World Health Organization Website Research Articles

Ultrasound Guided Axillary Node Sampling in Patients of Carcinoma Breast with Clinically Negative Axilla: A Pilot Study

Globally, gastric cancer has been acknowledged as a disease of public health concern because of its related morbidity, deaths and influence on multiple dimensions of the quality of life of the patient and their family members. The objective of this article is to systematically review the published literature on the potential risk factors of gastric cancer, and eventually suggest range of interventions to eventually minimize the prevalence of gastric cancer. An extensive search of all materials related to the topic was made using library sources including Pubmed, Medline, World Health Organization website and Google scholar searches for one month. Keywords used in the search include Gastric cancer, health, and Helicobacter pylori. Multiple ranges of factors have been attributed to the causation of gastric cancer in heterogeneous settings. To counter the consequences of gastric cancer, there is a crucial need to develop and implement a public health strategy to enable early detection of the cancer. In conclusion, in the global aim to reduce the burden of gastric cancer, the need of the hour is to formulate comprehensive & cost-effective strategies well supported by intensified awareness campaigns and strengthening of the health care delivery system.

The Western Africa ebola virus disease epidemic exhibits both global exponential and local polynomial growth rates.

Background: While many infectious disease epidemics are initially characterized by an exponential growth in time, we show that district-level Ebola virus disease (EVD) outbreaks in West Africa follow slower polynomial-based growth kinetics over several generations of the disease. Methods: We analyzed epidemic growth patterns at three different spatial scales (regional, national, and subnational) of the Ebola virus disease epidemic in Guinea, Sierra Leone and Liberia by compiling publicly available weekly time series of reported EVD case numbers from the patient database available from the World Health Organization website for the period 05-Jan to 17-Dec 2014. Results: We found significant differences in the growth patterns of EVD cases at the scale of the country, district, and other subnational administrative divisions. The national cumulative curves of EVD cases in Guinea, Sierra Leone, and Liberia show periods of approximate exponential growth. In contrast, local epidemics are asynchronous and exhibit slow growth patterns during 3 or more EVD generations, which can be better approximated by a polynomial than an exponential function. Conclusions: The slower than expected growth pattern of local EVD outbreaks could result from a variety of factors, including behavior changes, success of control interventions, or intrinsic features of the disease such as a high level of clustering. Quantifying the contribution of each of these factors could help refine estimates of final epidemic size and the relative impact of different mitigation efforts in current and future EVD outbreaks.

Iraqi Birth Defects and the WHO Report

Since the U.S.-led invasion of Iraq in 2003, epidemics of birth defects and cancers are rising in many Iraqi cities. In 2012, the World Health Organization (WHO) and the Iraqi Ministry of Health (MoH) undertook a large-scale epidemiological study to determine the prevalence of birth defects in the Iraqi population. A report which appeared on the WHO website in September 2013, claims that "The rates for spontaneous abortion, stillbirths and congenital birth defects found in the [Iraq] study are consistent with or even lower than international estimates." This article discusses the severe shortcomings of this report and questions its reliability .

At the end of summer

As the summer holiday comes to an end, so does the travel quest throughout the world, and with it the baggage of GERMS that we have come in contact with. During summertime the majority of trips are due to pleasure rather than business and the possibility of challenging behavior is increased. We are bombarded with lots of information regarding travel prevention risk from the legal authorities, but we are still on holiday so we tend not to follow them by heart, and this is why at the end of this period we can encounter lots of travel-associated diseases in our patients. It is therefore necessary to keep this in mind when performing the differential diagnosis, and definitely think about travel-associated diseases, according to the country/countries visited. You can find all the information you need on the Centers for Disease Control and Prevention (CDC, http://www.cdc.gov/) and World Health Organization (WHO, http://www.who.int/en/) websites, readily available to simplify your approach, but do keep in mind that some diseases have a short incubation period while others can become symptomatic even years after the initial exposure. Some of the categories generally considered to present the highest risk for complicated outlines of disease are children and elderly persons, and in these cases an infectious diseases physician specializing in either adult or pediatric patients can be your best choice. Before concluding, as a personal recommendation, stay updated with the latest information on germs by reading the current issue of the Journal and finding out more about rotavirus gastroenteritis in Nigeria, long-term follow-up of antiretroviral treatment in children, and pacemaker-associated endocarditis.

P132 Quality of Guidelines Developed by the World Health Organization: Preliminary Results

BackgroundThe World Health Organization (WHO) annually publishes hundreds of guidelines. Its guideline development process, however, is often criticised even after the implementation of a Guideline Review Committee (GRC) that ensure...

Monitoring the antigenic evolution of human influenza A viruses to understand how and when viruses escape from existing immunity

BackgroundThe World Health Organization (WHO) organizes consultations in February and September of each year, spearheaded by an advisory group of experts to analyze influenza surveillance data generated by the WHO Global Influenza Surveillance and Response System (GISRS). The purpose of these consultations is to recommend the composition on influenza virus vaccines for the northern and southern hemispheres, respectively. The latest news of influenza viruses is made available to the public and updated on the WHO website. Although WHO discloses the manner in which it has made the recommendation, usually by considering epidemiological and clinical information to analyze the antigenic and genetic characteristics of seasonal influenza viruses, most individuals do not possess an understanding of antigenic drift and when it occurs.FindingsWe have constructed a web server, named Fluctrl, and implemented a pipeline whereby HA sequence data is downloaded from the Influenza Virus Resource at NCBI along with their isolation information including isolation year and location, which are parsed and managed in MySQL database. By analyzing the frequency of each amino acid residue of the HA1 domain expressed by the viruses on annual basis, users are able to obtain evolutionary dynamics of human influenza viruses corresponding with epidemics. Users are able to upload and analyze their HA1 sequences for generating evolutionary dynamics. In addition, a distribution of amino acid residues at a particular site is represented geographically to trace the location where antigenic variants are seeded.ConclusionsFluctrl is constructed for monitoring the antigenic evolution of human influenza A viruses. This tool is intended to inform the general public how and when influenza viruses evade the human body's immunity. Furthermore, leveraging the geographic information, the original locations of emerging influenza viruses can be traced. Fluctrl is freely accessible at http://sb.nhri.org.tw/fluctrl.

Informacja farmaceutyczna w krajach Unii Europejskiej

The paper presents the phenomenon of a parallel import. It describes legal aspects and retrieval heuristics of information concerning an imported product, referring to an example of Betaxolol, coming from another EU country. The author discussed the retrieval strategy for a Portuguese product, referring to selected databases, i.e. ATC/DDD Index (WHO BAZYL, the Drug Bank, and the Infarmed. The article describes also the structure and application of the ATC Classification of the World Health Organization (WHO), as well as a method for finding a product in the WHO website search engine.

Diagnosis and management of venomous snakebites in Southeast Asia

Background: Globally, snake envenoming is an important medical problem. Various species from different parts of the world require a variety of diagnostic and therapeutic strategies. Objective: Review clinical manifestations, diagnosis, and management of venomous snakebites in Southeast Asia. Method: Relevant information was extracted from publications in the PUBMED database (up to June 2012) and the World Health Organization (WHO) website. Expert opinions of the authors were added when clinical trial evidence was lacking. Results: The clinical findings including local tissue damage, muscular weakness, coagulopathy, and renal injury were summarized. These data can be used to deduce the responsible snake species. The guide for the first aid, initial evaluation, follow-up observation, and antivenin administration was also suggested. Conclusion: It is critical to transport snakebite victims to hospitals as soon as possible for basic and advance life supports. Appropriate usage of antivenin is life-saving. However, a mode to prevent debilitating tissue necrosis remains to be defined. Keywords: Antivenin, diagnosis of snakebite, management of snakebite, Southeast Asia, venomous snakebite

Safety Checklists in the Operating Room

Over the past decade, increasing attention has been paid to quality and risk management in medicine. Haynes et al., in a path-breaking study published in the New England Journal of Medicine in 2009, showed that the use of a checklist developed by the World Health Organization (WHO) to prevent errors during surgical procedures significantly lowers surgical morbidity and mortality (1). This finding has led surgical societies in Germany and abroad to recommend that the WHO surgical safety checklist be used in all operative procedures. The number of hospitals in Germany that have implemented it to date is not documented. The WHO website lists only hospitals that have actively registered themselves and thus surely underrepresents the number in which the checklist is now being used (2). In this issue of Deutsches Arzteblatt International, Fudickar et al. (3) comprehensively review the current literature on “the effect of the WHO surgical safety checklist on complication rates and interdisciplinary communication.” In particular, they describe the resulting changes in operating-room safety culture. The authors’ encouraging findings ought to motivate the universal adoption of this new, beneficial instrument.

Novel coronavirus associated with severe respiratory disease: Case definition and public health measures

Two cases of rapidly progressive acute respiratory infection in adults associated with a novel coronavirus have generated an international public health response. The two infections were acquired three months apart, probably in Saudi Arabia and Qatar. An interim case definition has been elaborated and was published on the World Health Organization website on 25 September 2012.

Indicators of quality use of medicines in South‐East Asian countries: a systematic review

To identify indicators of quality use of medicines used in South-East Asian region. A systematic review was conducted searching MEDLINE, Embase and The International Network for Rational Use of Drugs (INRUD) and The World Health Organization (WHO) website. Original studies or reports carried out in the South-East Asian region, explicitly using indicators to measure quality use of medicines, and published between January 2000 and July 2011 were included. A total of 17 studies conducted in 7 of 11 countries in South-East Asia were included. WHO indicators focusing on general medication use in health facilities were most widely used (10 studies). Twelve studies used non-WHO indicators for measuring quality use of medicines in clinical areas (geriatrics and obstetrics) or specific diseases, such as diarrhoea and pneumonia. In five studies, WHO indicators were used along with non-WHO indicators. There was little information available about validity, reliability and feasibility of the non-WHO indicators. The majority of indicators measured process rather than structure or outcome. There were very few indicators addressing non-communicable diseases. A limited number of studies have been published explicitly using indicators of quality use of medicines across South-East Asia. Importantly, existing indicators need to be complemented with valid, reliable and feasible indicators related to non-communicable diseases, particularly those with a high financial burden to meet the current medical challenges in the region.

Priority Medicines for Maternal and Child Health: A Global Survey of National Essential Medicines Lists

BackgroundIn April 2011, the World Health Organization (WHO) published a list of “priority medicines” for maternal and child health based on 1) the global burden of disease and 2) evidence of efficacy and safety. The objective of this study was to examine the occurrence of these priority medicines on national essential medicines lists.Methods and FindingsAll essential medicines lists published since 1999 were selected from the WHO website collection. The most-up-to date list for each country was then selected, resulting in 89 unique country lists. Each list was evaluated for inclusion of medicines (chemical entity, concentration, and dosage form) on the Priority Medicines List. There was global variation in the listing of the Priority Medicines. The most frequently listed medicine was paracetamol, on 94% (84/89) of lists. Sodium chloride, gentamicin and oral rehydration solution were on 93% (83/89) of lists. The least frequently listed medicine was the children's antimalarial rectal artesunate, on 8% of lists (7/89); artesunate injection was on 16% (14/89) of lists. Pediatric artemisinin combination therapy, as dispersible tablets or flexible oral solid dosage form, appeared on 36% (32/89) of lists. Procaine benzylpenicillin, for treatment of pediatric pneumonia and neonatal sepsis, was on 50% (45/89) of the lists. Zinc, for treatment of diarrhoea in children, was included on only 15% (13/89) of lists. For prevention and treatment of postpartum hemorrhage in women, oxytocin was more prevalent on the lists than misoprostol; they were included on 55 (62%) and 31 (35%) of lists, respectively. Cefixime, for treatment of uncomplicated anogenital gonococcal infection in woman was on 26% (23/89) of lists. Magnesium sulfate injection for treatment of severe pre-eclampsia and eclampsia was on 50% (45/89) of the lists.ConclusionsThe findings suggest that countries need to urgently amend their lists to provide all priority medicines as part of the efforts to improve maternal and child health.

The economic burden of tuberculosis care for patients and households in Africa: a systematic review [Review article

To summarise the state of knowledge on the economic impact and consequences of tuberculosis (TB) diagnosis and treatment for patients/households in Africa, and to highlight any weaknesses in the work conducted to date. We systematically searched for published articles in English between 1990 and June 2010 in eight databases and the World Health Organization (WHO) website. Broad search terms were used ('tuberculosis' OR 'tuberculosis/HIV' AND 'costs' AND 'Africa'). Only studies that reported any costs of TB care for patients/households were retained. All costs were converted to 2009 USD in accordance with WHO cost analysis guidelines. Overall, 11 articles from eight countries met the inclusion criteria. Only one study met all the quality criteria for a cost-of-illness study; most of the studies focused on urban populations, reported incomplete (pre-diagnostic/average) costs, and did not report coping costs. Mean patient pre-diagnostic costs varied between US$36 and US$196, corresponding to respectively 10.4% and 35% of their annual income. Average patient treatment costs ranged between US$3 and US$662, corresponding to 0.2-30% of their annual income. Pre-diagnostic household costs accounted for 13% and 18.8% of patients' annual household income, while total household treatment costs ranged between US$26 and US$662, accounting for 2.9-9.3% of annual household income; 18-61% of patients received financial assistance from outside their household to cope with the cost of TB care. The average patient's/household's pre-diagnostic costs for TB care were catastrophic. More properly designed studies are needed among different populations throughout Africa.

Illegal online drug sellers: How to stop them?

Illegal online drug sellers: How to stop them?

Burden of rotavirus gastroenteritis and distribution of rotavirus strains in Asia: A systematic review

Rotavirus is the leading cause of severe diarrhea in children worldwide. We systematically reviewed the burden of rotavirus gastroenteritis (RVGE) and distribution of rotavirus strains in Asia. We searched MEDLINE, EMBASE and the World Health Organization (WHO) website for the term "rotavirus" and the name of each country. We included studies that were conducted in children between 2000 and 2011 and that examined the epidemiology, health and/or economic burden of RVGE, and G and P-type distribution in Eastern, South East, Southern and Central Asia. Random effects models were used to pool the proportions of RVGE. We also estimated child mortality due to RVGE using the updated WHO and United Nations Children's Fund's mortality estimates in 2008. The search identified 113 eligible articles. The incidence rates of rotavirus-related hospitalizations in children under 5 years of age ranged from 2.1 to 20.0 cases per 1000 children per year with the highest rates reported in Bangladesh, South Korea, Taiwan, Thailand, and Vietnam. Rotavirus accounted for 37.5% of year-round hospitalized gastroenteritis cases, with higher proportions reported in South East Asia. Rotavirus was associated with approximately 145,000 deaths every year in Asia, with the greatest numbers occurring in India, Pakistan, and Indonesia. The highest annual societal costs of treating RVGE were reported in China (US$365 million), followed by Japan (US$254 million) and India (US$41-72 million). A diversity of rotavirus G and P-types was observed across Asia and the distribution of strains differed by country and year. The most common strains were G1P[8] (23.6%), G2P[4] (11.8%), G3P[8] (18.9%), and G9P[8] (7.4%). Rotavirus is associated with substantial hospitalizations and deaths among children and causes large healthcare expenditures throughout Asia. Safe and effective rotavirus vaccines could substantially reduce the burden of disease.

Smallpox: The Death of a Disease and House on Fire: The Fight to Eradicate Smallpox

Smallpox: The Death of a Disease and House on Fire: The Fight to Eradicate Smallpox

Obesity Prevention and Treatment

Obesity Prevention and Treatment

The relationship between the use of mental health act and general population suicide rates in England and Wales

:Background:The relationship between suicide and involuntary admissions has been mainly examined in younger and mixed age groups. These studies provide mixed results with some demonstrating no relationship and others reporting increased rates of suicides in involuntarily admitted patients. However, the association between the utility of the Mental Health Act with general population suicide rates in England and Wales has not been formally studied. Methods:Thus, an ecological study, over the 19-year period, to examine the relationship between rates of involuntary admissions and general population suicide rates in England and Wales was undertaken using nationally collected data. Data on general population suicide rates for both sexes were ascertained from the World Health Organization (WHO) website. Data on the number of detentions under the Mental Health Act were ascertained from the Office of National Statistics website. Data on the population size for the elderly age-bands were ascertained from the WHO website. Spearman’s correlation coefficient was used to examine the relationship between suicide rates and rates of detention under the Mental Health Act.Results:There were negative correlations between rates of involuntary admissions and general population suicide rates in both sexes.Conclusions:A causal relationship and the direction of causality cannot be assumed because this was an ecological study. There is a need for sufficiently powered study to compare the number of suicide occurring in involuntarily and voluntarily admitted patients using a case-control or cohort design and survival analysis. If an inverse association can be demonstrated between suicide and involuntary admissions then it has important implications for the development of mental health legislation as an adjunct to national suicide prevention strategies.

Viewing the Kenyan health system through an equity lens: implications for universal coverage

IntroductionEquity and universal coverage currently dominate policy debates worldwide. Health financing approaches are central to universal coverage. The way funds are collected, pooled, and used to purchase or provide services should be carefully considered to ensure that population needs are addressed under a universal health system. The aim of this paper is to assess the extent to which the Kenyan health financing system meets the key requirements for universal coverage, including income and risk cross-subsidisation. Recommendations on how to address existing equity challenges and progress towards universal coverage are made.MethodsAn extensive review of published and gray literature was conducted to identify the sources of health care funds in Kenya. Documents were mainly sourced from the Ministry of Medical Services and the Ministry of Public Health and Sanitation. Country level documents were the main sources of data. In cases where data were not available at the country level, they were sought from the World Health Organisation website. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing.ResultsThe Kenyan health sector relies heavily on out-of-pocket payments. Government funds are mainly allocated through historical incremental approach. The sector is largely underfunded and health care contributions are regressive (i.e. the poor contribute a larger proportion of their income to health care than the rich). Health financing in Kenya is fragmented and there is very limited risk and income cross-subsidisation. The country has made little progress towards achieving international benchmarks including the Abuja target of allocating 15% of government's budget to the health sector.ConclusionsThe Kenyan health system is highly inequitable and policies aimed at promoting equity and addressing the needs of the poor and vulnerable have not been successful. Some progress has been made towards addressing equity challenges, but universal coverage will not be achieved unless the country adopts a systemic approach to health financing reforms. Such an approach should be informed by the wider health system goals of equity and efficiency.

Commentary: The World Health Organization's International Classification of Functioning, Disability, and Health: Invaluable Framework, Questionable Research Tool

I am a fan of the International Classification of Functioning, Disability, and Health (ICF). The statement from the World Health Organization Web site is clear: “disability … [is] a universal human experience” and “ICF takes into account the social aspects of disability and does not see disability only as a ‘medical’ or ‘biological’ dysfunction.”1 As an advocate for the superiority of the biopsychosocial over the biomedical model of illness (not to mention inveterate world traveler and international collaborator), this is music to my ears.