World Health Organization Task Research Articles

20-year trends in prevalence of overweight and obesity among children aged 0-6 in Harbin, China: A multiple cross-sectional study.

To examine the 20-year trends in the combined prevalence of overweight and obesity among children aged 0–6 years between 1995 and 2015 in Harbin, China, we selected altogether 49,553 children aged 0–6 years old by using a multistage stratified cluster sampling methods in Harbin, one provincial capital city in northeast China in 1995, 2005 and 2015. Height and weight information of the children were collected. We used the child growth standards of World Health Organization to calculate the Z-scores for body mass index (BMI). Cut-offs recommended by World Health Organization and International Obesity Task Force were used to define overweight and obesity for each children. We found there is no difference between boys’ BMI and girls’ among newborns in each survey point (p>0.05), but in older age groups, the BMI of boys was higher than that of girls (p<0.05). From 1995 to 2015, the average BMI was increasing continuously among boys older than 42 months and girls older than 48 months (p<0.01 for linear trend across year) in Harbin. The combined prevalence of overweight and obesity increased from 2.6% in 1995 to 7.6% in 2015. For every 10-year the risk of combined overweight and obesity in children aged 0–6 years increased by 167% (95%CI: 146%, 188%, p<0.01). The combined prevalence of overweight and obesity in most age subgroups showed an increasing trend over time (p<0.01 for trend test across survey year). The age when the combined prevalence of overweight and obesity dramatically increased was earlier in 2015 than that in 2005 and 1995. In conclusion, there was an increasing trend of the combined prevalence of overweight and obesity during the past 20 years in Harbin and the age when the prevalence dramatically increased became earlier. Comprehensive intervention should be undertaken among younger children to prevent and control children’s overweight and obesity.

Prevalence and geographic variation of abdominal obesity in 7- and 9-year-old children in Greece; World Health Organization Childhood Obesity Surveillance Initiative 2010

BackgroundIn children, abdominal obesity is a better predictor of the presence of cardiovascular risk factors than body mass index (BMI)-defined obesity. We aimed to evaluate the prevalence of abdominal obesity in the Greek pediatric population and to assess the impact of residence on the prevalence of both BMI-defined and abdominal obesity.MethodsIn the context of the Childhood Obesity Surveillance Initiative of the World Health Organization (WHO) Regional Office for Europe, a national representative sample of 7.0–7.9 and 9.0–9.9-year-old children was evaluated (n = 2,531 and 2,700, respectively). Overweight and obesity according to BMI were estimated using both the WHO and International Obesity Task Force cut-off points. Abdominal obesity was defined as waist circumference/height ratio >0.5.ResultsThe prevalence of abdominal obesity did not differ between 7-year-old boys and girls (25.2 and 25.3%, respectively; p = NS). Among 9-year-old children, abdominal obesity was more prevalent in boys than in girls (33.2 and 28.2%, respectively; p = 0.005). Among normal weight and overweight children, the prevalence of abdominal obesity was 1.6–6.8 and 21.8–49.1%, respectively. The prevalence of abdominal and BMI-defined obesity did not differ between children living in the mainland, in Crete and in other islands except in 7-year-old girls, where the prevalence of BMI-defined obesity was highest in those living in Crete, intermediate in those living in other islands and lowest in those living in the mainland. In 9-year-old boys and in 7- and 9-year-old girls, the prevalence of abdominal obesity was highest in children living in Athens and lowest in children living in Thessaloniki, whereas children living in other cities and in villages showed intermediate rates. The prevalence of abdominal obesity in 7-year-old boys and the prevalence of BMI-defined obesity did not differ between children living in cities and villages.ConclusionsThe prevalence of pediatric abdominal obesity in Greece is among the highest worldwide. Boys and children living in the capital are at higher risk for becoming obese. Given that abdominal obesity is more prevalent than BMI-defined obesity and appears to be more sensitive in identifying cardiovascular risk, measurement of waist circumference might have to be incorporated in the screening for childhood obesity.

Jenny Pronczuk de Garbino: a global champion for children's health.

Jenny Pronczuk de Garbino: a global champion for children's health.

Strengthening the bones in primary biliary cirrhosis

Strengthening the bones in primary biliary cirrhosis

Better Guidance Is Welcome, but without Blinders

The three-paper series on guidance for evidence-informed decisions about health systems, published in PLoS Medicine, and produced by members of the World Health Organization (WHO) Task Force on Developing Health Systems Guidance, offers important contributions to improving the quality of evidence-informed decision-making in health systems [1–3]. We recognize the importance of engendering greater structure and systematization in processes that collate and evaluate evidence, and bring it to bear on policy. However, there are significant challenges in doing this for policies related to health systems, and we caution against the adoption of rigid approaches to the development of guidance and to the application of evidence to policy. In recognizing the growing international consensus on the importance of strengthening health systems, particularly in lowand middle-income-countries (LMICs), the first paper argues that better guidance is needed to provide evidenceinformed decisions about interventions in health systems, analogous to the methods that have been used to develop clinical guidelines, and facilitate their implementation [1]. The second paper seeks to identify a series of practical processes and tools for policy development at international and national levels, and for developing guidance at the national level [2]. Many of the same authors have developed the Supporting Policy Relevant Trials (SUPPORT) tools [6] that provide a basis for a very systematic approach to organizing questions about health systems problems and decisions influenced by evidence (Tables 1–3 in [2]). The third paper attempts to adapt guidelines used in clinical evidence-based medicine to understand the quality of health systems evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria [3,7]. In the first paper, Xavier Bosch-Capblanch et al. identify multiple uses of guidance on health systems from a review of national policies and plans in LMICs, but for some of the guidance identified— such as the operational guidelines for procurement, human resource management, or planning and budgeting procedures— one wonders whether research evidence is critical. The authors offer little guidance as to where health systems guidance is most needed. Given the fairly resource-intensive approach proposed to producing health systems guidance a clear sense of priorities is required, and a recognition that sometimes adherence to ‘‘best practice’’ may be sufficient. The papers pay relatively little attention to the well known ‘‘policy-implementation gap’’, and sometimes appear to presume that getting policy right is sufficient. The WHO essential medicines program has encountered significant success in promoting the widespread adoption of an extensive set of guidelines (at global, national, and local levels) related to the development of evidence-based policies, institutions, and procedures [4]. Over 150 countries have adopted essential medicines lists based on thoughtful and evidence-informed guidance [5]. Yet, despite this significant success, policy implementation of essential medicines programs continues to face enormous challenges, with widespread irrational medicines use and a growing threat of counterfeit medicines. In practice, policy development is rarely a one-time event, but is rather a continuous process. National-level policy decisions may provide the overarching framework for change, but commonly the details of policy change are worked out on the ground through implementation processes and reflected in more informal expressions of policy such as ministerial memos and training manuals. While the second paper [2] in the series, by John Lavis et al., portrays a relatively clean process of interaction between global guidance and national guidance and policy, in practice there are likely to be multiple policy iterations as problems and issues merge. Accordingly, while establishing structured processes to promote evidence use, we must not lose sight of the importance of building networks of researchers and policy makers to facilitate ongoing dynamic interaction. The authors of the third paper, Simon Lewin et al., note that systematic evidence is needed to address questions of feasibility and acceptability of interventions, as well as effectiveness, though much of the discussion in the paper addresses evidence regarding ‘‘what can work’’, a question for which GRADE criteria function well. But policy makers may be more interested in questions such as ‘‘what can work in our (non-research) environment?’’, ‘‘how can we make an intervention work well?’’, or ‘‘how can we overcome obstacles to implementation in our situation?’’ They are also likely to be more concerned about the broader type of unintended consequences of an intervention (e.g., the political ramifications) [8], the type of results that are often not well examined by typical research on ‘‘what can work’’. These

Rational care is not rationing

mammogram and often an ultra-sonogram and/or MRI. Even if screening mam-mograms are delayed to age 50, women should still screen their breasts earlier and seek immediate at-tention for any abnormalities.Adding to the confusion are three sets of screen-ing guidelines and pending legislation that would force health plans to cover specific screening options regard-less of individual patient risk. To summarize our three current guidelines: (1) World Health Organization and US Preventive Services Task Force suggest screening every 1–2 years from age 50–75; (2) American College of Obstetrics and Gynecology suggests screening ev-ery 1–2 years from age 40, then annually from age 50; (3) American Cancer Society, American Medical Association, and the American College of Radiology suggest screening annually from age 40. The Task Force advised stopping screening at age 75, whereas others advise stopping when other medical conditions outweigh the benefits. What would be most helpful would be a tool that patients and clinicians could use. It could be simi-lar to the Gail risk model on the NCI Website but modified for breast density and other factors, such as menopausal status, hormone use, diet, and comor-bidities, to allow for more accurate individual discus-sions about risks and screening strategies as part of an overall health strategy. We also need to relay more accurate information to women buffeted by the pro-liferation of breast cancer awareness events stressing that one in eight women will get breast cancer in their lifetimes. Although that statistic is true if women live to age 90, the message distorts the risk of getting breast cancer at various ages.

Recommendations for Diagnosing a Mild Traumatic Brain Injury: A National Academy of Neuropsychology Education Paper

A special interest group of the American Congress of Rehabilitation Medicine [ACRM; Mild Traumatic Brain Injury Committee. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8 (3), 86-87.] was the first organized interdisciplinary group to advocate four specific criteria for the diagnosis of a mild traumatic brain injury (TBI). More recently, the World Health Organization (WHO) Collaborative Center Task Force on Mild Traumatic Brain Injury [Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J., & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, (Suppl. 43), 113-125.] conducted a comprehensive review of the definitions utilized in evidence-based studies with mild TBI patients. Based on this review, the WHO task force maintained the same four criteria but offered two modifications. The similarities and differences between these two definitions are discussed. The authors of the ACRM and the WHO definitions do not provide guidelines or specific recommendations for diagnosing the four criteria. Thus, we provide recommendations for assessing loss of consciousness, retrograde and post-traumatic amnesia, disorientation and confusion as well as clarification of the neurologic signs that can be indicative of a diagnosis of mild TBI. Finally, confounding factors mentioned in both definitions that should exclude a mild TBI diagnosis are summarized.

Estado nutricional de escolares de 1ª a 4ª séries do Ensino Fundamental das escolas urbanas da cidade de Pelotas, Rio Grande do Sul, Brasil

This cross-sectional study included 20,084 students from urban schools (first to fourth-grade) in Pelotas, Rio Grande do Sul State, Brazil. Weight and height were measured, and nutritional status was classified according to the World Health Organization (height deficit) and International Obesity Task Force (overweight and obesity) criteria. The study also recorded the variables age, gender, type of school, and schooling (grade-for-age adequacy). Prevalence of height-for-age deficit was 3.5% (3.9% in boys and 3.1% in girls). Prevalence rates for overweight and obesity were 29.8% and 9.1%, respectively. Overweight and obesity were more frequent in private schools, while height-for-age deficit was more frequent in municipal or State schools. For both boys and girls, age was positively associated with underweight and inversely related to overweight and obesity. Inadequate schooling was associated with increased risk of height deficit and decreased risk of overweight and obesity. In conclusion, primary students' nutritional status depends not only on demographic and socioeconomic factors, but also on type of school.

Persistent Symptoms Associated with Factors Identified by the WHO Task Force on Mild Traumatic Brain Injury

The current study examined the role of factors identified by the World Health Organization's Task Force on Mild Traumatic Brain Injury as being associated with poor outcome after mild traumatic brain injury. Employing symptom severity ratings at 3 months post-injury greater than “mild,” subgroups of Higher-Severity (20%) and Lower-Severity (80%) participants were identified. Findings revealed that individuals who report greater symptom complaints at 3 months post-MTBI may be identifiable soon after injury on the basis of the magnitude and severity of early self-reported symptoms, pre-morbid psychological issues, and involvement in compensation-seeking. Injury severity factors did not differ between the groups.

The WHO Collaborating Center in Szeged; the history of successful international collaboration in complicated times.

In the early 1970s researchers at the Department of Obstetrics and Gynecology in Szeged Hungary had few opportunities to communicate with the international scientific community and few resources to purchase needed equipment and supplies. However the Department was designated a World Health Organization (WHO) Collaborating Research Center of the Expanded Programme of Research Development and Research Training in Human Reproduction in 1972. This 23-year collaboration provided the Department with the equipment and training it needed to carry out more than 40 clinical and nonclinical research projects in collaboration with various WHO Task Forces. Thousands of Hungarian citizens benefitted from access to new and effective means of fertility regulation and staff members contributed to almost 100 scientific publications. When political change came to Europe during the 1980s and 1990s the Center was able to play a prominent role in promoting cooperation in reproductive health research. In 1990 the Center hosted a meeting of the directors of WHO Collaborating Centers in Europe to 1) exchange information 2) identify common reproductive health research needs and priorities 3) develop collaborative plans 4) mobilize scientific expertise and 5) explore ways to mobilize resources. This led to a workshop on reproductive health needs in eastern Europe in 1993 during which the 1994 "Szeged Declaration" was drafted. This declaration identifies the basic elements of reproductive health assesses the regional reproductive health indicators and contains 14 recommendations to further reproductive health. The regional problems identified were so serious that the WHO established a scientific working group to achieve regional improvement.

Vaginal administration of 15-methyl-PGF2α methyl ester for preoperative cervical dilatation

<h2>Abstract</h2> A multicentre clinical trial under the auspices of the World Health Organization's Task Force on Prostaglandins for Fertility Regulation involved 1001 primigravidae patients, 8–12 weeks pregnant, randomly treated either with 1.0 mg of 15-methyl-PGF_2α methyl ester in a vaginal suppository or a placebo suppository. Vacuum aspiration was undertaken three or twelve hours following insertion of the suppository. The results show that sufficient cervical dilatation can be achieved with a prostaglandin suppository which allows easier vacuum aspiration with less operative bleeding and fewer short-term complications. Diarrhoea and vomiting were more common in the treated group. The twelve-hour prostaglandin treatment period resulted in more dilatation up to the 10th week of pregnancy but also caused a higher incidence of side effects. If maximal dilatation is aimed for by twelve hours, pretreatment is preferable. If out-patient management is required,the three-hour schedule may be more convenient.