of peri- and postmenopausal conditions and diseases; and descriptive epidemiological studies of the age at menopause should be performed in a variety of settings.
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  15. 15

    Basic and clinical aspects of intra-uterine devices. Report of a WHO scientific group.


    Geneva, World Health Organization, 1966. (Technical Report Series NO. 332).

    The value and possible hazards of IUDs are discussed. Grafenberg developed a metal ring IUD in 1928. There was initial enthusiasm about the device, but it became discredited and interest was not revived in the method until 1959. Today, various shapes, sizes, and materials are employed in making IUD'S. No single cause or mechanism of action of an IUD has so far come to light. In sub-human primates the IUD causes accelerated passage of ova through the tube and the rest of the reproductive tract appears to be the major, but not necessarily the only, mechanism, of action. In ruminants, the contraceptive action of the IUD is exerted, at least in part, at the ovarian level. In rats, mice, rabbits, and ferrets, the main effect of the IUD is suppression of the implantation. It is concluded that the action of the IUDs in the human species is exerted before the stage of implantation. The most effective devices are associated with an incidence of 1.8 to 2.9 pregnancies per 100 insertions during the first year of use. The frequency of spontaneous expulsion ranges from about 5% to over 20% depending on the type of device. About one half of all expulsions occur in the first 3 months and comparatively few after the first year. The incidence of removal for medical reasons ranges from approximately 10% to 25% of first insertions during the first year. The method can be used successfully by almost 3 out of every 4 women who adopt it. Side effect and complications include bleeding and pain and less frequently pelvic inflammatory disease and perforation. The only absolute contraindications to the use of IUDs are: (1) active pelvic inflammatory disease, and (2) pregnancy, proven or suspected. Research needs are noted.
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  16. 16

    New Bangladesh disaster: wells that pump poison. Death by arsenic. A special report.

    Bearak B

    NEW YORK TIMES. 1998 Nov 10; A1, A10.

    In Bangladesh, the discovery by chemist and environmentalist Dipankar Chakraborti that the ground water pumped by millions of tube wells is poisoned by arsenic has cast a tragic pall over a safe water program carried out over 25 years by the government with the aid of the UN Children's Fund. Most of the pumps are 10-20 years old, exactly the period of time it takes arsenic poisoning to result in death from one of the many cancers it causes. As a result, experts fear that Bangladesh will experience the largest mass poisoning in history. A similar situation exists in the Indian state of West Bengal. The poisoning is manifest in skin lesions on the palms of the hands and soles of the feet of villagers. It is as yet unknown how many people are drinking the poison, how long they have been doing it, and when they will stop, but conservative estimates are that 18 million people are involved. The World Bank has responded by offering a $32.4 million credit to the Bangladeshi government to test every one of the 3.5-4 million wells. Soil variations mean that arsenic can be present in one well and not in another a mere 10 yards away. Once contamination has been found, the next problem is to find safe water for the people to drink. It took a massive effort to convert villagers to well water instead of relying on the contaminated natural ponds that caused cholera and diarrheal diseases. It will take another massive effort to convince them that the well water is poisoning them. In the meantime, there is no treatment for arsenic poisoning.
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  17. 17

    Quinacrine method of family planning [letter]

    Do Trong Hieu

    Lancet. 1994 Apr 23; 343(8904):1040.

    This letter is in reply to a news report by Malcom Potts that reviews a 46-month field trial of nearly 32,000 women who were given quinacrine pellets as a means of surgical sterilization. The program reached 33 provinces before it was halted in December when, as stated in a letter from Dr. F.T.G. Webb of the World Health Organization (WHO) to UN Population Fund director Linda Demers, experts from WHO and the US Food and Drug Administration (USFDA) expressed concern about the possible carcinogenicity of quinacrine. At that time there was no scientific evidence that quinacrine causes cancer in man, but the government discontinued trials in view of the authority of WHO. The FDA approved phase I clinical trials which used volunteers in San Antonio, Texas and followed the required toxicology work at Johns Hopkins University. The work was published and no objections were raised. A panel of toxicologists were asked by Family Health International in 1990 to evaluate quinacrine as a carcinogen; they found a lack of positive, in vivo data and of relevant human data. The authors in collaboration with FHI and Dr. Jaime Zipper of Chile conducted their own investigation in 1990 and found no evidence of excess risk associated with the use of quinacrine pellet transcervical sterilization. WHO and the Association for Voluntary Surgical Contraception (AVSC) have widely distributed their criticism of the authors' paper, which was published in Lancet and discussed at an AVSC meeting to which the authors were uninvited. This obstructs scientific debate. Unsubstantiated opinions should not be allowed to undermine this promising family planning method.
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  18. 18

    Quinacrine family-planning method [letter]

    Abdullah R

    Lancet. 1994 Jun 4; 343(8910):1425-6.

    Many Vietnamese women do not accept IUDs. Program planners, providers, and officials in Vietnam are therefore challenged with providing alternative methods of fertility control which are acceptable to the population. Nongovernmental organizations for women in Asia and the Pacific are concerned about Potts' assertion that the intrauterine insertion of quinacrine pellets is a safe and effective method of sterilization for Vietnamese women. Women's health advocates are most worried about safety, especially the long-term physiological effects and the risk of abuse or coercion. On the basis of a 1991 review, the World Health Organization Toxicology Panel recommended further study of the safety of quinacrine in sterilization, while Hieu et al from their report of a large field trial of Vietnamese women admitted their inability to study the risk of cancer of the uterus as a result of exposure with quinacrine. Work needs to be done before the use of quinacrine as a form of contraception may be declared safe and effective. Future field trials in Vietnam should interview users on their views and preferences. Moreover, since the administration of quinacrine involves no surgical procedure and the insertion procedure is identical for both IUD and quinacrine, some women may not fully understand that one method is permanent and the other is not. The right of women to make informed and individual choices about their fertility can easily be abused when countries try to achieve population growth and size targets. Efforts should be made to ensure that such abuses do not occur in Vietnam.
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  19. 19

    AIDS in Africa: a manual for physicians.

    Piot P; Kapita BM; Ngugi EN; Mann JM; Colebunders R; Wabitsch R

    Geneva, Switzerland, World Health Organization [WHO], 1992. viii, 125 p.

    The first reported AIDS cases in Africa occurred in central Africa in 1982. AIDS is rapidly spreading among the population living there as well as among populations in southern and western Africa. The AIDS pandemic is overtaxing an already burdened health system in sub-Saharan African countries. WHO has put together this manual so health workers in Africa could have a reliable source of current information in this new and rapidly expanding field. The manual's introduction discusses the public health and social significance of AIDS and provides some HIV seroprevalence rate (e.g., <1-20% of the general population, 27-88% of female prostitutes in some cities). The manual next covers the etiology and pathogenesis of AIDS, the human immunodeficiency virus (HIV) being the causative agent. Chapter 3 reviews the epidemiology of HIV infection and AIDS, including an historical review of AIDS in Africa and transmission. Clinical manifestations of acute retroviral illness and asymptomatic and symptomatic HIV infection are delineated in Chapter 4. Opportunistic infections (fungal, parasitic, bacterial, and viral infections), Kaposi's sarcoma, and lymphoma make up Chapter 5. Considerable information exists in Chapter 6 on HIV infection in children. Chapter 7 reviews clinical and laboratory diagnoses of HIV infection and AIDS. The most involved chapter in the manual is Chapter 8, which provides guidance on the management of HIV/AIDS patients. Counseling and psychosocial support is covered in Chapter 9. The manual concludes with a chapter on the prevention and control of HIV/AIDS. The annexes include the CDC 1987 revision of the case definition for AIDS for surveillance purposes and the CDC classification system for HIV infection.
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  20. 20

    Human immunodeficiency virus (HIV) infection codes and new codes for Kaposi's sarcoma. Official authorized addenda ICD-9-CM (revision no. 2). Effective October 1, 1991.

    United States. National Center for Health Statistics [NCHS]


    The addenda for Volumes 1 and 2 of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) were reported by the Collaborating Center for Classification of Diseases for North America at the National Center for Health Statistics. This was the second revision of these codes for the classification of HIV infection. THe addenda, effective October 1, 1991, replace the addendum containing codes for human immunodeficiency virus (HIV) infection that went into effect January 1, 1988. The structure of the classification, the codes within the classification, and the use of the codes remained the same. 3 basic modifications were accepted. A new 3-digit category was created for Kaposi's sarcoma; several new clinical conditions were added (acute or subacute endocarditis, microsporidiosis, acute or subacute myocarditis, bacterial and pneumococcal pneumonia, histiocytic or large cell lymphoma, secondary cardiomyopathy and nephritis and nephropathy); and several categories of HIV manifestations were expanded to include similar conditions (viral pneumonia, encephalitis, encephalomyelitis and myelitis). These modifications will improve the accuracy of reporting and allow public health officials, clinical researchers, and agencies which finance health care to monitor diagnoses of AIDS and other manifestations of HIV infection. HIV infection is divided into 3 categories: HIV infection with specified secondary infections or malignant neoplasms, or AIDS; HIV infection with other specified manifestations; and other HIV infections not classifiable above. AIDS is not synonymous with HIV infection or with such terms as pre-AIDS or AIDS-related complex. To use these codes correctly, the physician must provide complete information and state the relationship between HIV infection and other conditions.
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  21. 21

    Vasectomy: avoiding panic over prostate cancer.

    Haq F

    POPULI. 1993 Mar; 20(3):4-5.

    A study published in the Journal of the American Medical Association linked vasectomies to a 66% elevated risk of prostate cancer among men 15-20 years after the surgery, although a causal relationship between vasectomy and prostate cancer was not proven. Although 2 previous studies found no linkage, the study by Edward Giovannucci of Boston drew broad attention in the medical community. Prostate cancer in the industrial world is quite high: about 1 in 11 males in the US will develop prostate cancer for unexplained reasons. But the US-based Association for Voluntary Surgical Contraception (AVSC) warns that the public or medical professionals should not overreact to this new information. In 1991 a group of experts convened by WHO concluded that based on existing biological and epidemiological evidence any causal relationship between vasectomy and the risk of prostate or testicular cancer was unlikely and changing policies concerning vasectomy was unjustified. In contrast to the author's conjecture, experts at AVSC pointed out that models of cancer development suggest that a decrease in prostatic secretions following a vasectomy actually would reduce cancer risks. The cases of prostate cancer are unknown, and vasectomy is not associated with any increase in mortality. Family Health International (FHI) is concerned about the effect of perceptions in developed countries on policy in developing countries. However, the risks associated with vasectomy are still less than the risks of pregnancy. In India health risks linked to pregnancy and childbearing are 400 times greater than those linked to contraception. Further research, the continuation of vasectomy policies, and annual examinations for prostate cancer among men who have undergone vasectomies and for all men aged 50-70 years are recommended. The American Urological Association urges men who have had vasectomies not to have them reversed to try to prevent cancer.
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  22. 22

    Why men avoid vasectomies.

    Stein R

    WASHINGTON POST HEALTH. 1993 Jan 12; 11.

    In the United States a total of 490,000 men obtain vasectomies each year compared to more than 600,000 women who sought sterilization in 1992 via tubal ligation. Vasectomy is often permanent, and even monogamous men avoid the procedure, partly because of the misconception that vasectomies reduce sexual prowess, fear of emasculation, and its confusion with castration. Also, there have been suggestions that vasectomy may increase the risk of prostate cancer. The World Health Organization experts in 1991 concluded there was no reason to stop recommending vasectomies. However, 2 large studies at Harvard University in Boston have added to the controversy. The 1st study involved more than 23,000 husbands of women in the Nurses' Health Study and followed the men from 1976 until 1989. A preliminary analysis found that having a vasectomy appears to increase the risk for prostate cancer by 37%. The 2nd study involved more than 51,000 men in the Health Professionals Follow-up Study. Similarly, preliminary analysis indicated that vasectomized men appear to have a 21% increased risk for prostate cancer. These findings cause concern, since 4 million American men have had the procedure. A vasectomy involves severing each vas deferens, which carries sperm from the testicles into the penis. In the new, no-scalpel vasectomy technique the doctor makes 1 tiny puncture, and for the patient there is less swelling and bleeding. 300 US doctors are trained to perform the procedure, which was pioneered in China. Failure usually occurs because the vasa reconnect by themselves. Only a small percentage of men experience complications, most commonly excess bleeding or infections. Microsurgical techniques result in a 98% chance of reconnecting the vasa, if a reversal of the procedure is desired. But only about half of those who undergo a reversal succeed in fathering children, because after a vasectomy the immune system often produces antibodies against sperm.
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  23. 23
    Peer Reviewed

    Vasectomy and prostate cancer.

    Choo V

    Lancet. 1993 Feb 20; 341(8843):486-7.

    2 well-designed cohort studies involving 73,000 men found that the risk of prostate cancer increases after vasectomy. In the Health Professionals Follow-up Study vasectomized men had an age-adjusted relative risk of prostate cancer of 1.66. The risk was 1.85 among those who had had the operation at least 22 years previously. In the Nurses Health Study the age-adjusted relative risk of prostate cancer for vasectomized men was 1.56 overall and 1.89 for those who had had their vasectomy at least 20 years previously. The long-term safety of vasectomy raised by these reports could reduce its acceptability by about 42 million couples worldwide who rely on it. It is not clear whether the relation is causal. Prostate cancer develops in about 1 of 1 men in the US, and most of those affected would not have undergone vasectomy. Since the causes of prostate cancer are unknown, it is not sure whether true risk factors were equally distributed between vasectomized and control groups, a point supported by the finding that in the Nurses' Health Study the vasectomized group has a lower total mortality rate than did the controls. Further uncertainties are the weakness of the association, the lack of relation between vasectomy and prostate cancer in 3 other cohort studies, and the doubtful plausibility of the biological explanations. The experts convened by the World Health Organization in 1991 concluded, based on existing biological and epidemiological evidence, that a causal relation between vasectomy and prostate cancer was unlikely. However, the risk ought to be mentioned in prosterilization counseling, and vasectomized men aged 50-70 should consider annual checks for prostate cancer. The WHO Human Reproduction Program pointed to the up to 50-fold lower annual incidence of prostate cancer in developing countries compared to some parts of the US. WHO-supported pilot studies are under way, and the main case-control study is expected to start in 1994.
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  24. 24

    Action on ozone.

    United Nations Environment Programme [UNEP]

    Nairobi, Kenya, UNEP, 1989. 16 p.

    The stratospheric ozone layer 15-50 km above the earth's surface is made of the blue, pungent-smelling gas, a form of oxygen with 3 atoms instead of the normal 2. It almost totally shields from relatively short-wave ultraviolet radiation, known as UV-C, which is lethal to living things. In the middle lies UV-B, less lethal than shorter wave radiation but still dangerous; the ozone layer absorbs most of it. The small amount of UV-B radiation that penetrates the shield damages the genetic material DNA, and it is the main cause of rapidly increasing skin cancer around the world. There are an estimated 300,000 cases each year in the US alone. Cutaneous malignant melanomas kill about 6000 people/year in the US; the 20-30 times more numerous non melanoma cancers have the same mortality. UV radiation suppresses the immune system, and it also produces cataracts that blind 12-15 million people and seriously impair the vision of another 18-30 million worldwide. 2/3 of 300 crops and plants tested have been found to be sensitive to ultraviolet light. Chlorofluorocarbons (CFCs) destroy ozone. About 30% of the world CFC production is used in refrigerators, freezers, and air conditioners, about 25% in spray cans, another 25% in blowing foams, and the remaining 20% for cleaning. Halons, primarily used as fire extinguishers, destroy ozone up to 10 times as effectively as the most destructive CFCs. The Montreal treaty on the protection of the ozone layer was adopted and signed on September 16, 1987. It regulates a wide range of substances, 5 CFCs and 3 halons. It specifies heavy cuts in the consumption of the CFCs, and it provides tough trade sanctions against countries that do not join the treaty. Companies are also concentrating on recovering and recycling CFCs for reuse. Recycling and conservation also is the best short-term prospect for controlling the use of halons.
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  25. 25
    Peer Reviewed

    [The health-for-all strategy: are we reaching our targets to reduce mortality?] Helse for alle-strategien--nar vi malene for redusert dodelighet?

    Guldvog B

    Tidsskrift for den Norske Laegeforening. 1992; 112(1):57-63.

    The author examines Norway's efforts toward attaining the WHO goal of health for all by the year 2000. "This article presents and discusses the sub-goals for expectation of life and mortality, and analyzes the possibilities of reaching them." Consideration is given to reductions in mortality from accidents, cardiovascular effects, and cancer; age-specific mortality rates; and deaths from suicide and homicide. (SUMMARY IN ENG) (EXCERPT)
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