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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.
Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations.
Lancet. 1999 May 8; 353(9164):1,547-57.The WHO MONICA (monitoring trends and determinants in cardiovascular disease) Project monitored, from the early 1980s, trends over 10 years in coronary heart disease (CHD) across 37 populations in 21 countries. We aimed to validate trends in mortality, partitioning responsibility between changing coronary-event rates and changing survival.... During 371 population-years, 166,000 events were registered. Official CHD mortality rates, based on death certification, fell.... By MONICA criteria, CHD mortality rates were higher, but fell less.... Changes in non-fatal rates were smaller.... MONICA coronary-event rates (fatal and non-fatal combined) fell more...than case fatality.... Contribution to changing CHD mortality varied, but in populations in which mortality decreased, coronary-event rates contributed two thirds and case fatality one third. (EXCERPT)
WHO Scientific Group Meeting on Cardiovascular Disease and Steroid Hormone Contraceptives. Reunion du Groupe scientifique OMS sur les maladies cardio-vasculaires et les contraceptifs hormonaux steroidiens.
WEEKLY EPIDEMIOLOGICAL RECORD. 1997 Nov 28; 72(48):361-3.More than 100 million women worldwide are thought to use steroid hormone contraceptive methods, with an estimated 93 million women using combined oral contraceptives (COCs). The composition and use of these contraceptive preparations, especially those of COCs, have changed dramatically over the years. The World Health Organization (WHO) convened a Scientific Group Meeting on Cardiovascular Disease and Steroid Hormone Contraception during November 3-7, 1997, to review current scientific data on the use of steroid hormone contraception as they relate to the risk of myocardial infarction, ischemic and hemorrhagic stroke, and venous thromboembolic disease. The group also reviewed the incidence of cardiovascular disease among women of reproductive age in general, how the effect of risk factors for cardiovascular disease may be changed using hormonal contraceptives, and whether different compositions of COCs have different cardiovascular risk profiles. The group was comprised of the authors of background papers prepared for the meeting and experts from around the world. The scientific group's conclusions are presented. The incidence and mortality rates of all cardiovascular diseases are very low among reproductive-age women. For women who do not smoke, who have their blood pressure checked, and who do not have hypertension or diabetes, the risk of myocardial infarction in COC users is not increased regardless of age. While current users of COCs have a low absolute risk of venous thromboembolism, their risk is still 3-6 times greater than that of nonusers, with the risk probably being highest during the first year of use.
Lancet. 1997 Jul 12; 350(9071):141-2.A recent survey initiated by the World Bank and the World Health Organization (WHO) found ischemic heart disease and cerebrovascular disease to be the leading causes of death in the world, followed by other noncommunicable diseases, accidents, and injuries. In light of these findings, the journal's May 3 editorial argues that the WHO should consider changing its current policy stressing the eradication of infectious diseases in favor of higher priority for managing noncommunicable diseases. Care must be taken when comparing ischemic heart disease and cerebrovascular disease with HIV/AIDS. While no major change is expected in the trends of the two former diseases, the world remains only at the beginning of the HIV/AIDS pandemic. The major burden of HIV infection, AIDS, and AIDS-related mortality have yet to come. No other disease cited in the WHO study has a similar projected increase in mortality. The number of tuberculosis cases will also dramatically increase as a result of HIV infection and AIDS. Affecting mainly young adults, the HIV pandemic will have a major negative impact upon economic and social development. Since most of the 8500 new HIV infections which occur every day could be prevented, any reduction in efforts to check the spread of HIV would be irrational.
Lancet. 1997 Jul 12; 350(9071):141.A recent comprehensive global burden of disease survey initiated by the World Bank and the World Health Organization (WHO) found ischemic heart disease and cerebrovascular disease to be the leading causes of death in the world, followed by other noncommunicable diseases, accidents, and injuries. In light of these findings, the journal's May 3 editorial argues that the WHO should consider changing its current policy stressing the eradication of infectious diseases in favor of higher priority for managing noncommunicable diseases. WHO's reluctance to shift its focus away from infectious diseases stems from its concern for equity and the health of the poor. The global burden survey gives equal importance to the health of the lower, middle, and upper classes. However, the noncommunicable diseases noted in the study findings are far less important for the poor than for the rich. Infectious diseases remain the most important and urgent concern for the world's poorest people. To accord highest priority now to noncommunicable diseases would be at the disadvantage of those most in need, to the benefit of individuals living in the wealthiest countries and the emerging middle and upper classes in the developing world.
NURSING JOURNAL OF INDIA. 1992 Apr; 83(4):82-90.Heart attacks and stroke kill about 12 million people each year or 25% of all deaths. No other single disease takes so many lives or disables so many people each year. Besides many of these dead are <65 years old resulting in considerable premature deaths. Heart attacks and stroke caused by life style choices even affect people living in developing countries as these countries reduce the prevalence of infectious diseases and develop socioeconomically with their concomitant increase in life expectancies. People in these countries still develop heart diseases that almost do not even exist in developed countries including rheumatic heart disease and heart disease caused by Chagas' disease. Crowded living conditions caused by poverty and limited medical services cause strep throat which left untreated can turn into rheumatic fever and then to heart disease. Yet treatment with penicillin protects against all 3 conditions. About 300,000 new rheumatic heart disease cases arise each year. Yearly deaths from rheumatic heart disease equals about 60,000. Poverty is also responsible for Chagas' disease of which about 17 million suffer in Latin America. In developing countries, the middle class is at highest risk of hypertension. Health promotion activities have resulted in a decline in cardiovascular diseases in developed countries in Western Europe, North America, Australia, and New Zealand. These activities include health education, diet changes, exercise, and no tobacco use. These activities also reduce the prevalence of other diseases thus keeping populations healthier longer. It is important that the healthy life styles begin when children are young. WHO dedicated World Health Day 1992 to heart health to promote heart healthy activities which can save 6 million lives yearly.
WHO programme for the prevention of rheumatic fever / rheumatic heart disease in 16 developing countries: report from Phase I (1986-90). WHO Cardiovascular Diseases Unit and principal investigators.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1992; 70(2):213-8.The program for the prevention of rheumatic fever/rheumatic heart disease (RF/RHD) was initiated in 1984 by WHO in close collaboration with the International Society and Federation of Cardiology (ISFC). 16 countries in 5 WHO regions participated: Mali, Zambia, and Zimbabwe (in Africa); Bolivia, El Salvador, and Jamaica (in the Americas); Egypt, Iraq, Pakistan, and Sudan (in the Eastern Mediterranean); India, Sri Lanka, and Thailand (in Southeast Asia); and China, the Philippines, and Tonga (in the Western Pacific). The program was planned for implementation in 3 phases: pilot study and control program in a selected area, control programs in all the selected communities, and their extension throughout the entire country. In Phase 1, a total of 1,433,710 schoolchildren were screened and 3135 cases of RF/RHD were found, giving a prevalence of 2.2/1000 (higher in the African and Eastern Mediterranean regions); 33,651 recently identified or already known cases were registered; completion of secondary prophylaxis was irregular but averaged 63.2% coverage; percentage of adverse reactions (0.3%) and recurrence of acute RF (0.4%) were very small; 24,398 health personnel and teachers were trained. Health education activities were organized for patients, their relatives, and the general public in hundreds of health education sessions. Thousands of pamphlets, brochures, and posters were distributed, and health education programs were broadcast on radio and television. The quality of care for RF/RHD patients improved under the program, which has been expanded to other areas. (author's modified) (summaries in ENG, FRE)
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.
Brazzaville, Congo, World Health Organization, Regional Office for Africa, 1979. 283 p.From 1965 to 1978, the author made numerous formal addresses in conjunction with his duties as the World Health Organization's (WHO) Regional Director for Africa. The addresses provide a theoretical and practical foundation for the development of a health care strategy and are grouped in sections concerning general policy, ways and means, health services delivery and development, disease control, and training and development of health team personnel. Health development in African nations demands planning for the implementation of health services to meet local community needs and appropriate training and utilization of health care personnel. The ultimate goal of health development is social justice, defined as the proper amount of health care available to all. The benefits will be realized in increased labor productivity and economic development, better quality of life, and self reliance in African nations. To achieve social justice, African nations must abandon foreign concepts of medical care and develop their own solutions to health problems that are realistic for their populations. Through the application of the techniques of scientific management and the development of cooperative international forums, these solutions can be discovered. Planning, aided by the development of information systems, research, and regional cooperation, is vital to assure both curative and preventive health programs are delivered that meet the health services needs of the population. Disease control is important to the economic development of African nations. Preventive action can be realized through planning and organized delivery of health services, including immunization programs, which enhance the population's general health status. Where prevention is not possible, early detection followed by swift response is an objective of effective health services. Training of health care and service personnel should focus on preparing professionals to contribute to the welfare of the community and to African development. The development of the health care team, which encompasses traditional and nontraditional personnel, adequately utilizes available resources and is responsive to both curative and preventive health needs.
World Health Forum. 1981; 2(2):264-80.This 6th report on the world health situation covers the 1973-1977 period and corresponded to the World Health Organization's (WHO) Fifth General Program of Work. Attention is directed to broad population trends, the socioeconomic situation, poverty, employment, mortality and morbidity, cardiovascular diseases, diseases in developing countries, national mortality projections, special health risks--children, mothers, adolescents--health care delivery infrastructure, reorientation of health services, and awareness of health problems. The population of the world increased in the 1970s at an annual rate of 1.9% and exceeded 4000 million in 1977. By the end of the period under review, the rate of growth seems to have somewhat slowed down. The 1 common feature of recent health trends in all parts of the world appears to be a slow down in progress in the reduction of mortality. Possibly the most interesting recent health trend in the more developed countries concerns the cardiovascular diseases. During recent years, the general trend in the age groups 35 and older has been for mortality from cardiovascular disease to decline. Regarding the many diseases plaguing the developing countries, there appears to have been little or no progress in recent years in reducing either their incidence or their prevalence. Malnutrition is the most widespread condition affecting the health of the world's children, particularly children in the developing countries. In countries that have well developed health care systems and good health statistics, the maternal mortality rate is of the magnitude of 5-30/100,000 live births and is continuously decreasing. The situation is much worse in most of the developing countries.
WHO CHRONICLE. 1979 Sep; (9):348-9.A World Health Organization (WHO) consultative group, by introducing the concept of "primordal" prevention, has devised a strategy for developing countries where the known risk factors for cardiovascular diseases have not yet emerged. The objective is to prevent the occurrence of heart disease and to influence personal, social and environmental conditions in such a way that the risk of developing cardiovascular disease and particularly ischemic heart disease does not arise. The concept implies that diseases considered to be diseases of affluence are not necessarily unavoidable consequences of economic development. The group considered the following risk factors: nutritional factors, cigarette smoking, hypertension, and insufficient physical activity. Epidemiological evidence has shown that all populations with high incidence rates of ischemic heart disease have a high fat intake. The adverse effects of smoking on health have been demonstrated by a vast literature. In most developing countries hypertension is a common disorder, with prevalence rates of up to 8-10% in adult populations. Stroke and hypertensive heart failure are its primary complications in the developing countries. The consultative group recognized that a program to reduce these risks needs to involve political leaders, health authorities and all levels of health personnel, school teachers, physical education experts, and the family. It was recommended that task forces in food and nutrition and in smoking control be established to formulate and initiate the program.
Myocardial infarction community registers: a WHO International Collaborative Study coordinated by the Regional Office for Europe.
In: Holland, W.W., Ipsen, J., and Kostrzewski, J., eds. Measurement of levels of health. Copenhagen, Denmark, World Health Organization, Regional Office for Europe, 1979. (WHO Regional Publications, European Series No. 7) p. 341-352In 1967, it was shown that cardiovascular disease accounted for 39% of all male deaths between the ages of 25 and 64 years old in 29 technologically advanced countries. 75% of these deaths were due to IHD (Ischaemic Heart Disease) with the most frequent clinical syndrome being AMI (acute myocardial infarction). WHO office for central cardiovascular disease is studying the national mortality statistics and hospital mortality data covering a population of 3.5 million aged 20-65. Statistics showed that there was as much as a 3-1/2 hour delay in reaching the hospital, 1/4 of which is attributed to the delay between the time a physician is called and the 1st examination, but the greatest delay was the time lost before a physician is called. 32% of all deaths in 1 year occur within 30 minutes of onset, so approximately 13% are dead before medical assistance arrives. The biggest delay, created by the patient's reluctance to call for medical assistance, cannot be overcome by medical organizational solutions. The WHO/EURO CVD programs are establishing pilot areas for control of CVD, setting up rehabilitation and secondary prevention for AMI patients, and preparing registers of the diseases for further studies.
Geneva, Switzerland, WHO, 1975. 100 p. (WHO Technical Report Series No. 568)The objectives of a WHO Expert Committee on Smoking and its Effects on Health, which met in Geneva from December 9-14, 1974, were: 1) to summarize and restate in general terms the evidence on the harmful effects to health of smoking; and 2) to propose actions directed towards discouraging smoking. The Committee was asked to summarize the present evidence of the ill effects of smoking on health, and to suggest action that the WHO might recommend to member states and interested health organizations. The purpose of the present report is to formulate information obtained in general terms, and to recommend certain lines of action. Summaries of additional evidence on the effects of smoking on health since the 1970 report of the Director-General include: 1) smoking habits and total mortality; 2) cigarettes as a cause of excess mortality; 3) lung cancer; 4) other respiratory diseases; 5) ischaemic heart disease; 6) cerebrovascular diseases; 7) peptic ulcer; 8) smoking in pregnancy; 9) dependence on nicotine; and 10) involuntary exposure to smoke. Additional information is presented on worldwide smoking trends; smoking control measures; educational approaches; and legislation for antismoking campaigns. It is concluded that the evidence reviewed by the Committee leaves no doubt that many millions of lives are adversely affected by cigarette smoking each year, resulting in several recommendations for implementation by governments and health authorities, and by WHO. 3 annexes include: 1) smoking and health; 2) the limitation of smoking; and 3) legislation to combat smoking hazards: a code of practice.
Contraception. 1970 Jun; 1(6):409-445.This article reviews the validity of previously published material linking oral contraceptive usage to health hazards. The statistical methods involved in such studies are thoroughly examined, particularly those studies relating oral contraceptive usage to thromboembolic disease incidence. Problems inherent to the basic designs of such studies are discussed. Some relationship between thromembolic disease and oral contraceptive usage has been established. Studies on animals relating oral contraceptive usage with carcinogenesis are inconclusive due to the different metabolic rates obtained for different animals and different strains and the high dosage used to produce tumors. Review of the data relating oral contraceptives with alterations in carbohydrate metabolism, serum lipids, etc., show pure speculation of conclusion. Endrocrine effects persisting after discontinuation of oral contraceptives were rare; apparently both types of steroids play some part. It was suggested that most data on this subject is faulty and filled with fixed opinions which should be avoided.