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Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. 2006 revision.
Geneva, Switzerland, WHO, 2006. 127 p.This publication is intended to serve as a reference tool for countries with limited resources as they develop or revise national guidelines for the use of ART in adults and postpubertal adolescents (see Annex 9 for pubertal Tanner staging; prepubertal adolescents should follow the WHO paediatric guidelines). The material presented takes updated evidence into account, including new ART treatment options, and draws on the experience of established ART scale-up programmes. The simplified approach, with evidence-based standards, continues to be the basis of WHO recommendations for the initiation and monitoring of ART. The guidelines are primarily intended for use by national and regional HIV programme managers, managers of nongovernmental organizations delivering HIV care services, and other policy-makers who are involved in the scaling up of comprehensive HIV care and ART in resource-limited countries. The comprehensive, up-to-date technical and clinical information on the use of ART, however, also makes these guidelines useful for clinicians in resource-limited settings. The recommendations contained in these guidelines are made on the basis of different levels of evidence from randomized clinical trials, high-quality scientific studies, observational cohort data and, where insufficient evidence is available, expert opinion. The strengths of the recommendations in Table 1 are intended to indicate the degrees to which the recommendations should be considered by regional and country programmes. Cost-effectiveness is not explicitly considered as part of the recommendations, although the realities of human resources, health system infrastructures and socioeconomic issues should be taken into account when the recommendations are being adapted to regional and country programmes. (excerpt)
Paediatric and Perinatal Epidemiology. 1998 Apr; 12(2):176-181.In children, the treatment of acute diarrhoea with the World Health Organization (WHO) standard oral rehydration solution (ORS) provides effective rehydration but does not reduce the severity of diarrhoea. In community practice, carob bean has been used to treat diarrhoeal diseases in Anatolia since ancient times. In order to test clinical antidiarrhoeal effects of carob bean juice (CBJ), 80 children, aged 4±48 months, who were admitted to SSK Tepecik Teaching Hospital with acute diarrhoea and mild or moderate dehydration, were randomly assigned to receive treatment with either standard WHO ORS alone or a combination of standard WHO ORS and CBJ. Three patients were excluded from the study because of excessive vomiting. In the children receiving ORS + CBJ the duration of diarrhoea was shortened by 45%, stool output was reduced by 44% and ORS requirement was decreased by 38% compared with children receiving ORS alone. Weight gain was similar in the two groups at 24 h after the initiation of the study. Hypernatraemia was detected in three patients in the ORS group but in none of those in the ORS + CBJ group. The use of CBJ in combination with ORS did not lead to any clinical metabolic problem. We therefore conclude that CBJ may have a role in the treatment of children's diarrhoea after it has been technologically processed, and that further studies would be justified. (author's)
Public Health Nutrition. 2005 Oct; 8(7A):940-952.In anticipation of the revision of the 1985 Food and Agricultural Organization/World Health Organization/United Nations University (FAO/ WHO/UNU) Expert Consultation Report on 'Energy and Protein Requirements', recent scientific knowledge on the principles underlying the estimation of energy requirement is reviewed. This paper carries out a historical review of the scientific rationale adopted by previous FAO/WHO technical reports on energy requirement, discusses the concepts used in assessing basal metabolic rate (BMR), energy expenditure, physical activity level (PAL), and examines current controversial areas. Recommendations and areas of future research are presented. The database of the BMR predictive equations developed by the 1985 FAO/WHO/UNU Expert Consultation Report on Energy and Protein Requirements needs updating and expansion, applying strict and transparent selection criteria. The existence of an ethnic/tropical factor capable of affecting BMR is not supported by the available evidence. The factorial approach for the calculation of energy requirement, as set out in the 1985 report, should be retained. The estimate should have a normative rather than a prescriptive nature, except for the allowance provided for extra physical activity for sedentary populations, and for the prevention of non-communicable chronic diseases. The estimate of energy requirement of children below the age of 10 years should be made on the basis of energy expenditure rather than energy intake. The evidence of the existence of an ethnic/tropical factor is conflicting and no plausible mechanism has as yet been put forward. (author's)
Public Health Nutrition. 2005 Oct; 8(7A):932-939.This background paper considers the extent to which the development of new recommendations for dietary energy requirements needs to account for the macronutrient (fat, carbohydrate, protein and alcohol) profiles of different diets. The issues are discussed from the dual perspectives of avoiding under-nutrition and obesity. It is shown that, in practice, human metabolic processes can adapt to a wide range of fuel supply by altering fuel selection. It is concluded that, at the metabolic level, only diets with the most extreme macronutrient composition would have any consequences by exceeding the natural ability to modify fuel selection. However, diets of different macronutrient composition and energy density can have profound implications for innate appetite regulation and hence overall energy consumption. (author's)
Bibliography on human reproduction, family planning and population dynamics: annotated articles and unpublished work in the South-East Asia Region: steroid contraception (including review of current status).
New Delhi, India, World Health Organization, Regional Office for South-East Asia, November 1974. (Special Supplement No. 1) 77 pThis annotated bibliography lists pamphlets, articles, and studies on combined contraceptives; low dose; injectables; long-acting; implants; postcoital; metabolic effects; lactation; long-term effects; biologic effects; metabolism; mode of action; contraception in the male; field studies; use in gynecological disorders; and works in progress on aspects of steroid contraception in centers in the South-East Asia Region. Sample titles are "Inhibition of ovulation for control of conception" and "Action of cyproterone acetate on male reproductive functions." A review of current status of steroid contraception includes a brief history; description of chemical composition; rates of effectiveness; side effects; clinical aspects; and return to fertility. Steroid releasing vaginal rings, IUDs, and intracervical devices are also described.