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BMJ Open. 2015; 5(10):e007004.OBJECTIVES: To explore whether the rule of law is a foundational determinant of health that underlies other socioeconomic, political and cultural factors that have been associated with health outcomes. SETTING: Global project. PARTICIPANTS: Data set of 96 countries, comprising 91% of the global population. PRIMARY AND SECONDARY OUTCOME MEASURES: The following health indicators, infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, were included to explore their association with the rule of law. We used a novel Rule of Law Index, gathered from survey sources, in a cross-sectional and ecological design. The Index is based on eight subindices: (1) Constraints on Government Powers; (2) Absence of Corruption; (3) Order and Security; (4) Fundamental Rights; (5) Open Government; (6) Regulatory Enforcement, (7) Civil Justice; and (8) Criminal Justice. RESULTS: The rule of law showed an independent association with infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, after adjusting for the countries' level of per capita income, their expenditures in health, their level of political and civil freedom, their Gini measure of inequality and women's status (p<0.05). Rule of law remained significant in all the multivariate models, and the following adjustment for potential confounders remained robust for at least one or more of the health outcomes across all eight subindices of the rule of law. Findings show that the higher the country's level of adherence to the rule of law, the better the health of the population. CONCLUSIONS: It is necessary to start considering the country's adherence to the rule of law as a foundational determinant of health. Health advocates should consider the improvement of rule of law as a tool to improve population health. Conversely, lack of progress in rule of law may constitute a structural barrier to health improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Best Practice and Research. Clinical Obstetrics & Gynaecology. 2014 Aug; 28(6):917-30.Many women in the reproductive years have chronic medical conditions that are affected by pregnancy or in which the fetus is placed at increased risk. In most of these women, ongoing medical management of their conditions is greatly improved, even compared with a decade or two ago. However, their condition may still be seriously exacerbated by the physiological changes of pregnancy, and close monitoring of a carefully planned pregnancy is optimal. This requires effective and safe contraceptive use until pregnancy is desired and the medical condition is stabilised. Many contraceptives will also have adverse effects on some medical conditions, and there is now a considerable awareness of the complexities of some of these interactions. For this reason the World Health Organization has developed an excellent, simple and pragmatic programme of guidelines on a four point scale (the WHO "Medical Eligibility Criteria": WHO-MEC), summarising risk of specific contraceptive methods in women with specified chronic medical conditions. The general approach to contraceptive management of many of these conditions is addressed in this article. Copyright (c) 2014. Published by Elsevier Ltd.
AIDS Reader. 2009 Apr; 19(4):131-9, 148-52.This article reviews the medical literature for information about lipodystrophy in Africa and Asia. These 2 regions were selected because both are of particular interest to the declaration for universal access. Africa represents the epidemic's epicenter. Asia, especially India and China, will soon have HIV / AIDS prevalence rates that will outstrip those seen in the rest of the world combined. The methodology is summarized first: how articles were selected, the inclusion and exclusion criteria used, and how information was synthesized. The results and discussion focus on 3 specific areas: how lipodystrophy is defined and measured, the study populations, and the persons excluded from these studies. A summary of what is and what is not yet known about lipodystrophy in Africa and Asia is also included.
[Geneva, Switzerland], WHO, 1997 Apr 24. 3 p. (Press Release WHO/33)A study conducted by the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction confirmed that young women in both developed and developing countries with no predisposing risk factors for cardiovascular disease can use oral contraceptives (OCs) without increasing their risk of acute myocardial infarction. The study was conducted in 21 centers in 12 developing and 7 developed countries and involved 369 women with acute myocardial infarction and 941 healthy controls. The duration of OC use did not affect the risk of heart attack. In OC users under 35 years who smoke and use the pill, the incidence of heart attack increases from the 3.5 cases/million woman-years recorded in nonsmoking OC users to about 40 cases/million woman-years. The risk of heart attack rises substantially, however, in OC users over 35 years of age who smoke: to 500 cases/million woman-years. The overall risk of heart attack is 10 times higher in OC users with high blood pressure than in women with normal blood pressure or non-users of OCs. The data did not reveal consistent differences in heart attack risk according to the OC's estrogen dose; there were too few OC users enrolled in the study who were using pills containing gestodene or desogestrel to permit conclusions about the relative safety of second- and third-generation OCs. These findings indicate that the minimal heart attack risk associated with OC use can be avoided by screening women for potential risk factors for such disease, especially high blood pressure, diabetes, and smoking.
Are the WHO (1980) criteria for the 75 g oral glucose tolerance test appropriate for pregnant women?
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1993 Jul; 100(7):645-8.To assess the normal response to the 75 gm oral glucose tolerance test (OGTT) in normal pregnant women, healthy Chinese and Malay women who had been referred to the antenatal clinic of the Department of Reproductive Medicine, Kandang Kerbau Hospital, Singapore, were evaluated. The women were selected on the basis of having none of the generally accepted risk factors for diabetes mellitus: their age was < 35 years, they weighed < 80 kg, they did not have a personal history of diabetes or a family history of diabetes or a family history of diabetes in first degree relatives, nor did they have a history of babies weighing > 4000 gm at birth, still-births, neonatal deaths, congenital malformations, or recurrent miscarriages. All OGTTs were performed after 28 weeks of gestation. The fasting blood sample was taken from the antecubital vein. Further samples were taken 1 and 2 hours after the glucose drink. A glucose analyzer using 5 mcl of plasma was employed. The analytical method was based on the glucose oxidase/peroxidase/aminophenazone process. There was no significant difference in mean glucose levels at corresponding points of the OGTT in Chinese and Malay women. correlation calculations confirmed the absence of any influence of gestational age after 28 weeks on glucose tolerance. Of the 64 women, 47 were Chinese and 17 Malays; 20 wee nulliparous, and 44 were parous. Their mean age was 27.2 years (range 18-35). The mean birthweight of the infants was 3140 gm (range 2094-4240 gm). There were 33 female and 31 male infants. The mean apgar scores at 1 and 5 min were 8.8 (range 7-9) and 9.0 (range 6-10). The mean values and the proposed upper limits of normality for the 75 gm OGTT were 3.9 and 4.9 mmol/1, respectively. 6 women had abnormal OGTT results according to the WHO criteria (fasting glucose > 6 mmol/1; 2 hour glucose > 8 mmol/1).
AFRICA HEALTH. 1992 Jul; 14(5):10-1.An update on clinical aspects of HIV in africa highlights new proposed clinical definitions of adult AIDS and of tuberculosis in HIV+ adults, and staging of adult HIV infection. The 1986 WHO clinical definition of AIDS has been widely used in Africa, but now research suggests that this definition has several limitations: the definition will pick up several unrelated diseases such as diabetes mellitus and renal failure. It does not ascertain cases of AIDS marked by nonopportunistic infections. Most persons with pulmonary tuberculosis may be wrongly diagnosed with AIDS by this definition. The study showed that the WHO clinical definition has good specificity and positive predictive value for HIV+ people, but its positive predictive value fell to 30% in identifying people with AIDS in Africa. New definitions should take into account any serious morbidity, tuberculosis, neurological disease, both endemic localized Kaposi's, and aggressive typical Kaposi's sarcoma, and HIV serological testing. Tuberculosis is a problem because few HIV+ people suspected of having pulmonary TB (sputum-negative TB) actually have it based on bronchoscopy, while HIV+ persons with TB experience high mortality, often from pyogenic bacteremia. HIV+ persons with TB suffer high rates of relapse, possibly related to insufficient drug treatment or reinfection. 1 study showed that 6 months of isoniazid significantly improved incidence of TB over 30 months of follow-up. Staging of AIDS in Africa based on degree of immunosuppression was proposed as: 1) clinically inapparent HIV infection marked by pulmonary TB, soft tissue infections, and community acquired pneumonia; 2) lymphadenopathy, oral thrush, widespread pruritic maculopapular rash, herpes zoster, enteric illness, dysentery, and Kaposi's sarcoma; and 3) HIV wasting syndrome, chronic pulmonary disease, meningitis, and fever of unknown origin.
WORLD HEALTH. 1991 May-Jun; 8-10.Developing countries now feel the effects of chronic diseases such as diabetes mellitus. Its incidence is growing in these countries. Today >50 million people suffer from diabetes, almost 50% of whom live in developing countries. Public health specialists believe that for every person known to have diabetes in a developing country there is probably at least 1 other person with it that has not been counted. For every known diabetic, health workers have not yet diagnosed it in perhaps 4 other people. The proportion of diabetics in developing countries is increasing due to higher life expectancy, rural-urban migration, shifts from traditional to modern life styles, changes in diet and physical inactivity, and obesity. Every other Micronesian living on Nauru has diabetes--the highest recorded rates for diabetes. The severest form of diabetes (insulin dependent diabetes) seems to be somewhat rare in most developing countries, but it may be that many children with this form of diabetes die without ever being diagnosed. The noninsulin dependent diabetes predominates and its effects contribute greatly to premature deaths. In some developing countries, a rare form of diabetes has emerged called malnutrition related diabetes. Low literacy levels hinder diabetes education efforts. In developing countries, diabetics face discrimination. Competition with other health conditions often results in diabetic care and management being considered a low priority. The leading cause of death from diabetes is nonavailability of insulin. Developing countries should adopt a primary health care approach to prevention and management of diabetes similar to what they do for acute diseases. Health education for the individual, family, community, and policymakers; intersectoral cooperation; and nongovernmental organization participation are needed to affect change in diabetes prevention and control.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1988; 41(3-4):267-73.Because declining mortality from infectious diseases is accompanied by increasing mortality from noncommunicable diseases in both developed and developing countries, the World Health Organization (WHO) has initiated the Integrated Program for Community Health in Noncommunicable Diseases (Interhealth). Interhealth is based on the concepts that 1) noncommunicable diseases are related to a set of risk factors some of which can be controlled; 2) the entire community must be involved; 3) health promotion intervention strategies, such as population control, risk identification, screening and prevention strategies, must be integrated; 4) different categories of intervention (e.g., lifestyle changes, health care reorganization) must be coordinated; 5) social and environmental changes will be necessary; and 6) noncommunicable disease prevention and control strategies will be implemented through existing primary health care systems. The core program of Interhealth addresses heart diseases, stroke, diabetes, cancer, and respiratory diseases from the point of view of their common risk factors: diet, tobacco, physical activity, environment, oral hygiene, blood pressure, lipids, and glucose. The Interhealth program is being developed as a dynamic system, consisting of 4 main activities: experimental testing by means of demonstration projects (of which there are currently 18 in 15 countries); mathematical modeling of disease/risk factor interrelations; training; and research activities. These activities will be supported by organizational, financial and information activities at WHO headquarters and in the WHO Regional Offices.