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Answering the call: The international donor community's response to the HIV / AIDS crisis in Eurasia.
CommonHealth. 2005 Spring; 19-23.On the occasion of World AIDS Day, December 1, 2003, Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS) had some good news to share: Spending on HIV/AIDS programs rose 50 percent in 2003, from 3.1 to 4.7 billion dollars. In large part he attributed this to the efforts of the international donor community. International donor contributions traditionally stem from UN programs, affluent governments, development banks, and quasiprivate or private organizations, such as the Bill and Melinda Gates Foundation. Various other donor agencies, including The Global Fund to Fight AIDS, Tuberculosis, and Malaria--a partnership between governments, civil society, and the private sector--are providing valuable resources in the fight against HIV/AIDS. The support provided by these groups could not come at a more critical time. According to the latest statistics, 42 million people are living with HIV/AIDS worldwide and UN Secretary-General Kofi Annan has described the pandemic as the greatest threat to the well-being of future generations. Two of the areas most affected by the disease are the World Bank's Eastern Europe and Central Asia sub-regions--which include all of the countries of the former Soviet Union--where the AIDS epidemic is growing at a faster rate than anywhere else in the world. According to a United Nations Report published in February 2004, "One out of every 100 adults walking down the streets of a city in Eastern Europe or the Commonwealth of Independent States carries the HIV virus that causes AIDS." (excerpt)
Lancet. 2006 Dec 9; 368(9552):2081-2094.William Harvey was born in Folkestone on April 1, 1578. He was educated at the King's School, Canterbury, Gonville, and Caius College, Cambridge, and the University of Padua, graduating as doctor of arts and medicine in 1602. He became a Fellow of the Royal College of Physicians in 1607 and was appointed to the Lumleian lectureship in 1615. In the cycles of his Lumleian lectures over the next 13 years, Harvey developed and refined his ideas about the circulation of the blood. He published his conclusions in 1628 in Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, which marks the beginning of clinical science. In it, Harvey considered the structure of the heart, arteries, and veins with their valves. By carefully devised experiments and supported by the demonstration of the unidirectional flow of the blood in the superficial veins of his own forearm, he established that the blood circulated, and did not ebb and flow as had been believed for more than 1000 years. (excerpt)
Human Reproduction. 2007 Jan; 22(1):311-312.We thank Professor Evers for his interest in our preliminary work. We agree that a positive likelihood ratio (LR+) of 1.67 will change the likelihood of disease in a clinically not very relevant way. Indeed, we have moderated our purpose saying that an LR+ of 1.67 indicated a small impact on the post-test probability of successful IVF. However, this change was statistically significant as our study showed. Thus, we believe that in the lack of other predictive tests that could be performed routinely, this new combined test is helpful to decrease the risk of fertilization failure during IVF therapy in the case of unexplained infertility. Concerning male factor, we have found an LR+ of 6.0, which indicated a better, though moderate, post-test impact, as we have said in our study and accordingly to Professor Evers' letter. However, we effectively did not include the 95% confidence interval (CI) of this LR in our study, and we agree that this could lead to misinterpretation. We thought that this CI is calculated using an approximate formula, which could not be considered as valid on such a small sample. (excerpt)
Human Reproduction. 2007 Jan; 22(1):311.I have read with great interest the article by Sifer et al. (2005) on the combination of a newly developed sperm-zona pellucida-binding assay and WHO grade 'a' sperm motility to predict sperm fertilizing ability in IVF. The authors have to be commended for developing a--theoretically very appealing--new sperm function test, and it is easy to understand how they could get carried away by their enthusiasm about the clinical applicability of this new test. In fact, the authors are so positive about the results of their combination test that they consider it 'an excellent predictor of sperm fertilizing potential in cases of mild male-factor infertility', and they recommend that it 'should be incorporated as a functional test to direct patients to IVF or ICSI at their first attempt'. They continue by stating that 'the positive LR of 1.67 (95% CI 1.07-2.59) allowed us to use this test in these cases' (i.e. in patients with unexplained infertility). (excerpt)
Geneva, Switzerland, UNICEF, Regional Office for CEE / CIS, Child Protection Unit, 2006. 89 p.This Report outlines some key findings and recommendations from an assessment of the efforts to prevent child trafficking in South Eastern Europe. Its main purpose is to increase understanding of the work prevention of child trafficking, by looking at the effectiveness of different approaches and their impacts. The assessment covered Albania, Republic of Moldova, Romania and the UN Administered Province of Kosovo. The Report is based on a review of relevant research and agency reports as well as interviews with organizations implementing prevention initiatives and with trafficked children from the region. The first part of the Report reviews key terms and definition related to child trafficking, as common understanding about what constitutes trafficking and who might be categorised as a victim is crucial to devising prevention initiatives and guaranteeing adequate protection for trafficked children. Furthermore, to intervene in any of the phases of the trafficking process it is essential to understand specific factors contributing to the situation and the key actors involved. Different approaches to understanding the causes of child trafficking and methods for developing prevention initiatives are also explored. The Report notes that all prevention efforts should incorporate the principles that have proved essential in designing and implementing other initiatives in the ares of child rights and protection. That is, good prevention initiatives should be rooted in child rights principles and provisions, use quality data and analysis, applying programme logic, forge essential partnerships, monitor and evaluate practice and measure the progress towards expected results. (excerpt)
London, England, ECPAT UK, 2006. 55 p.The sexual abuse of children perpetrated by foreign nationals in tourism destinations, was first formally investigated in South East Asia in the late 1980s. One of the first organizations to expose 'child sex tourism' was the Bangkok based Ecumenical Coalition On Third World Tourism (ECTWT) which had been monitoring the impacts of tourism in Asia since 1982. ECTWT researchers investigated the growth in tourism related child prostitution in several Asian countries including Thailand, the Philippines, Sri Lanka and Taiwan. While largely anecdotal, this early research found that child prostitution was reaching alarming levels and that while the highest level of demand for children in prostitution was from local men, it was increasingly also coming from foreign tourists. The research findings were the impetus for a number of Asian-based non-governmental organisations to launch the international Campaign to End Child Prostitution in Asian Tourism (ECPAT) in 1990. The ECPAT international movement has grown to encompass national representatives in over 70 countries. ECPAT UK was one of the first European ECPAT partners and was established in 1994 as The Coalition Against Child Prostitution and Tourism to campaign for new laws to prosecute British nationals travelling abroad to abuse children. (excerpt)
Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics / WHO international growth reference: implications for child health programmes.
Public Health Nutrition. 2006 Oct; 9(7):942-947.The objectives were to compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards ('the WHO standards') and the National Center for Health Statistics (NCHS)/WHO international growth reference ('the NCHS reference'), and discuss implications for child health programmes. Design: Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives. Settings: Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe. Subjects: Respectively 4787, 10 381 and 226 infants and children. Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%. The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations. (author's)
American Journal of Clinical Nutrition. 1997; 65 Suppl:1194S-1197S.The 1992 International Conference on Nutrition, new legislation in developing countries, and international trade agreements have renewed interest in food-composition data. Because of the costs involved in gathering such information and the need for it to be uniform, collaborative efforts are required. The production of new food-composition data must be viewed with respect to value gained for money spent, the need for more precise information, and the opportunity to use new analytic methods while not depending too heavily on high-technology systems. The Food and Agriculture Organization and the United Nations University have agreed to collaborate in stimulating the development of new food-composition programs. Their efforts will be directed toward promoting national, regional, and international activities in the food-composition field and will include strengthening existing laboratory facilities and programs, publishing technical manuals and documents, assisting countries to disseminate data, training workers, and sponsoring regional workshops. The Food and Agriculture Organization is well positioned to fulfill this coordinating role because of its past work in food composition, international mandates regarding its activities, its established communication system with national governments, and its ability to provide open forums for discussion of food-composition issues. (author's)
Resourcing global health: a conference of the Global Network of WHO for Nursing and Midwifery Development, Glasgow, Scotland, June 2006.
Midwifery. 2006 Sep; 22(3):200-203.With the focus of the World Health Report 2006 Working for health together firmly on the issue of human resources in health, the subject is officially placed among those at the top of the international agenda. The debates at this conference, held June 7--9 and hosted by the WHO Collaborating Centre (WHOCC) for Nursing & Midwifery Education, Research & Practice, based in Glasgow Caledonian University's School of Nursing, Midwifery and Community Health, were therefore highly topical and drew significant speakers from both the host country Scotland and 20-plus other nations. The conference was held in conjunction with the Royal College of Midwives (RCM) and the Royal College of Nursing (RCN). (excerpt)
Copenhagen, Denmark, World Health Organization [WHO], Regional Office for Europe, Health Evidence Network, 2006 Feb. 37 p. (Health Evidence Network Report)This is a Health Evidence Network (HEN) synthesis report on the effectiveness of empowerment strategies to improve health and reduce health disparities. The report shows that empowering initiatives can lead to health outcomes and that empowerment is a viable public health strategy. The key message from this review is that empowerment is a complex strategy that sits within complex environments. Effective empowerment strategies may depend as much on the agency and leadership of the people involved, as the overall context in which they take place. HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN. This HEN evidence report is a commissioned work and the contents are the responsibility of the authors. They do not necessarily reflect the official policies of WHO/Europe. The reports were subjected to international review, managed by the HEN team. (author's)
Emerging Infectious Diseases. 2006 Sep; 12(9):1389-1397.Evidence of successful management of multidrugresistant tuberculosis (MDRTB) is mainly generated from referral hospitals in high-income countries. We evaluate the management of MDRTB in 5 resource-limited countries: Estonia, Latvia, Peru, the Philippines, and the Russian Federation. All projects were approved by the Green Light Committee for access to quality-assured second-line drugs provided at reduced price for MDRTB management. Of 1,047 MDRTB patients evaluated, 119 (11%) were new, and 928 (89%) had received treatment previously. More than 50% of previously treated patients had received both first- and second-line drugs, and 65% of all patients had infections that were resistant to both first- and second-line drugs. Treatment was successful in 70% of all patients, but success rate was higher among new (77%) than among previously treated patients (69%). In resource-limited settings, treatment of MDRTB provided through, or in collaboration with, national TB programs can yield results similar to those from wealthier settings. (author's)
WHO training course for TB consultants: RPM Plus drug management sessions in Sondalo, Italy. Trip report: May 17-20, 2006.
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2006 May 29. 33 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-499; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)WHO, Stop-TB Partners, and NGOs that support country programs for DOTS implementation and expansion require capable consultants in assessing the capacity of countries to manage TB pharmaceuticals in their programs, developing interventions, and providing direct technical assistance to improve availability and accessibility of quality TB medicines. Beginning in 2001, RPM Plus, in addition to its own formal courses on pharmaceutical management for tuberculosis, has contributed modules and facilitated sessions on specific aspects of pharmaceutical management to the WHO Courses for TB Consultants in Sondalo. The WHO TB Course for TB Consultants was developed and initiated in 2001 by the WHO-Collaborating Centre for Tuberculosis and Lung Diseases, the S. Maugeri Foundation, the Morelli Hospital, and TB CTA. The main goal of the course is to increase the pool of international level TB consultants. As of December 2005, over 150 international TB consultants have participated in the training, a majority of whom have already been employed in consultancy activities by the WHO and international donors. In 2006 fiscal year RPM Plus received funds from USAID to continue supporting the Sondalo Course, which will allow RPM Plus to facilitate sessions on pharmaceutical management for TB at four courses in May, June, July, and October of 2006. (excerpt)
BMJ. British Medical Journal. 2006 Aug 26; 333(7565):410.A group of Czech Roma women who said that they were forcibly sterilised have, on 17 August, outlined their stories in person to a United Nations committee in New York. They hope this will exert pressure on the Czech government to apologise. On the same day, many Roma women staged a protest outside a hospital in the east of the Czech Republic to raise awareness for their cause. About 30 women carrying banners stating "we want children" and "sterilise gherkins not women" protested outside the municipal hospital in Ostrava in an attempt to get a public apology from the government. A report by the Czech ombudsman released several months ago found that at least 50 women had been unlawfully sterilised as recently as 2003. Eighty women had lodged complaints with the ombudsman, alleging they underwent operations to be sterilised against their will. (excerpt)
Choices. 2001 Dec; 18-19.I don't have any used syringes. Somebody has stolen all, Anka was almost begging. In a worn-out black T-shirt and torn jeans, she looked helpless and desperate, standing in the middle of a vacant square, squeezed between Warsaw's main railway station and a Holiday Inn hotel. "I really don't have any," she repeated. "You know it's an exchange. Go and find some," Grzegorz Kalata said, patiently but firmly. Kalata comes to the square -- a meeting point for local drug users -- almost every evening. He is a streetworker from Monar, Poland's leading chain of non-profit detoxification centres. Under a harm reduction programme, partly sponsored by the United Nations Development Programme (UNDP), Kalata gives disposable syringes and needles, bandages, condoms and antiseptics to drug addicts who meet at the square. In return, he collects used syringes and needles in a plastic container, usually full by the end of his visit. After scouring the grass at the site, Anka came back with four used needles. Kalata gave her seven new ones and a package of bandages. On average, Kalata gives out some 200 needles and 150 syringes during an evening. (excerpt)
Fighting AIDS: HIV / STI prevention and care activities in a military and peacekeeping setting in Ukraine. Country report.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], Office on AIDS, Security and Humanitarian Response, 2004 Feb. 43 p. (UNAIDS Series: Engaging Uniformed Services in the Fight against AIDS. Case Study 2.)Ukraine has one of the highest HIV prevalence rates in Eastern Europe. It was first in the region to face an aggressive epidemic among injecting drug users in 1995, and the epidemic now appears to have entered a more generalized phase. The Government of Ukraine responded to HIV at an early stage. Several Presidential Decrees urged the Government to initiate and enhance activities against the epidemics, and mobilize various ministries including the Ministry of Defence. In June 1999 the heads of the Educational Branch in the Preventive Medicine Department of the Ministry of Defence (MoD) met with UNAIDS officials and discussed HIV/AIDS issues in the Ukrainian army. The meeting resulted in an agreement to launch a project on prevention of HIV/AIDS and sexually transmitted infections (STIs) in Ukraine's armed forces. Funds and technical support were provided by UNAIDS, and the Main Educational Department started implementation of the project with the assistance of the United Nations Population Fund (UNFPA). The project focused on the development of training and educational materials, integration of education about HIV/STI prevention in the curricula of the Humanitarian Institute of the National Academy of Defence and the Kharkiv Tank Forces Institute, and on cascade training (cascading information down to all levels of rank and file) of the officers and soldiers in five field garrisons. Around 20,000 servicemen were trained in the first phase. The second phase of the project will run to early 2004 and the army headquarters are applying for resources from the Global Fund to Fight AIDS, Tuberculosis and AIDS in order to strengthen these activities. During the second phase of the project 350,000 servicemen are to be targeted with comprehensive information and education relating to HIV/AIDS and STIs. (excerpt)
Lancet. 2006 Jul 15; 368(9531):177-179.The unexpected and shocking death of Lee Jong-wook, Director-General of WHO, on May 22, the first morning of the Fifty-ninth World Health Assembly, placed WHO in the unprecedented situation of being without its leader at a peak decision-making season. Where does Dr Lee's death leave WHO? Remarkably, WHO has not been incapacitated, although his loss continues to be deeply felt. The organisation has maintained momentum in part because of his management style, which strategically devolved responsibility, and also because of a change in the way in which WHO is finding solutions to global health problems. In the past, there was sometimes a conceptual divide between the adoption of a resolution by the governing bodies as a generally good principle and the more painful realisation of it in practice in countries. The watershed came with tobacco control. The process to arrive at the WHO Framework Convention on Tobacco Control was slow and difficult, fraught with legal complexities, and detailed negotiations over texts. But the end product is a powerful instrument that is already proving useful to Member States in enforcing a rigorous, internationally supported approach to improving health. (excerpt)
Bulletin of the World Health Organization. 1956; 15:389-401.The author discusses the meaning of insecticide resistance and the manner in which it should be detected and measure. From some recent data he gives a number of examples of measurements of resistance in mosquitos of different species in various areas. He then proceeds to a speculative discussion on the way in which insecticide resistance arises, whether it can be prevented and overcome, its importance in the past and at present, and finally its future prospects. (excerpt)
Bulletin of the World Health Organization. 1955; 12:401-409.Certain performance characteristics of the insecticide-sprayer nozzle tip and its relationship to the pressure regulator are discussed. After analysing the effectiveness of residual spraying at various pressures, the author concludes that low-pressure application would best attain the pattern and rate of insecticide discharge laid down by the WHO Expert Committee on Insecticides. (excerpt)
Bulletin of the World Health Organization. 1954; 11:513-520.Residual-insecticide spraying methods may lead to the eradication of malaria from a country or from an area of it, and therefore to the possibility that the spraying campaign may eventually be discontinued. This is the final target to be aimed at in planning national malaria-control campaigns. As it is now known that some anopheline vector species may develop resistance to insecticides, a plea is made that control programmes should be planned to cover such large areas and with such criteria of efficiency as to eradicate malaria and to enable the campaign to be discontinued before resistance may have developed. (author's)
Bulletin of the World Health Organization. 1954; 10:627-690.This report presents the results of a six-month survey of the nature and extent of venereal diseases in Turkey which was undertaken by the author, on behalf of WHO, at the request of the Turkish Government. The first part of the report outlines the present venereal-diseases-control system and includes descriptions of the work undertaken by public authorities, hospitals and dispensaries, mobile venereal-disease-control teams, and laboratories; in the second part, the author enumerates certain recommendations for the intensification of the current control programme. These recommendations are particularly concerned with the control of syphilis (since the incidence of other venereal diseases in Turkey is of very secondary importance), and with the expansion, standardization, and co-ordination of serodiagnostic facilities and services. It is suggested that there might be a gradual intensification and reorientation of the present programme. A proposed plan of operations for an eight-year period is described. (author's)
Lancet Infectious Diseases. 2006 Jun; 6(6):328.Ukraine plans to restructure a key HIV/ AIDS and tuberculosis control project to help ensure disbursement of a US$60 million loan recently suspended by the World Bank. Alla Shcherbinska (Ukrainian Centre to Combat HIV/AIDS) told journalists that it will take the government only a few weeks to "reconstruct" the project. However, Shiyan Chao, a senior health economist at the World Bank cautioned that: "resumption of the funds will hinge on the government's concrete actions to improve earlier shortcomings related to policy issues on tuberculosis control, procurement, fiduciary controls, and other important aspects of project management". The World Bank suspended the loan, complaining of poor implementation by the Ukrainian ministry of health. "At the time of suspension, which came after the first 3 years of implementation, only 2% of funds available for this project had been disbursed by the Ukrainian ministry of health", Merrell Tuck, a spokesperson of the Bank said. The Bank says "there is also concern about the government's full commitment to both condom use and harm reduction for injecting drug users [IDUs]". (excerpt)
BMJ. British Medical Journal. 2006 Jul 1; 333(7557):8.Hundreds of thousands of women in developing countries suffer the devastating injury during child bearing of obstetric fistula. But the agency behind a global campaign to eradicate the condition says it is simple to prevent and easy to treat. The global campaign, led by the international development agency the United Nations Population Fund, has launched a month long advertising drive in the United Kingdom to raise awareness of a condition that is believed to affect between 50 000 and 100 000 women each year. Obstetric fistula is usually caused by several days of obstructed labour without prompt medical intervention and leaves the woman with agonising, long term pain, chronic incontinence, and--in most cases--a stillborn baby. (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)
[Kyiv], Ukraine, UNDP, 2004.  p.The United Nations Development Program (UNDP) organized a series of "Leadership for Results" workshops on May 24-31 2004 to develop and boost leadership skills of several participants' categories: trade union leaders, public figures, physicians, women-leaders, Peer Education Program trainers, etc. Allan Henderson, who facilitated this workshop, pointed out that "these workshops are not meant to make leaders of those who are not leaders, but rather to provide the opportunity for people who already are leaders to step out of the day-to-day business and address their own development." The task for participants is to improve themselves and society, to get to the higher leadership level, to develop more holistic outlook and support leadership skills with more comprehensive background. The structure of this leadership workshop stipulates three meetings with three months intervals. Methods applied in the workshop are as follows: education (knowledge transfer); training (practice of skill development) and coaching (establishing new opportunities for the future). The first workshop on May 24-25 that UNDP held jointly with the International Labor Organization (ILO) welcomed over 70 leaders from four most active trade union associations in Ukraine. It was just recently that trade unions started paying attention to the problem of HIV/AIDS. For the majority of participants it was their first workshop. (excerpt)
Kyiv, Ukraine, UNDP, . 15 p.Ukraine is at a critical point in its response to the HIV/AIDS epidemic. The country has the highest rate of HIV infection prevalence in Europe and the CIS, about one per cent of the adult population. At the heart of generating an effective national response on HIV/AIDS are committed, mobilized leaders who are speaking out and taking action in their respective spheres of influence. Analysis of successful responses around the globe has highlighted leadership as a key ingredient for overcoming stigma and effective action in both prevention and care. Leaders for an effective national response must come from all levels of society -- national, regional and local Government; NGOs; media; schools; youth organizations; and the household. In modern, democratic Ukraine, citizens enjoy unprecedented freedoms and choices. Each leads his or her own life in a very personal way. Faced with the present onslaught of HIV/AIDS such individuals need basic information and support for their safe behaviour choices to avoid infection, for their compassion for those living with the virus and for their inclusion in the nationwide response. (excerpt)