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  1. 126
    Peer Reviewed

    AIDS definition for Africa.

    Van de Perre P; Nzaramba D; Ntilivamunda A; Uwimana A; Lepage P; Rouvroy D; Maurel R; Gatsinzi T; Bugingo G

    Lancet. 1987 Jul 11; 2(8550):99-100.

    The positive predictive values for HIV seropositivity are compared using WHO and US Centers for Disease Control (CDC) clinical case definitions of acquired immunodeficiency syndrome (AIDS), for cases in Rwanda, Africa. It is postulated that the article by Colebunders and co-workers should encourage clinicians and epidemiologists working in Africa to adopt the World Health Organization's provisional clinical case definition for AIDS. Although the predictive value for HIV seropositivity calculated in urban-based adults, as measured by the 2 different criteria, is comparable, (both criteria yield a 93% positive predictive value), this high % is not reached for cases of AIDS diagnosed for rural adults or urban-based children, using the WHO criteria. These data confirm the opinion of Colebunders and co-workers that regional variations in the prevalence of HIV infection can interfere with the positive predictive value for HIV seropositivity of this definition. Workers in other countries should test the validity of the WHO criteria in their own settings and evaluate the WHO case definition adapted to pediatric AIDS in Africa.
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  2. 127
    Peer Reviewed

    [The Collaborating Centers of the World Health Organization and AIDS: report of a meeting of the World Health Organization] Les Centres Collaborateurs de l'OMS et le SIDA: memorandum d'une reunion de l'OMS.

    World Health Organization [WHO]


    The World Health Organization (WHO) meeting on acquired immune deficiency syndrome (AIDS) held in Geneva in September 1985 stressed the importance of the WHO collaborating centers in the worldwide struggle against AIDS. The network of collaborating centers was established after and April 1985 WHO meeting to facilitate international cooperation in training of laboratory personnel, supplying reference reactives, evaluating diagnostic tests, and organizing activities to establish the natural history of the disease in different parts of the world. The AIDS virus is transmitted during sexual intercourse, by parenteral exposure to blood or contaminated blood products, or from the mother to the infant during the perinatal period. In the US and Western Europe, over 90% of victims are still homosexual and bisexual men, intravenous drug users, and their sexual partners, but in many developing countries heterosexuals with active sex lives are the main victims. There are no indications that the virus is spread by casual contact or by insect vectors. Health authorities of all countries should establish surveillance programs to measure the extent of AIDS infection. A precise case definition including only the most serious manifestations of the disease should be used. The US Centers for Disease Control definition has been approved for countries with appropriate diagnostic capabilities. Only immunological diagnostic methods are practical for large scale routine testing. Radioimmunological and immunoenzymatic titers are the most frequently used routine testing procedures. They are very sensitive, but because of the possibility of false positive results, confirmation using another test is needed for individuals belonging to low risk populations. The Western blot or other immunoblotting tests are most often used for confirmation. Progress in laboratory diagnosis would be furthered if international reference standards, simpler diagnostic tests, and other measures were made avaliable. Until drugs capable of preventing and treating AIDS become available, prevention will depend mainly on reduction of risks based on information and education. Cases of AIDS spread by blood transfusion can be eliminated by excluding donors belonging to high-risk groups and by testing the blood for antibodies before transfusion. Reuse of nonsterile needles and syringes should be absolutely avoided. Despite efforts to identify an effective agent for treatment of AIDS, no substance has been found as yet that supplies more than a transitory arrest of viral replication. Interferon has been shown to be effective against Kaposi's sarcoma. New antiviral agents should be careful studied in conformity with accepted protocols for drug evaluation. Numerous attempts to develop an anti-AIDS vaccine are underway. The heterogeneity of the virus poses a significant problem. Several specific recommendations for its 1986-87 program were made to further the role of the WHO as a centraL clearinghouse for AIDS information.
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  3. 128

    Guidelines for the prevention and control of infection with LAV/HTLV III.

    World Health Organization [WHO]

    [Unpublished] 1986 May. [17] p. (WHO/CDS/AIDS/86.1)

    These guidelines, prepared by WHO, address the prevention and control of the acquired immunodeficiency syndrome (AIDS) infection with lymphadenopathy associated virus/human T-lymphotropic virus Type III (LAV/HTLV-III) and are suitable for international application. The Introduction sets forth case definitions of AIDS and discusses the virus, its transmission and clinical features, laboratory methods for detection, and notification and confidentiality. The chapter on recommendations for health care workers proposes precautions for specific personnel such as laboratory staff, providers of home care, dental care personnel, and eye examiners. Also included are considerations relevant to non-health-care workers such as personal service workers and food service workers. Procedures for the handling of blood and blood products and disinfection and sterilization are set forth, and means of avoiding sexual and parenteral transmission of LAV/HTLV-III infection are suggested. Another chapter focuses on screening, diagnostic testing, and counseling of seropositive individuals. The strategies outlined are anchored in fundamental public health concepts and utilize the best available knowledge on the laboratory, clinical, and epidemiologic aspects of LAV/HTLV-III infection. The guidelines are directed toward public health authorities and health professionals who have the responsibility of adapting the general guidelines to meet the diverse requirements of different populations and settings. The document is not complete at this time; several sections are currently under development and will be made available as soon as they are finished.
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  4. 129

    Acquired immune deficiency syndrome (AIDS)--recommendations of IMAP.

    International Planned Parenthood Federation [IPPF]. International Medical Advisory Panel [IMAP]

    IPPF MEDICAL BULLETIN. 1986 Jun; 20(3):3-4.

    This statement was prepared by the IPPF Medical Department in response to requests from family planning associations for clear and accurate information about the acquired immunodeficiency syndrome (AIDS) and the precautions needed to avoid AIDS infection. It summarizes current knowledge on the epidemiology, transmission, diagnosis, symptoms, and prevention of AIDS. Transmission of human lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) occurs through sexual contact with an infected person, transfusion of infected blood or blood products, injection with a needle contaminated with the virus, or artificial insemination with infected semen. Transmission also can occur perinatally from an infected mother to her infant. At present, persons who have antibody to HTLV-III/LAV are believed to harbor the virus and are considered infectious. Recommendations for the prevention of sexually acquired AIDS include avoidance of casual sex, especially with those from high risk groups (homosexual or bisexual men, intravenous drug users, prostitutes), and condom use. Transmission by nonsexual means can be controlled by refusing to accept blood, semen, organ, or tissue donations from persons in high risk groups; avoidance of illicit use of intravenous drugs or use of nonsterile needles; awareness on the part of health workers involved in providing artificial insemination services or blood and blood products of the risk of HTLV-III/LAV infection; and screening of semen donors for antibody at the time of donation and after 3 months. In terms of prevention of perinatal transmission, it should be noted that women with HTLV-III/LAV infection who become pregnant are at increased risk of developing AIDS and have a 50% chance of transmitting infection to their infant. Women with HTLV-III/LAV infection should be advised of the need for a highly efficient type of contraception to prevent pregnancy. Since AIDS is an uncommon disease of low infectivity, family planning workers are not considered to be at greater risk than the broader population.
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  5. 130
    Peer Reviewed

    [Record of the second meeting of the WHO Collaborating Centers on AIDS] Deuxieme reunion des centres collaborateurs de l'OMS pour le SIDA: memorandum d'une reunion de l'OMS.


    Participants at the 2nd meeting of World Health Organization (WHO) collaborating centers on AIDS (acquired immune deficiency syndrome) held in Geneva in December 1985 reported on progress since the 1st meeting in September 1985 and made a number of recommendations for future action in the areas of information, education, and prevention; reference reactants and tests of anti-HTLV-III antibodies; epidemiologic evaluation; and research on vaccines and antiviral agents. It was recommended that ministries of health, education, and social services provide the public with timely and accurate information on AIDS, that physicians, nurses, and similar personnel inform the ill and the public about AIDS and its prevention, and that school age children and young people be informed about AIDS and how to avoid infection. Systems of registration of AIDS cases should be implemented in order to provide the WHO and member states with data on the international level. Standardization and availability of serologic tests is also required. Instructions for avoiding infection should be provided for health personnel and others caring for AIDS patients, for individuals providing personal services to the public, and to ensure adequate methods of disinfection. Instructions for preventing AIDS should discuss sexual and parenteral transmission as well as perinatal transmission. Specific recommendations for education and family placement for children with AIDS have already been published. Instructions should be provided for prisons and similar estabilshments. Requiring international travellers to provide certificates attesting to their AIDS-free status is not justified as a preventive measure. The significant existing demand for reference reactants including human serums with anit-HTLV-III antibodies and controls is being addressed by several institutes in different countries, but it would be premature to furnish reference reactants other than serums. The WHO collaborating centers should furnish materials for purposes of training in diagnostic techniques. Existing tests for diagnosis and confirmation should be imporved and new tests should be developed, with particular attention to simple methods appropriate for use in developing countries. It will be necessary to establish international biological standards for the HTLV-III virus, but the required specifications are not yet known. Technical cooperation and epidemiological evaluation must be planned separately, based on the different prevalence of infections and technical expertise of different countries. A clinical definition of AIDS is needed for countries lacking resources needed to apply the Centers for Disease Control/WHO definition. Surveillance methods and laboratories can be installed with WHO assistance, to help evaluate the extent of AIDS infection in different countries. Later technical cooperation in the areas of continued surveillance and laboratory capacities will depend on results of the initial evaluation in each country. Research is currently underway in several countries of possible vaccines and drugs. Careful preclinical studies should be done to evaluate the toxicity of an agent before clinical studies are conducted. Convenient animal models should be sought for future research. 3 annexes to this report specify methods of disinfection; general principles of preventing transmission of the AIDS virus through parenteral exposure or following donation of organs, sperm, or other tissue; and a proposed definition of clinical cases of AIDS.
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  6. 131

    Annual report 83/84.

    Family Planning Association of Hong Kong

    Hong Kong, Family Planning Association of Hong Kong, 1984. [108] p.

    This 1983-84 Annual Report of the Family Planning Association of Hong Kong lists council and executive members as well as subcommittee members and volunteers for 1983 and provides information on the following: administration of the Association; clinical services; education; information; International Planned Parenthood Federation (IPPF) activities; laboratory services; library service; motivation; personnel resource development and production; the Sexually Assualted Victims Service; studies and evaluation; subfertility service; surgical service; training; the Vietnamese Refugees Project; women's clubs; the Youth Advisory Service; and youth volunteer development. In 1983, there was a total of 45,384 new cases; total attendance at clinics was 261,992. A series of thirteen 5-minute segments on sex education was produced as part of a weekly television youth program. An 8-session sexual awareness seminar continued to receive a very good response. To meet the increasing demand of young couples for better preparation towards satisfactory sexual adjustment in marriage, a 3-session seminar on marriage was regularly conducted every month during 1983. 13 seminars were held, reaching a total of 374 participants. Other education efforts included a family planning talk, the Kwun Tong Population and Family Life Education Week, and 39 sessions of talks and lectures on various topics related to family planning and sex education. The year-long information campaign was organized in response to the 1982 Knowledge, Attitude, Practice findings that many couples still fail to recognize the concept of shared responsibility in family planning. Laboratory services include hepatitis screening, premarital check-up examinations, pap smear, the venereal disease research laboratory test (VDRL), and seminal fluid examinations. Throughout the year, 256 interviews were given to sexually assaulted victims. To arouse the awareness of the public with regard to preventing rape through education, counselors conducted talks and gave radio and television interviews on the Sexually Assaulted Victims Service. The records of the 3 sub-fertility clinics showed that altogether in 1983 there were 1355 new cases and 561 old cases, with a total attendance of 6682. 144 pregnancies also were recorded. Training programs included sex education seminars for social workers, a sex education course for secondary school teachers, a sex education seminar for student guidance officers, and an advanced course on human sexuality for teachers and social workers.
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  7. 132

    Research as an aid to filariasis and onchocerciasis control.

    Nelson GS

    In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 167-72. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)

    Research is the tool which can help accelerate control of filariasis including the most important, river blindness and elephantiasis. The principles for control include eliminating the vectors and changing the way of life of the people. However these methods do not take into account the different ecologies of the land, cultures of the people and technical and political differences of the endemic areas. The WHO Onchocerciasis Control Program in the Volta Basin has been highly successful, but reinvasion of vectors is possible and there is concern that unacceptable levels of pollution will occur. Several successful limited programs of control are cited, but the absence of suitable drugs to kill the parasites is evident. One of the areas of research is centering on the characterization of the parasites and their vectors. More studies of isoenzyme markers are needed to distinguish different species of filarial parasites. An important advance in the diagnosis of filariasis has been the application of membrane filtration techniques for detecting light infection. Some of the current vector research is noted. This is particularly important because the main vectors of filariasis in Africa are also the main vectors of malaria. WHO is encouraged to stimulate collaborative research in this area. Chemotherapy is currently the most encouraging aspect of research. WHO is supporting 4 major centers where old and new filaricides are being evaluated. Some experiments are indicating the possibility that resistance to the disease can be stimulated by using irradiated larvae as appear in a cat model. Testing is now underway in a bovine onchocerciasis model. The new laboratory developments must continue so they can be applied clinically.
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  8. 133

    Oral rehydration therapy for treatment of rotavirus diarrhoea in a rural treatment centre in Bangladesh.

    Taylor PR; Merson MH; Black RE; Rahman AS; Yunus MD; Alim AR; Yolken RH

    Archives of Disease in Childhood. 1980 May; 55(5):376-9.

    The outcome of a rehydration treatment used during a 40-day period at a WHO Center in Bangladesh on 216 children under age 5 is reported. In addition, an enzyme-linked immunosorbentassay (ELISA) designed to detect rotavirus in stool specimens is described and its application explained. The ELISA assay was adaptable to use in a rural treatment center. In a 40-day period, using the new virus-detecting assay, rotavirus without other pathogens was found in stools of 216 (45%) of 480 children who attended the center with gastrointestinal illness. Of these 216 children with only rotavirus pathogen, 188 were treated with oral rehydration alone (oral glucose solution prepared according to WHO procedures); 28 required additional intravenous rehydration therapy. No deaths occurred. 95% of the cases were judged successful on oral rehydration alone for gastrointestinal effects of rotavirus infection. No serious side effects were reported. This oral glucose solution is now indcated in E. coli (enter otoxin)-mediated diarrhea as well as in rotavirus-induced diarrhea.
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  9. 134

    Handbook on infertility.

    Kleinman RL; Senanayake P

    London, International Planned Parenthood Federation, 1979. 58 p.

    This International Planned Parenthood report states the agency's policy position on management of infertility, and then briefly goes on to cover the following topics, in handbook form: 1) epidemiology of infertility; 2) etiology of infertility; 3) proper infertility counseling; 4) prevention (trauma avoidance and early treatment of diseases); 5) diagnostic techniques for the couple, man, and woman; 6) treatment of infertility in women and men; 7) use of artificial insemination, both with donor's semen and partner's semen; and 8) the place of adoption within the community of infertile couples. Prevalence of infertility is placed at an international average of 10%, though places such as Cameroon have rates as high as 40%. The factors influencing infertility are divided into 3 groups: 1) socio-cultural, 2) sexually transmitted diseases, and 3) other diseases and disorders. Causes of female infertility include: ovulation dysfunction; tubal obstruction or dysfunction; uterine actors such as fibroids, polyps, or developmental abnormalities; cervical abnormalities; vaginal factors, such as severe vaginitis or imperforate hymen; endocrine and metabolic factors, particularly thyroid disturbances, diabetes, adrenal disorder, severe nutritional disorders (anemia), or other systemic conditions; and repeated pregnancy wastage. Male causes include poor semen quality; ductal obstruction; ejaculatory disturbances (i.e., failure to deliver sperm to vagina); emotional stress (may lead to hypogonadism); and genetic factors (Klinefelter syndrome). Causes specific to the couple include lack of understanding of reproductive physiology, immunoloigcal incompatibility, nutritional deficiencies, and psychogenic factors.
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  10. 135

    Design of studies for the assessment of drugs and hormones used in the treatment of endocrine forms of female infertility.


    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. 135-154

    The lack of uniformity in diagnostic selection of women for treatment of infertility, in choice of therapy, in monitoring of therapy, and in follow-up, frequently does not allow a meaningful comparison of results reported from different centers. To design studies assessing effectiveness of therapy of endocrine forms of female infertility, it is essential to consider: 1) mechanism controlling reproductive functions (e.g., process of ovulation); 2) cause(s) responsible for infertility (mechanical factors, ovarian failure, and pituitary failure); and 3) the mechanism of action of agents used for therapy (e.g., gonadotropins stimulate gonadal function, clomiphene stimulates gonadotropin secretion, and ergoline derivatives inhibit prolactin secretion). Patients selected for therapy should be grouped according to etiology: 1) hypothalamic-pituitary failure; 2) hypothalamic-pituitary dysfunction; 3) ovarian failure; 4) congenital or acquired genital tract disorder; 5) hyperprolactinemic patients with a space-occupying lesion in the hypothalamic-pituitary region; 6) hyperprolactinemic patients with no space-occupying lesion; and 7) amenorrheic women with space-occupying lesion. Ideally, an infertile couple should be diagnosed and treated as a unit.
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  11. 136

    The investigation of the infertile couple: a critique of the currently available diagnostic tests.


    In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagan, Denmark, Scriptor, 1977. p. 111-134

    A 6-month regimen for managing infertile men and/or women ideally forms 4 stages: 1) history and examination of the couple; 2) confirmation of ovulation, compatibility of sperm and mucus, and seminology; 3) tests for tubal patency; and 4) detailed endocrine tests for abnormalities found in Stages 1-3. Medical history should include emotional stress and work pressures, if any. Ovulation confirmation requires 2 tests combined from these 4: 1) basal body temperature; 2) endometrial biopsy; 3) blood progesterone levels; and 4) urinary pregnanediol. These procedures are outlined in detail, and figures chart body temperature variations and expected progesterone and pregnanediol levels. Assessment of cervical mucus and measurement of sperm penetration combine in vitro and in vivo tests. The Sims-Huhner test (postcoital test), though not standardized, is used to analyze sperm-mucus interaction by quantitative scoring of sperm count and motility. Other in vitro tests are the sperm-mucus match test and the fractional postcoital test (both described). Tubal patency is investigated by tubal insufflation with CO2, hysterosalpingography, endoscopy, and laparoscopy. Additional Stage 4 tests include vaginal cytology and assessment of estrogen and progesterone effects.
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  12. 137

    Ectopic pregnancy rates in IUD users [letter]


    British Medical Journal. 1978 Mar 25; 1(6115):785-6.

    The steering committee of the Task Force on Intrauterine Devices for Fertility Regulation of the World Health Organization's Special Program of Research, Development, and Research Training in Human Reproduction has cited the following reservations regarding the hypothesized link between IUD use and ectopic pregnancy: 1) while available data suggest a real increase in the risk of ectopic pregnancy for IUD users, the magnitude of this risk cannot be quantitated in the absence of adequate comparative studies with nonusers; 2) the presentation of ectopic pregnancy rates as a percentage of total pregnancies may be affected by the conception-dependent reduction in intrauterine pregnancy rates; thus, ectopic pregnancy rates should be expressed as a life table rate/100 woman-years; 3) the risk factors predisposing to ectopic pregnancy vary between population and users of different methods, introducing bias unless this variability is considered in the study design; 4) failure to state the criteria for the diagnosis of ectopic pregnancy may have led to an overestimation of its incidence. Decidual reaction and/or blood in the Fallopian tubes are not sufficient diagnostic indicators; fetal parts (identified grossly or microscopically) and/or trophoblast must be identified; and 5) the limited data available and lack of comparability between studies do not permit the conclusion that Progestasert IUD users are at a higher risk of ectopic pregnancy, as has been suggested in recent reviews.
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  13. 138

    Guide to equipment selection for M/F sterilization procedures. Guide du materiel utilise pour les procedures de sterilisation des hommes et des femmes.

    Reingold LA

    Population Reports. Series M: Special Topics. 1977 Sep; (1):[36] p.

    This is a guide to aid in selecting and maintaining the proper equipment used in the following sterilization procedures: 1) minilaparotomy, 2) laparoscopy, 3) conventional laparotomy, 4) colpotomy, 5) culdoscopy, and 6) vasectomy. Prototype, experimental, or infrequently used instruments are not discussed. Colpotomy, minilaparotomy, and conventional vasectomy are low-technology procedures requiring relatively simple, locally produced instruments, e.g., retractors, forceps, and scalpels. High-technology equipment consists of specialized items, e.g., laparoscopes and culdoscopes. These are produced in a limited number of technically advanced countries. Equipment donor agencies are discussed. The following factors must be considered in selecting equipment: 1) suitability for the intended procedures, 2) quality of the instrument, 3) ease of repair, and 4) initial cost. Each type of equipment is pictured, diagrammed, described, and charted against others of its kind. Maintenance and repair guidelines are provided.
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  14. 139

    Research in family planning: 2.

    WHO Chronicle. 1982; 36(5):179-85.

    The World Health Organization (WHO) Special Programme of Research, Development and Research Training in Human Reproduction supports investigations on the safety and efficacy in developing countries of oral contraceptive (OC) methods and provides advice on the best preparations or devices for particular groups and the safety of controversial products such as injectable progestins. Comparative studies on OC dosages and preparations, interaction of OCs with parasitic diseases such as malaria, timing of IUD insertion, comparison of available types of IUDs, clinical and epidemiological studies of the safety and dosage levels of long acting progestin preparations, and a comparison of surgical sterilization techniques have been carried out. High priority is given to the development of better methods of fertility control. A simplified questionnaire to determine prevalence of primary and secondary infertility, pregnancy wastage, and infant and child mortality has disclosed some very high rates of infertility, particularly in Africa. Other studies seek to standardize the protocol for diagnosis and investigation of infertility and to evaluate commonly used treatment and evaluation procedures for infertility. The Special Programme seeks to strengthen the capability of institutions in developing countries to conduct research and collaborate in projects. 250 research and visiting scientist grants were awarded in 1980-81, and 20 research training courses were organized. A major effort was made in the standardization and quality control of laboratory procedures, and 142 laboratories in 48 countries now participate.
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  15. 140


    Cook JA

    In: National Council for International Health [NCIH]. New developments in tropical medicine. Washington, D.C., NCIH, 1982 Jan. 43-7.

    Schistosomiasis is a chronic trematode infection caused by 3 different schistosome species: 1) schistosoma mansoni, 2) schistosoma japonicum, and 3) schistosoma haematobium. The life span of the worms is between 3-7 years; eggs are passed in urine or feces and on reaching fresh water, hatch. The biologic principles of the life cycle have a major effect on the epidemiology of infection; the worm does not multiply in the human host, so the extent of infection is dependent on the number of cercariae that penetrate which in turn is dependent upon the human exposure to infective fresh water. Based on a recent World Health Organization survey of 103 countries, schistosomiasis is one of the most widespread parasitic infections of man; it is present in 73 countries, infecting 200 million people. As world population grows and people are more dependent on unclean water systems and poor sanitation systems, the prevalence of schistosomiasis is rising. Actual disease due to schistosomes results from the human host's inflammatory response to the many eggs that remain in the intestine near the site of oviposition. There are 3 syndromes to consider: 1) schistosome dermatitis which is not of any clinical significance, 2) acute schistosomiasis, also called Katayama Fever, which is an acute febrile illness with cough, chills, hepatomegaly, lymphadenopathy, and eosinophilia, and 3) chronic schistosomiasis, which has symptoms such as bladder calcification, terminal haematuria, occasional dysuria, ureter lesions causing hydroureters and hydronephrosis. The definitive diagnosis is made by examination of excreta or more rarely on rectal biopsy specimens. For s. mansoni in the western hemisphere the treatment is oxamniquine, 15 mg/kg in a single oral does, for s. mansoni from Africa, a dose of up to 60 mg/kg may be needed. For s. haematobium, metrifonate is usually used, 7.5 mg/kg in 3 doses separated by 2 weeks intervals, and for s. japonicum, praziquantel, 60 mg/kg in 3 equal doses in a 24-hour period. Control programs have generally relied on safe water and sanitary facilities, use of molluscicides to kill snails, and the use of chemotherapy to kill schostosomes within the human host.
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  16. 141

    The eastern Mediterranean region.

    Baasher T

    In: Bannerman RH, Burton J, Ch'en Wen-Chieh. Traditional medicine and health care coverage: a reader for health administrators and practitioners. Geneva, Switzerland, World Health Organization, 1983. 253-62.

    This article describes the present state of traditional medicine in the Eastern Mediterranean Region and its future prospects with special emphasis on the role of WHO in the promotion and development of research activities. Attitude and the official policy towards traditional medicine vary from country to country. In practically all the countries 2 systems of health care are in operation--allopathic or modern medicine, which comes under official regulations by the State, and traditional medicine, which is community-related and generally self-developed. Professional and community attitudes, official policies, the categories of traditional practitioners, and techniques used in diagnosis and treatment are discussed. The diagnosis is essentially based on general observations and history taking. Usually no resort is had to medical instruments or to laboratory tests to establish a diagnosis. The techniques used in treatment can be grouped under physical remedies, social and psychotherapeutic practices. The physical remedies are mainly the prescription of certain diets, the use of drugs and chemicals, cautery, simple surgical operations, bonesetting, massage, hydrotherapy, cupping, and bloodletting. The psychotherapeutic devises may be simple practices for protection or may entail a complex group interaction and abreactive measures. The ancient Zar cult, for example, is a psychodramatic technique based on musical therapy and group activity. The only available statistical data are for the traditional birth attendants (TBA), and even these are limited. TBA's attend about 99% of mothers in Pakistan, 80% in Iraq, 60% in Iran and 50% in Egypt. Although some countries have no organized training for traditional practitioners, others have a long and rich background in the field of training. Innovative approaches in Sudan and Pakistan are mentioned and significant contributions to traditional pharmacopoeia and research activities in traditional medicine are discussed. WHO has played a major role in the development programs to promote traditional medicine and to investigate its optimal utilization in modern medical health services.
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  17. 142

    Biological approaches to ovulation detection.

    Bonnar J

    In: Jeffcoate SL, ed. Ovulation: methods for its prediction and detection. Chichester, England, John Wiley, 1983. 33-47. (Current Topics in Reproductive Endocrinology Volume 3)

    This chapter reviews certain recognizable biological effects that occur due to the major changes in the circulating blood levels of estrogen and progesterone and discusses the ongoing use of these biological signals for the self detection of ovulation and the fertile phase of the cycle. These biological changes include the basal body temperature, changes in the cervix and its mucus secretion, mittelschmerz, and the menstrual cycle molimina. The calculation or calendar method is the oldest technique for determining the fertile period and followed the work of Ogino (1930) and Knaus (1933). The fertile phase of the cycle was identified from the records of the previous 6-12 menstrual cycles. The potential fertile period was then calculated on the following basis: define the shortest and the longest menstrual cycle over the preceding 6 and preferable 12 cycles; the 1st day of the potentially fertile phase is the longest cycle minus 11 days. For a women whose menstrual cycles have varied between 26-31 days, the potential fertile period would be days 8-20 of the cycle. The greatest weakness of the calendar calculation is that it depends on a prediction, based on the menstrual history, of what is likely to occur and not on what is actually taking place. Very rapid electronic thermometers are now available which offer considerable advantages over the clinical thermometer. The daily taking and charting of the basal body temperature (BBT) is the simplest and most widely used method for detecting ovulation. To overcome the drawbacks of the calendar method and the BBT method for identifying the fertile period, John and Evelyn Billings of Melbourne in the early 1970s developed the ovulation method. Self recognition of cervical mucus symptoms provides the woman with a simple means of detecting the fertile phase of her cycle and the likely time of ovulation. Individual cycle variation in the preovulatory duration of the symptoms limits the position of the prediction, yet the "peak" day correlates better with the time of ovulation than the shift in BBT. In addition to effects on cervical mucus, estrogen also changes the morphology of the cervix. The preovulatory rise in estrogensoftens the tissues of the cervix and opens the cervical os. The softened cervix and gaping os with a cascade of clear mucus is a sign of optimal estrogen response and of imminent ovulation. A World Health Organization (WHO) multicenter study of the ovulation method provided a substantial amount of information of the normal menstrual cycle of a large number of women of proven fertility in the age group 18-39 years whose cycles were not influenced by the use of hormonal or other contraceptive methods.
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  18. 143

    Annual report 1982/1983.

    Family Planning Association of Hong Kong

    Hong Kong, Family Planning Association of Hong Kong, 1983. [93] p.

    This 1982-83 Annual Report of the Family Planning Association (FPA) of Hong Kong reports on the following: program administration; activities of the International Planned Parenthood Federation (IPPF); personnel; clinical services; surgical services; laboratory services; affiliated volunteer groups; education; information; library services; motivation and promotion; statistics and evaluation; training; the Vietnamese Refugees Project; and the Youth Advisory Service. The Association's services are managed by 133 full-time and 21 part-time staff. The clinic attendance figures quoted are for the 1982 calendar year; otherwise, the report refers to the current financial year. There were 43,818 new cases and 51,031 old cases making a total clinic attendance figure of 257,185. Of the 772 female applicants for sterilization, 599 female clients were treated for sterilization in 1982, 502 having mini-laparotomy and 97 having culdoscopic sterilization. 367 vasectomies were performed, representing an increase of 8.6% over the previous year. Educational efforts took the form of Working Youth's Programs, Sexual Awareness Seminars, Sex in Marriage Seminars, Family Planning Talks, and talks and lectures on various topics related to family planning and sex education. Information activities included exhibitions, columns in newspapers and magazines, media coverage and advertisements, and talks by Association staff to various service clubs and community organizations and universities. Resource development efforts took the form of the production of new family life education resources as well as other resource materials; film, slide, and video production; and audiovisual services. The 1982 Knowledge, Attitude, and Practice Survey revealed that 59.2% of the 1403 currently married women interviewed approved, with or without reservation, of the provision of a contraceptive services to the unmarried. 30.5% disapproved of it, and 10.4% had no idea or gave no answer. Studies of the termination of pregnancy and a family life education survey also were conducted. Training efforts included sex education seminars for social workers, a sex education course for secondary school teachers, a sex education seminar for student guidance officers, and an advanced course on human sexuality for social workers and teachers. Total clinic attendance recorded for the Vietnamese Refugees project was 2680; 580 were new cases. The Youth Advisory Service recorded a big increase in the number of new clients (1723), old clients (270), with a total attendance of 3901.
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  19. 144

    Smallpox: post-eradication vigilance continues.

    WHO CHRONICLE. 1982; 36(3):87-91.

    This article summarizes the major findings and recommendations of the Committee on Orthopoxvirus Infections, established by the World Health Assembly to advise on posteradication policy. Although smallpox has been eradicated, there remains a need for the monitoring of vaccination practices, investigation of rumored smallpox cases, verification of virus and vaccine storage conditions, and surveillance of the other orthopoxviruses, including monkeypox. Routine vaccination for smallpox has been officially discontinued in 150 of the 158 Member States and Associate Members of the World Health Organization (WHO); Egypt and Kuwait continue to immunize, while the present status of vaccination remains unknown in 6 other countries. WHO is taking further steps to encourage all countries to cease this practice and is contracting laboratories that continue to produce smallpox vaccine to request that they cease commercial vaccine distribution. Since 1979, 124 rumors of smallpox cases from 55 countries have been investigated, most of which were misdiagnosed cases of chickenpox, measles, and other skin diseases; none has been smallpox. At present, variola virus is being stored in 4 laboratories, 3 of which are WHO collaborating centers. WHO will continue to inspect these laboratories to ensure that requirements for containment are being met. Programs for the surveillance of human monkeypox in west and central Africa are being initiated, although present data indicate that this disease is not of public health importance. The total number of known cases of human monkeypox since 1970 stands at 63. Important studies for the postsmallpox surveillance program include the development of simple and reliable screening tests for orthopoxvirus antibody and of reliable tests for antibody specific to monkeypoxvirus. Plans are underway to publish a book dealing with all aspects of the smallpox eradication campaign.
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  20. 145

    Treponemal infections. Report of a WHO scientific group.

    World Health Organization [WHO]. Scientific Group on Treponemal Infections

    World Health Organization Technical Report Series. 1982; (674):1-75.

    The World Health Organization (WHO) Scientific Group on Treponemal Infections met in Geneva during October 1980 with the objective of reviewing all aspects of the treponematoses and of providing updated standards and guidelines for their diagnosis, treatment, and control. WHO has always attached great importance to the sexually transmitted diseases and to the nonvenereal endemic treponematoses, because of the heavy burden they impose on both the individual and the society. This report of the WHO Scientific Group on Treponemal Infections covers the following: epidemiological aspects (syphilis and nonvenereal treponematoses); clinical aspects; laboratory aspects (diagnosis, microcsopic tests used to identify treponemes, serological tests for the detection of antibodies in individuals with treponemal infections, and diagnosis of neurosyphilis by cerebrosponal fluid (CSF) examination); management aspects; control aspects; and research aspects. The diagnosis of a primary or secondary treponemal infection should be established by identification of the causative organisms using darkfield microscopy. A reliable nontreponemal serological test has confirmatory value in such circumstances. A combination of nontreponemal and treponemal serological tests is essential for the diagnosis of all other stages of syphilis. In clinical outposts where nonmedical health workers deliver health care, simple clinical algorithm may help to ensure that genital ulcers and other clinical manifestations of treponemal infections are treated immediately with adequate doses of suitable penicillin preparations. After nearly 40 years, penicillin remains the drug of choice in the treatment of all forms of syphilis. The following were among the recommendations made by the Scientific Group on Treponemal Infection: the following categories should be used in reporting cases of syphilis, i.e., primary and secondary infections, early latent infections, late latent infections, symptomatic late infections, congenital infections in patients under 2 years of age, and congenital infections in patients 2 years of age and older; improved teaching should have the highest priority, particular attention being directed to congenital syphilis; darkfield microscopy should be the preferred diagnostic test for infectious treponemal disease; physicians should be cautioned never to use less than the recommended dosages of penicillin; practical guidelines should be established on the efficient epidemiological analysis of the extent of syphilis, the logistics of syphilis control programs, and the indications for, and application of, various control strategies; and the highest priority should be given to the prevention of congenital syphilis.
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