World Health Organization Performance Research Articles

AB003. Clinical analysis of central nervous system (CNS) World Health Organization (WHO) grade 4 gliomas with IDH-mutant versus IDH-wildtype focused on CDKN2A homozygous deletion.

We are primarily investigating the prognostic role of cell-cycle-dependent kinase inhibitor (CDKN)-2A homozygous deletion in central nervous system (CNS) World Health Organization (WHO) grade 4 gliomas. Additionally, traditional prognostic factors for grade 4 gliomas will be examined, and our results will be validated. We conducted a retrospective analysis of glioma cohorts in our institute. Medical records were reviewed for 142 glioblastoma patients for 15 years, and pathological slides were examined again for the updated diagnosis according to the 2021 WHO classification of CNS tumors. The isocitrate dehydrase (IDH) mutation and CDKN2A deletion were examined by next generation sequencing (NGS) analysis using ONCO accuPanel®. Traditional prognostic factors including age, WHO performance status, extent of resection, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation were examined. After the exclusion of 6 patients with poor status of pathologic samples, 136 glioblastoma that were diagnosed by previous WHO criteria were changed into 29 (21.3%) astrocytoma, IDH-mutant, CNS WHO grade 4 and 107 (78.7%) glioblastoma, IDH-wildtype, CNS WHO grade 4. Among them, 61 patients (56.0%) had CDKN2A deletion. Group A with IDH-wildtype and CDKN2A deletion had a mean overall survival (OS) of 15.70 months [95% confident interval (CI): 13.86-17.54], group B with IDH-mutant and CDKN2A deletion had a mean OS of 19.37 months (95% CI: 13.43-25.30), group C with IDH-wildtype and intact CDKN2A had a mean OS of 22.63 months (95% CI: 20.10-25.17), and group D with IDH-mutant and intact CDKN2A had a mean OS of 33.38 months (95% CI: 29.35-37.40). Multifactor analysis showed following factors were independently associated with OS: age [≥50 vs. <50 years; hazard ratio (HR) 4.642], extent of resection (gross total resection vs. others; HR 5.523), WHO performance (0, 1 vs. 2; HR 5.007), MGMT promoter methylation, (methylated vs. unmethylated; HR 5.075), IDH mutation (mutant vs. wildtype; HR 6.358), and CDKN2A deletion (absence vs. presence; HR 13.452). The presenting study suggests that CDKN2A deletion should play a powerful prognostic role in CNS WHO grade 4 gliomas as well as low-grade glioma. Even if CNS WHO grade 4 gliomas had mutant IDH, they can have poor clinical outcomes due to CDKN2A deletion.

Evaluation of Chitosans as Coagulants-Flocculants to Improve Sand Filtration for Drinking Water Treatment.

The World Health Organization (WHO) reports that two billion people worldwide lack access to safely managed water sources, including 1.2 billion who already have access to improved water sources. In many countries, household point-of-use (POU) water-treatment options are used to remove or deactivate microorganisms in water, but not all POU technologies meet WHO performance requirements to achieve safe drinking water. To improve the effectiveness of POU technologies, the use of multiple treatment barriers should be used as a way to increase overall treatment performance. The focus of this research is to evaluate multiple barrier treatment using chitosan, an organic coagulant-flocculant, to improve microbial and turbidity reductions in combination with sand filtration. Bench-scale intermittently operated sand filters with 16 cm layers of sands of two different grain sizes representing slow and rapid sand filters were dosed daily over 57 days with microbially spiked surface water volumes corresponding to household use. E. coli bacteria and MS2 coliphage virus reductions were quantified biweekly (N = 17) using culture methods. Bacteria and virus removals were significantly improved over sand filtration without chitosan pretreatment (Wilcoxon Rank-Sum, p &lt; 0.05). When water was pretreated at an optimal chitosan dose of 10 mg/L followed by sand filtration, log10 reductions in bacteria and viruses met the two-star WHO performance level of effectiveness. Microbial and turbidity reductions generally improved over the filter operating period but showed no trends with filtration rates.

Association of Pretreatment Physical and Geriatric Parameters with Treatment Tolerance and Survival in Elderly Patients with Stage I-II Non-Small Cell Lung Cancer: An Evaluation of Usual Care Data.

In this study, the association of pretreatment physical and geriatric parameters with treatment tolerance and survival in elderly patients with stage I−II NSCLC was evaluated. Retrospective data for patients aged ≥70 years, diagnosed between 2016 and 2020 with stage I−II NSCLC, and who underwent surgery or stereotactic ablative radiotherapy (SABR) in a large Dutch teaching hospital were retrieved from medical records. Associations of pretreatment physical and geriatric parameters with treatment tolerance and survival were analyzed. Of 160 patients, 49 of 104 (47%) patients who underwent surgery and 21 of 56 (38%) patients who received SABR did not tolerate treatment. In univariable analysis, World Health Organization (WHO) performance status ≥ 2, short nutritional assessment questionnaire score > 1, short physical performance battery score ≤ 9, and geriatric-8 score ≤ 14 were significantly associated with postoperative complications. Forced expiratory volume of one second < 80% of predicted was significantly associated with intolerance of SABR. In multivariable analysis, WHO performance status ≥ 2 and diffusing capacity for carbon monoxide < 80% were significantly associated with decreased overall survival. This is the first study that investigated the association between pretreatment physical and geriatric parameters and treatment outcomes in patients with stage I−II NSCLC. Evaluation of physical and geriatric parameters before treatment initiation seems highly recommended to select patients who might benefit from preventive interventions before and/or during treatment.

Adsorption of recalcitrant contaminants of emerging concern onto activated carbon: A laboratory and pilot-scale study

According to the World Health Organization (WHO), the definition of water quality indicators, including contaminants of emerging concern (CECs), associated with the development of multi-barrier approaches for wastewater treatment, are crucial steps towards direct potable reuse of water. The aims of this study were 1) quantifying twelve CECs (including pharmaceutical, stimulant, and artificial sweetener compounds) in both untreated and treated wastewater samples in a Brazilian wastewater treatment plant (WWTP) using bidimensional liquid chromatography coupled with tandem mass spectrometry, allowing the selection of five marker (i.e., priority) CECs; 2) evaluating the adsorption potential of such selected CECs [caffeine, hydrochlorothiazide, saccharin, sucralose (SUC), and sulfamethoxazole (SMX)] onto coconut-shell granular activated carbon (GAC); and 3) investigating the removal of the same CECs by a multi-barrier system (pilot-scale, 350 L h−1) treating the effluent of the WWTP and composed of reverse osmosis (RO), photoperoxidation (UV/H2O2), and filtration with GAC. Such technologies were tested separately and in binary or ternary combinations. Eleven and eight CECs were detected and quantified on the untreated and treated wastewater samples of the Brazilian WWTP, respectively. For the treated wastewater, the concentrations ranged from 499 ng L−1 (SMX) to 87,831 ng L−1 (SUC). The adsorption onto AC data fitted the Sips isotherm model, indicating monolayer chemisorption, which was also suggested by the mean adsorption energy values (>16 kJ mol−1). SMX and SUC were the most and the least adsorbed CECs (4.33 and 1.21 mg g−1, respectively). Concerning the pilot-scale treatment plant, the ternary combination (RO + UV/H2O2+GAC) removed >99% of the five marker CECs and promoted reductions on water color, turbidity, as well as on nitrogen and phosphorus concentrations. Further studies on water reuse could prioritize the selected marker CECs as quality indicators. While the removal of marker CECs is one of the WHO performance requirements, the RO + UV/H2O2+GAC system showed promising results as a first approach to direct potable reuse of water.

Taxane monotherapy regimens for the treatment of recurrent epithelial ovarian cancer.

Taxane monotherapy regimens for the treatment of recurrent epithelial ovarian cancer.

A randomized phase II study of anlotinib combined with STUPP versus STUPP alone in patients with newly diagnosed glioblastoma (GBM).

TPS2079 Background: Postoperative with radiotherapy, and concomitant and up to 6 cycles of maintenance temozolomide (TMZ) chemotherapy (STUPP regimen) is now the standard treatment for newly diagnosed GBM, while the effectiveness is limited. Anlotinib is a novel, multi-kinase inhibitor against both tumor angiogenesis and tumor cell proliferation with encouraging findings in preclinical GBM models. Our previous single-arm study (NCT04119674) showed that the addition of anlotinb to STUPP exhibited promising progression-free survival (PFS) in patients with GBM. Therefore, a phase II trial was designed to assessed the efficacy and safety of anlotinib with the STUPP regimen. Methods: This is a multicenter, randomized, controlled, phase II superiority trial. Approximately 150 patients will be randomly assigned 1:1 to receive TMZ-based radiochemotherapy with anlotinib or TMZ-based radiochemotherapy with placebo. All patients will receive radiotherapy (fractionated focal irradiation in daily fractions of 1.8–2.0 Gy given 5 days per week for 6 weeks, for a total of 54–60 Gy) concurrently with TMZ (75 mg/m2 QD) and anlotinib (10 mg QD, d1–14/3wks) or placebo. Anlotinib or placebo is administrated during the 28-day treatment break. Adjuvant therapy start four weeks after radiotherapy completion, including six cycles of TMZ (150–200mg/m2, d1–5/4wks) and eight cycles of anlotinib (10 mg QD, d1–14/3wks) or placebo. Patients who complete adjuvant therapy are administrated anlotinib or placebo continuously until the disease progressed or unacceptable toxic effects developed. Eligibility criteria include histologically confirmed newly diagnosed GBM and a World Health Organization (WHO) performance status ≤ 2. Additional inclusion criteria include patients between 18 and 75 years old with adequate wound healing of craniotomy or biopsy; adequate hematologic, hepatic, and renal function; acceptable blood coagulation levels; and the stable or decreasing usage of glucocorticoid doses within 5 days before randomization. Exclusion criteria include potentially fatal intracranial hemorrhage on magnetic resonance imaging (MRI); tumors located only in the brainstem; prior chemotherapy or radiotherapy administered for GBM; and IDH1/2 mutation. The primary objective of this study is to compare PFS accessed by Independent Review Committee in patients receiving anlotinib in addition to standard treatment with patients receiving standard treatment only. Secondary endpoints include overall survival (OS), PFS accessed by investigators, overall response rate (ORR), severity and frequency of AEs (CTCAE V5.0), and quality of life (QOL). The disease control rate (DCR) and duration of response (DOR) will also be explored. Clinical trial information: NCT04959500. Research Sponsor: Chia Tai Tianqing Pharmaceutical Group Co., Ltd .

Microbial reductions and physical characterization of chitosan flocs when using chitosan acetate as a cloth filter aid in water treatment.

The World Health Organization (WHO) estimates 2.1 billion people lack access to safely managed water. Cloth filtration is often employed in rural and developing communities of South Asia for point-of-use water treatment, but bacteria and viruses are too small for efficient removal by this filtration method. Chitosan is a biodegradable, cationic, organic polymer derived from the chemical treatment of chitin that acts as a coagulant and flocculant of contaminant of microbes and other particles in water, thereby facilitating filtration of microbes. This research 1) evaluated the use of chitosan acetate as a pre-treatment coagulation-flocculation process followed by cloth filtration for microbial reductions and 2) assessed floc particle size under three stirring conditions. E. coli KO11 bacteria and MS2 coliphage virus removals were quantified using culture-based methods. Chitosan acetate coagulation-flocculation pre-treatment of water, followed by cloth filtration, met or exceeded the protective (2-star) WHO performance levels for bacteria (2 log10 reduction) and viruses (3 log10 reduction), and filtrate turbidity was consistently reduced to < 1 NTU, meeting United States Environmental Protection Agency (EPA) and WHO targets.

Fairness of the Distribution of Public Medical and Health Resources.

The fairness of health services is an important indicator of the World Health Organization's performance evaluation of health services, and the fairness of health resource allocation is the prerequisite for the fairness of health services. The research in this article aims to explore how to use health and medical resources fairly and effectively to allocate health resources in different fields, populations and projects, in order to achieve the maximization of social and economic benefits of health and medical resources. In the study of the distribution and equity of public health and medical resources, we comprehensively apply Gini coefficient, Theil index, Lorentz curve and difference index, based on the theory of health resource allocation and the theory of health equity, the province's health service resources have been researched and evaluated, combined with regional health planning theories and public health theories, a variety of scientific methods were used to analyze community health service resources at all levels across the country. At the same time, we reviewed the journal literature about the treatment of patients and children, and analyzed the patients admitted to medical institutions in various regions. The research in this paper found that from 2016 to 2020, the Gini coefficient of the province's health institutions according to population distribution has been fluctuating between 0.14 and 0.17. During this 5-year period, the Gini coefficient of the distribution of medical and health expenditures by population shows a downward trend year by year. From 2019, reach below 0.1, this shows that the fairness of the allocation of health resources according to population has a clear trend of improvement.

Australian National Enterovirus Reference Laboratory annual report, 2020.

Australia monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization (WHO). Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2020, no cases of poliomyelitis were reported from clinical surveillance; Australia reported 1.09 non-polio AFP cases per 100,000 children, thereby meeting the WHO's performance criterion for a sensitive surveillance system. The non-polio enteroviruses coxsackievirus A10 and coxsackievirus A16 were identified from clinical specimens collected from AFP cases. Australia also performs enterovirus surveillance and environmental surveillance to complement the clinical system focussed on children. In 2020, there were 140 cases of wild poliovirus reported from the two remaining endemic countries: Afghanistan and Pakistan. Another 28 countries reported cases of circulating vaccine-derived poliovirus.

Clinical Outcomes Following Re-Operations for Intracranial Meningioma.

Simple SummaryThis study investigated patients who underwent more than one operation for a meningioma, a type of brain tumor. Currently, there is little evidence available for this specific patient group. The purpose of this study was to determine if patients had an improvement or deterioration following a second operation for a recurrent meningioma, and to identify any factors that may influence this change. The results demonstrated that following a second operation for meningioma, patients have poorer outcomes. The findings of this study provide supporting information for surgeons and patients, thereby informing decisions related to patient care and re-operation. The outcomes following re-operation for meningioma are poorly described. The aim of this study was to identify risk factors for a performance status outcome following a second operation for a recurrent meningioma. A retrospective, comparative cohort study was conducted. The primary outcome measure was World Health Organization performance. Secondary outcomes were complications, and overall and progression free survival (OS and PFS respectively). Baseline clinical characteristics, tumor details, and operation details were collected. Multivariable binary logistic regression was used to identify risk factors for performance status outcome following a second operation. Between 1988 and 2018, 712 patients had surgery for intracranial meningiomas, 56 (7.9%) of which underwent a second operation for recurrence. Fifteen patients (26.8%) had worsened performance status after the second operation compared to three (5.4%) after the primary procedure (p = 0.002). An increased number of post-operative complications following the second operation was associated with a poorer performance status following that procedure (odds ratio 2.2 [95% CI 1.1–4.6]). The second operation complication rates were higher than after the first surgery (46.4%, n = 26 versus 32.1%, n = 18, p = 0.069). The median OS was 312.0 months (95% CI 257.8–366.2). The median PFS following the first operation was 35.0 months (95% CI 28.9–41.1). Following the second operation, the median PFS was 68.0 months (95% CI 49.1–86.9). The patients undergoing a second operation for meningioma had higher rates of post-operative complications, which is associated with poorer clinical outcomes. The decisions surrounding second operations must be balanced against the surgical risks and should take patient goals into consideration.

A survey of International Health Regulations National Focal Points experiences in carrying out their functions

BackgroundThe 2005 International Health Regulations (IHR (2005)) require States Parties to establish National Focal Points (NFPs) responsible for notifying the World Health Organization (WHO) of potential events that might constitute public health emergencies of international concern (PHEICs), such as outbreaks of novel infectious diseases. Given the critical role of NFPs in the global surveillance and response system supported by the IHR, we sought to assess their experiences in carrying out their functions.MethodsIn collaboration with WHO officials, we administered a voluntary online survey to all 196 States Parties to the IHR (2005) in Africa, Asia, Europe, and South and North America, from October to November 2019. The survey was available in six languages via a secure internet-based system.ResultsIn total, 121 NFP representatives answered the 56-question survey; 105 in full, and an additional 16 in part, resulting in a response rate of 62% (121 responses to 196 invitations to participate). The majority of NFPs knew how to notify the WHO of a potential PHEIC, and believed they have the content expertise to carry out their functions. Respondents found training workshops organized by WHO Regional Offices helpful on how to report PHEICs. NFPs experienced challenges in four critical areas: 1) insufficient intersectoral collaboration within their countries, including limited access to, or a lack of cooperation from, key relevant ministries; 2) inadequate communications, such as deficient information technology systems in place to carry out their functions in a timely fashion; 3) lack of authority to report potential PHEICs; and 4) inadequacies in some resources made available by the WHO, including a key tool – the NFP Guide. Finally, many NFP representatives expressed concern about how WHO uses the information they receive from NFPs.ConclusionOur study, conducted just prior to the COVID-19 pandemic, illustrates key challenges experienced by NFPs that can affect States Parties and WHO performance when outbreaks occur. In order for NFPs to be able to rapidly and successfully communicate potential PHEICs such as COVID-19 in the future, continued measures need to be taken by both WHO and States Parties to ensure NFPs have the necessary authority, capacity, training, and resources to effectively carry out their functions as described in the IHR.

Efficacy of Ibandronate Loading Dose on Rapid Pain Relief in Patients With Non-Small Cell Lung Cancer and Cancer Induced Bone Pain: The NVALT-9 Trial.

Introduction: Approximately 80% of non-small cell lung cancer (NSCLC) patients with bone metastases have cancer induced bone pain (CIBP).Methods: The NVALT-9 was an open-label, single arm, phase II, multicenter study. Main inclusion criterion: bone metastasized NSCLC patients with uncontrolled CIBP [brief pain inventory [BPI] ≥ 5 over last 7 days]. Patients were treated with six milligram ibandronate intravenously (day 1–3) once a day. Main exclusion criteria: active secondary malignancy, systemic anti-tumor treatment and radiotherapy ≤4 weeks before study start, previous bisphosphonate treatment. Statistics: Simon's Optimal two-stage design with a 90% power to declare the treatment active if the pain response rate is ≥ 80% and 95% confidence to declare the treatment inactive if the pain response rate is ≤ 60%. If pain response is observed in ≤ 12 of the first 19 patients further enrollment will be stopped. Primary endpoint: bone pain response, defined as 25% decrease in worst pain score (PSc) over a 3-day period (day 5–7) compared to baseline PSc with maximum of 25% increase in mean analgesic consumption during the same period. Secondary endpoints: BPI score, quality of life, toxicity and World Health Organization Performance Score.Results: Of the 19 enrolled patients in the first stage, 18 were evaluable for response. All completed ibandronate treatment according to protocol. In 4 (22.2%), a bone pain response was observed. According to the stopping rule, further enrollment was halted.Discussion: Ibandronate loading doses lead to insufficient pain relief in NSCLC patients with CIBP.

Geriatric assessment in older patients with a hematologic malignancy: a systematic review.

The aim of this systematic review is to give an update of all currently available evidence on the relevance of a geriatric assessment in the treatment of older patients with hematologic malignancies. A systematic search in MEDLINE and EMBASE was performed to find studies in which a geriatric assessment was used to detect impaired geriatric domains or to address the association between geriatric assessment and survival or clinical outcome measures. The literature search included 4,629 reports, of which 54 publications from 44 studies were included. Seventy-three percent of the studies were published in the last 5 years. The median age of the patients was 73 years (range, 58-86) and 71% had a good World Health Organization (WHO) performance status. The median prevalence of geriatric impairments varied between 17% and 68%, even in patients with a good WHO performance status. Polypharmacy, nutritional status and instrumental activities of daily living were most frequently impaired. Whereas several geriatric impairments and frailty (based on a frailty screening tool or summarized geriatric assessment score) were predictive for a shorter overall survival, WHO performance status lost its predictive value in most studies. The association between geriatric impairments and treatment-related toxicity varied, with a trend towards a higher risk of (non-)hematologic toxicity in frail patients. During the follow-up, frailty seemed to be associated with treatment non-completion, especially when patients were malnourished. Patients with a good physical capacity had a shorter stay in hospital and a lower rate of hospitalization. Geriatric assessment, even in patients with a good performance status, can detect impaired geriatric domains and these impairments may be predictive of mortality. Moreover, geriatric impairments suggest a higher risk of treatment-related toxicity, treatment non-completion and use of healthcare services. A geriatric assessment should be considered before starting treatment in older patients with hematologic malignancies.

Australian National Enterovirus Reference Laboratory annual report, 2016.

Australia monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization (WHO). Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2016, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.38 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Several non-polio enteroviruses, coxsackievirus A6, enterovirus A71, enterovirus A74 and enterovirus D68, were identified from clinical specimens collected from AFP cases. The global withdrawal of Sabin poliovirus type 2 from oral polio vaccine occurred in April 2016. This event represents the start of the polio endgame with an increased focus on the laboratory containment of all remaining wild and vaccine strains of poliovirus type 2. The National Enterovirus Reference Laboratory was designated as a polio essential facility as part of this process. In 2016, 37 cases of wild polio were reported with three countries remaining endemic: Afghanistan, Nigeria and Pakistan. Nigeria was declared polio-free in 2015, after 12 months without detection of wild poliovirus, but was reinstated as an endemic country after the reporting of four cases in August 2016. This is a salient reminder of the need to maintain sensitive surveillance for poliovirus until global eradication is certified.

Australian National Enterovirus Reference Laboratory annual report, 2015.

Australia conducts surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years as recommended by the World Health Organization (WHO) as the main method to monitor its polio-free status. Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2015, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.2 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Two non-polio enteroviruses, enterovirus A71 and coxsackievirus B3, were identified from clinical specimens collected from AFP cases. Australia complements the clinical surveillance program with enterovirus and environmental surveillance for poliovirus. Two Sabin-like polioviruses were isolated from sewage collected in Melbourne in 2015, which would have been imported from a country that uses the oral polio vaccine. The global eradication of wild poliovirus type 2 was certified in 2015 and Sabin poliovirus type 2 will be withdrawn from oral polio vaccine in April 2016. Laboratory containment of all remaining wild and vaccine strains of poliovirus type 2 will occur in 2016 and the National Enterovirus Reference Laboratory was designated as a polio essential facility. Globally, in 2015, 74 cases of polio were reported, only in the two remaining countries endemic for wild poliovirus: Afghanistan and Pakistan. This is the lowest number reported since the global polio eradication program was initiated.

Australian National Enterovirus Reference Laboratory annual report, 2017.

Australia monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization (WHO). Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2017, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.33 non-polio AFP cases per 100,000 children, meeting the WHO performance criterion for a sensitive surveillance system. Three non-polio enteroviruses, coxsackievirus B1, echovirus 11 and enterovirus A71, were identified from clinical specimens collected from AFP cases. Australia established enterovirus and environmental surveillance systems to complement the clinical system focussed on children and an ambiguous vaccine-derived poliovirus type 2 was isolated from sewage in Melbourne. In 2017, 22 cases of wild polio were reported with three countries remaining endemic: Afghanistan, Nigeria and Pakistan.

Correlation between Body Mass Index on Presenteeism and Absenteeism on Dislipidemia Worker

Obesity and Dyslipidemia are the highest health problem at a Fertilizer Company in 2015, Until now the relationship between overweight which measured by body mass index (BMI) and working productivity, in this point is absenteeism, presenteeism have never been assessed. The purpose of this study is to assess the association between the dislipidemic worker's BMI and the reduction of productivity, that is presenteeism, absenteeism. And also to determine the indirect costs due to absenteeism. This study is an observational analytic research using cross sectional type. This study use a questionnaire survey of the World Health Organization (WHO) Health and Performance Qustionnaire (HPQ). Samples were taken from a population of 166 workers by HSE department. With solvin's formula, the number of samples 121 workers. The Result showed significant relationship between body mass index with presenteeism, because the Spearman correlation coefficient showed r = 0.221 and 0.015 Significance values. There is a significant relationship between Body Mass Index (BMI) and Absenteeism, with Spearman correlation coefficient r = 0.227. Significance value is 0.012. Conclusion: The body mass index is highly correlated with workers productivity that are presenteeism and absenteeism, Productivity decreases will affect the indirect costs incurred by the company, especially their absenteeism.

The Ebola Outbreak: Catalyzing a "Shift" in Global Health Governance?

BackgroundAs the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO), is the subject of continued debate. Criticism of WHO’s performance grew louder in the outbreak’s wake, placing this international health UN-specialized agency in the difficult position of navigating a complex series of reform recommendations put forth by different stakeholders. Decisions on WHO governance reform and the broader role of the United Nations could very well shape the future landscape of 21st century global health and how the international community responds to health emergencies.DiscussionIn order to better understand the implications of the EVD outbreak on global health and infectious disease governance, this debate article critically examines a series of reports issued by four high-level commissions/panels convened to specifically assess WHO’s performance post-Ebola. Collectively, these recommendations add increasing complexity to the urgent need for WHO reform, a process that the agency must carry out in order to maintain its legitimacy. Proposals that garnered strong support included the formation of an independent WHO Centre for Emergency Preparedness and Response, the urgent need to increase WHO infectious disease funding and capacity, and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners. The recommendations also raise more fundamental questions about restructuring the global health architecture, and whether the UN should play a more active role in global health governance.SummaryDespite the need for a fully modernized WHO, reform proposals recently announced by WHO fail to achieve the “evolution” in global health governance needed in order to ensure that global society is adequately protected against the multifaceted and increasingly complex nature of modern public health emergencies. Instead, the lasting legacy of the EVD outbreak may be its foreshadowing of a governance “shift” in formal sharing of the complex responsibilities of global health, health security, outbreak response, and managing health emergencies to other international structures, most notably the United Nations. Only time will tell if the legacy of EVD will include a WHO that has the full support of the international community and is capable of leading human society in this brave new era of the globalization of infectious diseases.

PWE-068 Higher Diagnostic Yield, Younger Age and Improved Performance Status at Diagnosis Associated with The National Oesophago-Gastric (OG) Awareness Campaign (2015) – A District General Hospital Perspective

Introduction A retrospective study evaluating the impact of the English national oesophageal and gastric cancer awareness campaign (26/01/2015-22/02/2015) on a large district general hospital (DGH). The campaign involved radio and television broadcasts advising medical assessment for dysphagia or persistent dyspepsia. Methods Data from all two week wait (2 ww) OG referrals triaged to gastroscopy (OGD) from January to July in 2014 and 2015, was audited retrospectively. The Somerset Cancer Register (SCR) database was used for data collection. Age and World Health Organisation (WHO) performance status, recorded at point of referral, was retrieved from the SCR. Number of referrals, cancer diagnoses, age, WHO performance status and treatment intent were compared between an identical 6 month period in 2014 and 2015. Formal statistical analysis was not carried out. Results There was a 26% increase in 2 ww referrals from 2014 to 2015 (530 to 667) and 4% in non 2 ww referrals (477 to 496). The number and percentage (%yield) of OG cancer diagnoses from 2 ww referrals was 27 (5.0%) in 2014 compared to 32 (4.8%) in 2015. The number and percentage (%yield) of OG cancer diagnoses from routes other than 2 ww OG referral was 17 (3.6%) in 2014 compared to 26 (5.2%) in 2015. The mean and median age at diagnosis expressed in years was 77 and 79 (2014) compared with 69 and 75 (2015). Of OG cancer diagnoses, the treatment intent was considered potentially curative in 33% (2014) compared with 34% (2015). Percentage of patients recorded as WHO performance status 0 and 1 combined was 74% (2014) compared to 91% (2015). One year mortality data is not yet available due to early reporting. Conclusion The 26% increase in 2 ww OG referrals is likely to be heavily influenced by the national OG awareness campaign, on the background of an 11% per annum increase in demand for diagnostic endoscopy services. Interestingly the percentage of cancer findings at OGD remained around 5% indicating that the increased diagnostic throughput has translated to OG cancer diagnoses. The mean and median age at diagnosis was 8 and 4 years lower respectively; this may indicate earlier patient directed self-referral to primary care with OG symptoms, suggesting that the campaign has reached its target audience. Unfortunately, there was not been an obvious increase in potentially curative OG cancer diagnoses; however, the younger group and better performance status may support more intense oncological therapy, leading to improved outcomes. Disclosure of Interest None Declared

Combination of radiofrequency ablation with transarterial chemoembolization for treatment of hepatocellular carcinoma: experience from a Danish tertiary liver center.

Recent studies have shown that the combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC) may offer a survival advantage compared to monotherapy. To study the effectiveness of combination therapy with RFA and TACE compared to that of TACE alone in a Scandinavian tertiary liver cancer center. A retrospective study of the patients treated with combination therapy vis-à-vis TACE alone from June 2007 to November 2012 was performed. Eighteen patients were treated with a combination of RFA and TACE with an interval of 1-4 days between the treatments. For comparison, a group of 18 patients treated with TACE as monotherapy in the same time period was matched with the combination group by demographic data, tumor characteristics, biochemical and clinical parameters, and performance status (PS). Each group consisted of 14 patients with cirrhosis and four without. There were no significant differences between the groups regarding age, gender, tumor characteristics, causes of cirrhosis, levels of bilirubin, creatinine, prothrombin time, Child Pugh score, or World Health Organization (WHO) performance status. The median survival of patients in the RFA + TACE combination group was 586 days compared to 296 days in the control group. The difference was not statistically significant (P = 0.26). However, when we stratified the data for cirrhosis and WHO performance status, patients in the combination group had significantly better survival (P = 0.024). Combination therapy with RFA and TACE for unresectable HCC, compared to TACE alone, may offer a survival benefit for a selected group of patients with HCC.