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  1. 1

    Antenatal care: report of a Technical Working Group.

    World Health Organization [WHO]. Technical Working Group on Antenatal Care (1994: Geneva)

    Geneva, Switzerland, WHO, 1996. [30] p. (WHO/FRH/MSM/96.8)

    A Technical Working Group on Antenatal Care was convened in Geneva, 31 October - 4 November 1994, by the World Health Organization. The original objectives of the Technical Working Group were: 1. To review current antenatal care practices and make recommendations for the identification of high-risk pregnancies and their management, taking into account the timing of the pregnancy, resources available, and skills of the health worker; 2. To draw up recommendations on antenatal care and specifically outline the tasks and procedures health workers are expected to perform at different levels of the health care system; 3. To review the basic equipment, procedures, and supplies used in antenatal care from the point of view of cost, maintenance, scientific validity, and skills required to employ them appropriately; 4. To examine how to optimize antenatal care in terms of clinical tasks and procedures in relationship to the timing of the visits, distance to referral centres, and frequency of attendance. (excerpt)
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  2. 2

    Hepatitis B and breastfeeding.

    World Health Organization [WHO]. Global Programme for Vaccines and Immunization; World Health Organization [WHO]. Division of Child Health and Development; World Health Organization [WHO]. Division of Reproductive Health (Technical Support)

    Geneva, Switzerland, WHO, Division of Child Health and Development, 1996 Nov. [4] p. (Update No. 22)

    The question of whether breastfeeding plays a significant role in the transmission of hepatitis B has been asked for many years. It is important given the critical role of breastfeeding and the fact that about 5% of mothers worldwide are chronic hepatitis B virus (HBV) carriers. Examination of relevant studies indicates that there is no evidence that breastfeeding poses any additional risk to infants of HBV carrier mothers. The use of hepatitis B vaccine in infant immunization programmes, recommended by WHO and now implemented in 80 countries, is a further development that will eventually eliminate risk of transmission. This document discusses the issues relevant to breastfeeding and HBV transmission, and provides guidance from a WHO perspective. (excerpt)
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  3. 3

    AIDS prevention in military populations -- learning the lessons of history.

    Kingma SJ

    [Hanover, New Hampshire], Civil-Military Alliance to Combat HIV and AIDS, 1996. [4] p. (Occasional Paper Series No. 2)

    CONCLUSION: The armed forces that do not deal with HIV prevention will be condemned to deal with AIDS. One can paraphrase the military leader quoted at the outset of this paper by saying that the armed forces that ignore the mission of HIV prevention will be "destined to repeat the errors of history by failing to perceive the impact of [this] disease." The armed forces of all countries must face the increasing risk of HIV infection in their ranks, and address the prevention of AIDS as a priority mission. (excerpt)
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  4. 4

    Antenatal care. Report of a Technical Working Group, Geneva, 31 October - 4 November 1994.

    World Health Organization [WHO]. Family and Reproductive Health. Maternal and Newborn Health / Safe Motherhood

    Geneva, Switzerland, WHO, Family and Reproductive Health, 1996. [3], 29 p. (WHO/FRH/MSM/96.8)

    The World Health Organization (WHO) convened the Technical Working Group on Antenatal Care in Geneva for October 31-November 4, 1994. The group focused on developing recommendations on antenatal care (i.e., outlining the tasks and procedures for health workers to follow and skills of the health worker) and on examining how to optimize antenatal care in terms of clinical tasks and procedures in relationship to the timing of the visits, distance to referral centers, and frequency of attendance. Group members agreed that antenatal care significantly contributes to maternal and perinatal health and is a critical component of care for mothers and infants, together with family planning, clean and safe delivery, and essential obstetric care. Group presentations included organization of antenatal care in India, US Expert Panel on the content of antenatal care, the background and rationale for the WHO randomized clinical trial of antenatal care, development and implementation of the antenatal care protocol for the UN Relief and Works Agency for Palestine Refugees in the Near East, the potential impact of antenatal care on maternal and perinatal mortality in Malawi from the perspective of midwifery, the current draft of the Mother-Baby Package, and maternal health care. Participants divided into three subgroups to formulate recommendations: normal pregnancy, risk factors for poor maternal or fetal outcome; and medical conditions and complications of pregnancy. They considered the constraints of many countries when they identified the minimum level of care needed in terms of the number (4), length (20 minutes), and content (assessment [history, physical examination, and laboratory tests], health promotion, and care provision) of antenatal visits. They agreed that women with high-risk pregnancies or pregnancy complications will need more antenatal care visits. Participants wanted to emphasize the key role of counseling skills in the delivery of effective care. Additional recommendations were made.
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  5. 5

    AIDS and the military: "The quintessential AIDS in the workplace issue".

    Jackson H

    SAfAIDS News. 1996 Jun; 4(2):2-6.

    The interrelationship between AIDS and the military is fraught with ironies and contradictions. High levels of militarization exacerbate the spread of HIV and AIDS, just as civil unrest and wars disrupt a nation's health and welfare services and its capacity to deal with infection. In addition, HIV and AIDS may be a factor increasing civil unrest and destabilization and, at the same time, decreasing military readiness to cope with the unrest. In addition, high levels of HIV in a nation's armed forces transform the military's protective role into one of risk to the civilian population…This article explores the HIV risk in the military and its consequences for military and civilian populations and looks at potential responses. It also documents the development and focus of the Civil- Military Alliance to Combat HIV and AIDS, an initiative by Joint UN Programme on HIV/AIDS and the WHO. (excerpt, modified)
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  6. 6

    Recent studies confirm the safety of oral contraceptives with respect to stroke.

    CONTRACEPTION REPORT. 1996 Nov; 7(4):4-9.

    Two recent studies provide confirmation of the safety of low-dose oral contraceptives (OCs) with respect to stroke. The first study (Petitti et al.) investigated all strokes that occurred in 1991-94 among women 15-44 years of age who were members of the Kaiser Permanente Medical Care Programs of Northern and Southern California. A total of 408 confirmed strokes occurred among 1.1 million women during 3.6 million women-years of observation. There was no increased risk of ischemic or hemorrhagic stroke among current low-dose OC users. The adjusted odds ratio (OR) for ischemic stroke among current users compared to former users and never users was 1.2 (95% confidence interval (CI), 0.5-2.6). The adjusted OR for hemorrhagic stroke was 1.1 (95% CI, 0.6-2.2). Past users had a significantly decreased ischemic stroke risk compared to never users (OR, 0.5; 95% CI, 0.3-0.98). For subarachnoid hemorrhage, the OR was 1.5 (95% CI, 0.6-3.6) for current users compared to former and never users. The second study (World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception) investigated 3792 cases of stroke, myocardial infarction, and venous thromboembolism and 10,281 hospitalized controls. Current OC use significantly increased the risk of ischemic stroke in both Europe (OR, 3.0; 95% CI, 1.7-5.4.0) and developing countries (OR, 2.9; 95% CI, 2.1-4.0). Current OC use was associated with hemorrhagic stroke in developing countries (OR, 1.8; 95% CI, 1.3-2.3), but not in Europe (OR, 1.4; 95% CI, 0.8-2.3). European users of low-dose OCs showed no excess risk of stroke. Both smoking and hypertension were independent risk factors for stroke.
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  7. 7

    Indonesia and Vietnam may face AIDS pandemic.

    AIDS WEEKLY PLUS. 1996 Oct 28; 13.

    Recent reports regarding the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection epidemic in member countries (Brunei, Indonesia, Malaysia, the Philippines, Singapore, Thailand, and Vietnam) of the Association of Southeast Asian Nations (ASEAN) task force, indicated that more than 1 million people in Indonesia and Vietnam may be infected with HIV by the turn of the century; the number of HIV-positive people in Southeast Asia would be greater than 2 million. All the risk factors for the spread of HIV are present in Indonesia: high-risk sexual behavior, poverty, high prevalence of sexually transmitted diseases (STDs), an active tourist industry, increasing population mobility, and many seaports that are frequently visited by sailors from high-prevalence countries. Although Indonesia, with a population of 200 million, currently has 303 reported cases of HIV, this number could rise to 750,000 by the year 2000. According to the report of Professor Le Dien Hong of the National AIDS committee in Vietnam, the cumulative number of people with HIV in Vietnam will be 300,000 by the year 2000; this includes 20,000 persons living with acquired immunodeficiency syndrome (AIDS) and more than 15000 dead. 90,000 Filipinos may be HIV positive by 2000; Malaysia has 16,000 HIV positive persons; Singapore reported 477; and Brunei stated 350 foreigners and 8 Bruneians were positive.
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  8. 8

    Depot medroxyprogesterone acetate contraception and the risk of breast and gynecologic cancer.

    Kaunitz AM

    JOURNAL OF REPRODUCTIVE MEDICINE. 1996 May; 41(5 Suppl):419-25.

    This article reviews recent epidemiological data assessing the risk of breast, endometrial, ovarian, and cervical cancer in women using the injectable contraceptive depot medroxyprogesterone acetate (DMPA). A review is also provided of epidemiological and biostatistical concepts which relate to the literature on the relationship between the use of hormonal contraception and cancer. Breast cancer is a common and lethal disease in the US, and evidence suggests that gonadal steroids play a role in the development of breast cancer. Two major case control studies (one in New Zealand and the other under the auspices of the World Health Organization [WHO]) as well as a pooled analysis of these studies found no increased overall breast cancer risk in DMPA users. A currently unexplained pattern of increased risk in recent users mimics that seen with oral contraceptive (OC) use and term pregnancy. A WHO hospital-based study of the relationship between endometrial cancer and DMPA use found a protective effect of DMPA which appeared to be longterm and as great as that associated with OCs. Whereas it is plausible that DMPA, which suppresses ovulation, would lower the risk of ovarian cancer in users, a WHO case-control and hospital-based study failed to uncover such a protective effect. Studies of the routine use of DMPA in nulliparous women (who have higher risk of ovarian cancer) will shed more light on any effect DMPA may have on ovarian cancer. The unique epidemiology of cervical cancer (including number of sexual partners, use of barrier contraception, and frequent screening) makes it difficult to assess any association with contraceptive use. However, a large population-based, case-control study in Costa Rica; a WHO hospital-based, case-control study in Thailand, Mexico, and Kenya; and a study in New Zealand indicate that the risk of cervical neoplasia does not appear to be affected by DMPA use. While some issues regarding DMPA and the risk of reproductive tract carcinoma remain to be resolved, clinicians can be reassured that, for appropriately selected clients, the substantial benefits of DMPA outweigh any risks.
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