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New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization / Nutrition for Health and Development Iodine Deficiency Study Group Report.
American Journal of Clinical Nutrition. 2004 Feb; 79(2):231-237.Goiter prevalence in school-age children is an indicator of the severity of iodine deficiency disorders (IDDs) in a population. In areas of mild-to-moderate IDDs, measurement of thyroid volume (Tvol) by ultrasound is preferable to palpation for grading goiter, but interpretation requires reference criteria from iodine-sufficient children. The study aim was to establish international reference values for Tvol by ultrasound in 6–12-y-old children that could be used to define goiter in the context of IDD monitoring. Tvol was measured by ultrasound in 6–12-y-old children living in areas of long-term iodine sufficiency in North and South America, central Europe, the eastern Mediterranean, Africa, and the western Pacific. Measurements were made by 2 experienced examiners using validated techniques. Data were log transformed, used to calculate percentiles on the basis of the Gaussian distribution, and then transformed back to the linear scale. Age- and body surface area (BSA)–specific 97th percentiles for Tvol were calculated for boys and girls. The sample included 3529 children evenly divided between boys and girls at each year (x ± SD age: 9.3 ± 1.9 y). The range of median urinary iodine concentrations for the 6 study sites was 118-288 µg/L. There were significant differences in age- and BSA-adjusted mean Tvols between sites, which suggests that population-specific references in countries with long-standing iodine sufficiency may be more accurate than is a single international reference. However, overall differences in age- and BSA-adjusted Tvols between sites were modest relative to the population and measurement variability, which supports the use of a single, site-independent set of references. These new international reference values for Tvol by ultrasound can be used for goiter screening in the context of IDD monitoring. (author's)
A dose escalation study of docetaxel and oxaliplatin combination in patients with metastatic breast and non-small cell lung cancer.
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)
Geneva, World Health Organization, 1966. (Technical Report Series No. 334.) 21 p.A WHO Scientific Group on Immunological Aspects of Human Reproduction met in Geneva October 4-9, 1965. Topics of discussion included: 1) immunology of human gonadotropins; 2) sperm and seminal fluid; 3) blood group antigens and human reproduction; and 4) maternal-fetal immunological interactions. It was concluded that further investigations are required to study: 1) the correlation between physiocochemical, biological, and immunological criteria for the purity of antigens concerned in human reproduction; 2) the chemical structure of hormones concerned with reproduction, with special reference to the biologically active sites and the nature of antibodies against these active sites; 3) production of antibodies to the gonadotropins by the use of adjuvants and/or chemically modified gonadotropins; 4) modification of hormones from other species to render them active but non-antigenic in man; 5) the use of immunological methods for assisting in the detection of the time of ovulation: these could aid in the control of fertility and in the treatment of infertility; 6) the development of strains of animals of high immunological competence; 7) characterization of the male antigens responsible for various immunological phenomena in males; 8) characterization of male antigens responsible for inducing circulating antibodies and reducing the fertility of immunized females; 9) the nature and biological significance of the antagglutinins; 10) possible ways of interfering with the transmission of antibodies in man; and 11) the possible occurrence of specific antitrophoblastic antibodies in pre and postpartum. Other research needs are also outlined.
NETWORK. 1990 Apr; 11(2):5-7,20.Safe and adequate blood supplies are needed, especially in high Human Immunodeficiency Virus (HIV) prevalence rate areas. Tests for HIV are available in most developing countries today. Much virus screening is taking place. The best way to control HIV's transmission is to establish a blood transfusion system (BTS). Proper storage, distribution, collection, and testing of blood must be done. Trained technicians and appropriate criteria for using transfusions should be included in any BTS. Establishing a central BTS requires much money and the national government must be committed to it. In 1988, WHO started the Global Blood Safety Initiative (GBSI) in conjunction with others. It's objective is to support integrated BTSs in all countries. 8 countries have been chosen for priorities, to develop BTSs. GBSI is also working in other countries to train technicians, get blood donors, and prevent HIV infections. A major problem in most developing countries is adequate blood supplies. In rural areas, many transfusions come from family members. Blood can be screened, and results given in 10-15 minutes. Large city hospitals can use ELISH HIV testing. It requires a 1-day wait for results but costs < the faster tests. Paid donors do not like blood screening, because it may lead to loss of income. Large countries need to use testing facilities in different regions. But smaller ones can use a centralized system, if they have good transportation. In November, 1989 a workshop was held in Yaounde, the capital of Cameroon, to set up appropriate blood transfusion guidelines. 45 physicians and blood bank managers took part. 9 of the 10 provinces were represented. The conference concluded that the number of transfusions should be reduced, and volunteer donors should be sought. In February, 1990 more than 700 Romanian children had been infected with HIV. This may have been caused by injecting adult blood into young babies who appear anemic. This is known as microtransfusion and health officials have banned it.
Who Chronicle. 1985; 39(3):104-6.In Africa the issue of smoking and health is complicated by the fact that in many countries tobacco is grown commercially and is relied upon to bring in foreign exchange through export, of revenue for the government if sold on the home market. Consequently, in some nations the ministries of health and of agriculture are working at cross purposes. This contradiction is recognized in the report issued recently of a World Health Organization (WHO) seminar on smoking and health organized for English-speaking Member States of the WHO African Region, and held in Zambia. In opening the seminar, the prime minister of Zambia, Mr. N. Mundia, stated that governments had an obligation to educate people on the risks involved in the use of tobacco but that this could pose a moral dilemma where tobacco production made an apparently significant contribution to the economy. Additionally, he warned that developing countries are considered valuable markets by tobacco companies and stressed that if the promotion of tobacco products by such companies represented a threat "to the health of our people, we cannot let it happen." This point was endorsed by Mr. W.C. Mwambazi, the National WHO Program Coordinator who stated that smoking was on the increase in many developing countries as a result of unscrupulous marketing practices by cigarette manufacturers and that smoking was a major threat to the realization of health for all by the year 2000. Aspects of smoking and health that have special relevance for Africa are emphasized in the report. The few studies carried out in Africa tend to confirm findings from the developed world that smoking increases the risk of cancer and coronary heart disease. Not only is tobacco smoked in Africa, but it is chewed and taken as snuff, and these uses also entail a risk to health. Case studies included in the report show that transnational tobacco companies take full advantage of the present lack of legislation in most African countries on the promotion and use of tobacco. Health hazards are the primary reason why smoking controls are needed, but there are also economic arguments. Tobacco cultivation requires land that could otherwise be used for the production of much needed food. Curing tobacco leaves requires vast amounts of heat that is generated by burning either expensive (and usually imported) oil or timber, the consumption of which ultimately leads to deforestation, soil erosion, and desertification. Although tobacco may be cultivated primarily as an export crop, the country of origin rarely escapes the health hazards of smoking and their economic consequences, including increased cost of health care and absenteeism from work. According to the report, control measures should include the following: data collection; public information and education; and legislation. The report proposes that a functional committee on smoking control be established in the ministry of health to work especially within the primary health care machinery.
World Health Statistics Quarterly. Rapport Trimestriel de Statistiques Sanitaires Mondiales. 1985; 38(3):302-16.Tables present data on the prevalence of anemia in the world. Anemia may be defined as a state in which the quantity or the quality of circulating red cells is reduced below the normal level. The most common way to diagnose anemia is by measuring the hemoglobin concentration in the blood which is controlled by a homeostatic mechanism. It varies slightly among normal subjects. In 1959, the World Health Organization (WHO) proposed levels of hemoglobin concentrations for different groups of individuals that could be considered as the lower limits of normality. Subjects with values below these levels were considered to be anemic. The causes of anemia, which are multiple, include a deficiency of hemopoietic factos, genetic disorders causing hemolytic anemias, infections including malaria, and increased losses of blood caused inter alia by infections such as ankylostomiasis or schistosomiasis. A survey of the prevalence of anemia in women in developing countries was published by WHO in 1982. It estimated the prevalence of nutritional anemia in developing countries (other than China) at 60% in pregnant women and 47% in non-pregnant women. The prevalence of anemia in all women of reproductive age was estimated at 49%. It appears that studies on the prevalence of anemia were conducted regularly during the 1960-84 period, with the exception of studies on elderly people most of which were conducted before 1970. Most studies included from 100 to 300 subjects. Studies on adolescents usually covered fewer than 100 subjects. The tables provide no data on the severity of anemia, i.e., the percentage of subjects with a hemoglobin concentration below a specific level. On the basis of the present review, the total prevalence of anemia in the world is most likely about 30%. Expressed in absolute numbers this means some 1300 million people of the estimated world population of 4440 million in 1980. For the developing regions of the world, the prevalence of anemia is probably about 36% or 1200 million people, and for the more developed regions about 8% or just under 100 million people. Young children and pregnant women are the most affected groups with an estimated global prevalence of 43% and 51%, respectively. The regions with the highest overall prevalence of anemia are South Asia and Africa. With the exception of pregnant women, the prospects for the prevention of iron deficiency anemia in a population are poor at the present time. Iron fortification and the daily administration of an iron supplement present great problems in developing countries, and they will not be resolved easily.
Nutritional anemia: its understanding and control with special reference to the work of the World Health Organization.
American Journal of Clinical Nutrition. 1979 Feb; 32(2):368-417.Since 1949, the World Health Organization, recognizing the public health importance of nutritional anemia, has sponsored efforts directed towards its understanding and control. During this period, often as a result of the work of the Organization, advances have been made in many areas. Basic understanding of iron, folate, and vitamin B12 nutrition, and the various factors which may influence the availability and requirements of these factors, has greatly increased. Surveys in a number of countries have highlighted the widespread prevalence of nutritional anemia, particularly in developing countries. The major factor responsible is a deficiency of iron, with folate deficiency also playing a role in some population groups, especially in pregnant women. There is increasing evidence that anemia adversely affects the health of individuals and may have profound socioeconomic consequences. Control of nutritonal anemia is possible by providing the deficient nutrient(s) either as therapeutic supplements or by fortification of commonly used foodstuffs. Some control programs are reviewed and suggestions for further action are outlined. The Organization still has an important role to play in this field, encouraging the development of control programs and providing advice and technical assistance to member countries. (author's)
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 253-282This review of combined oral contraceptive (OC) preparations presents formulations, pregnancy rates, biochemical parameter changes, morbidity, and OC indications in 15 tables. The OC preparations are based on 2 different estrogens and 14 progestagens. Though steroid content differs among products, all act primarily to inhibit ovulation by suppression of midcycle release of pituitary gonadotropins. Variable-dose products are associated with higher pregnancy rates than fixed-dose preparations. Side effects of OCs, while difficult to identify, fall into 2 categories: 1) common adverse associations similar to responses to inert placeboes; and 2) serious biochemical and physiological alterations. There is no evidence of any increase in morbidity due to OC use, whereas avoidance of risks associated with pregnancy is beneficial. No convincing evidence of carcinogenic hazard is presented. Some evidence of reduced systemic side effects by lower-dose products is presented, though gynecological side effects, such as irregular bleeding, may increase. Drug interaction with OCs is described; rifampicin causes the most serious of these. OCs induce wide-ranging metabolic changes in many organ systems. These may relate to undesirable side effects (psychological or neurological signs, skin disorders, and blood pressure changes).
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 283-321This review of low-dose gestagen contraception emphasizes the variety of findings from different studies. For example, studies of chlormadinone acetate have found pregnancy rates of 1.1-12/100 woman-years. Results of trials of megestrol acetate suggested that a 500-mcg dose level yielded unacceptable pregnancy rates. No significant difference between various doses of norgestrel which have been studied were found (e.g., 50 and 75 mcg daily of dl-norgestrel or 30 mcg daily of the d-isomer). Pregnancy rate reported for most trials with this gestagen and also norethisterone and quingestanol were within an acceptable range. With 1 exception, pregnancy rates reported in trials of lynestrenol were remarkable low. Cumulative results of trials with various gestagens show Pearl Index rates between 2 and 3, except for lynestrenol. Dose level was the critical variable; i.e., it must be sufficiently high to exert antifertility action and low enough to avoid a high incidence of irregular bleeding. Apart from menstrual irregularities, other side effects from the minipill seem minor and in general less severe than those encountered with combined oral contraceptives.