World Health Organization Proposal Research Articles

Hepatitis C Virus Infection: What Are We Currently Doing in Latin America About WHO's Proposals for 2030?

Hepatitis C Virus Infection: What Are We Currently Doing in Latin America About WHO's Proposals for 2030?

Complex post-traumatic stress disorder: a new diagnosis in ICD-11

SUMMARYThe World Health Organization's proposals in ICD-11, released for comment by member states in 2018, introduce for the first time in a major diagnostic system a distinction between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). This article sets the new diagnosis of CPTSD within the context of previous similar formulations, describes its definition and requirements, and reviews the evidence concerning its epidemiology, differential diagnosis, assessment and treatment.

METHODS OF CONTROL DIPHTHERIA VACCINE SAFETY

Vaccination success depends not only on the timely coverage of threatened contingents, but also on the quality of vaccines. Every day, the requirements for security guarantees vaccines and their use guarantees of security increases. For the fast, reliable and independent scientific assessment of vaccine safety issues, WHO in 1999 created the Global Advisory Committee on Vaccine Safety. To enhance the capacity of pharmaceutical supervision in relation to vaccines in 2012 it was developed the Global Vaccine Safety Initiative. The main directions of the Global Vaccine Safety programs are considered in this review. It’s noted more strict requirements of Ukrainian pharmaceutical industry to produce public immunization drugs regulated Supplements to the State Pharmacopoeia of Ukraine, in comparison with other countries. This review considered diphtheria vaccine safety monitoring in the process of production according to the recommendations of the World Health Organization (WHO), described a subcutaneous method for determining the specific toxicity of the combined purified toxoid, characterized an intracutaneous method of determining of the presence of diphtheria toxin in each sample of the combined purified toxoid, that additionally used by some manufacturers. The definition of diphtheria toxin in dilutions of purified toxoid is presented. This review considered diphtheria vaccine safety monitoring in the process of production according to the recommendations of the World Health Organization (WHO), described a subcutaneous method for determining the specific toxicity of the combined purified toxoid, characterized an intracutaneous method of determining of the presence of diphtheria toxin in each sample of the combined purified toxoid, that additionally used by some manufacturers. The definition of diphtheria toxin in dilutions of purified toxoid is presented. As methods for determination of diphtheria toxin must be able to detect even a small amount of toxin it's examined the WHO's proposal to use an intradermal method on guinea pigs and tests on cell cultures. Attention is drawn to the fact that the determination of specific toxicity in cell culture can be carried out at presence of the approval of this method of a national control authority and sensitivity rates no less than in experiments on guinea pigs. The determining of specific toxicity of ready vaccine by subcutaneous method is described. The publication gave a test for elevated toxicity of the final product by intraperitoneal infection of mice and guinea pigs. It’s cited the WHO recommendations aimed at removing the possibility of recovery of the refined toxin toxicity. Checking vaccines toxicity, pyrogenicity, sterility, allergenicity, teratogenicity, mutagenicity and immunogenicity mainly performed on laboratory animals. The review examined the unreliability of animal experiments and the need to find alternative methods for determining the toxicity without their use particularly in light of the “3R”concept. Methods for determining diphtherial toxin using cell cultures is considered, namely, colony overlay test (COT), tests using a monolayer of HeLa cell culture, a culture of Vero cells (kidney cells of african green monkeys ), a culture of CHO cells (cells of Chinese hamster ovary), which are based on the toxin cytopathic effect on sensitive cell culture. Their advantages and disadvantages are listed. An alternative method for the quantitative detection of C. diphtheriae toxin using the polystyrene plate coated with monoclonal antibody to the part of the diphtheria toxin which defines its binding to the cell, is described. It’s regarded the cytotoxic effect of diphtheria toxin on cells of the immune system of mice and guinea pigs: splenocytes, adhesive phagocytes i B- lymphocytes.

Modelos de rehabilitación en atención primaria y comunitaria. Revisión bibliográfica

This article discusses the various tendencies and models for providing rehabilitation services in primary care through a review of the literature published in the past 30 years.A literature search was conducted using PubMed, CINAHL and MEDLINE, as well as grey literature and less specific search engines. The most relevant articles were selected.The following key models for providing rehabilitation in primary care are presented: the physiatrist as a general practitioner for the disabled; integrating rehabilitation in primary care services (clinical model, outreach, self-management, community-based rehabilitation, case management, and shared care); models for integrating the community; and the World Health Organization's proposal for a community-based model.

Transfusão de hemácias em terapia intensiva: controvérsias entre evidências

Anemia is a prevalent issue in intensive care units. It appears in the first days, and may continue or worsen during hospital stay. Its etiology is generally multifactorial. Red blood cell transfusion is the most common intervention for treating anemia. Approximately 12 million blood units are used for transfusions in the United States, 25% to 30% in the intensive care units. Due to reduction of transfusion infections the increased safety has allowed an expansion of clinical indications. However, transfusion therapy is associated with other adverse effects such as nosocomial infections, immunological impairment, lung injury, hemolytic reactions and higher cancer incidence. Various papers have tried to show an association between correction of anemia and mortality-morbidity, but no consensus has been reached in literature. One of the current World Health Organization's proposals is to reduce potentially unnecessary transfusions, promoting a rational transfusion attitude. The primary objective of this narrative review is to approach controversies regarding the transfusion threshold according to recent studies, and as a secondary objective, it aims to discuss iatrogenic anemia aspects and the different behaviors among intensivists on the best practices for implementation of transfusion practices. It is not within our objectives to discuss transfusion complications, although they are mentioned. A search was conducted on electronic literature databases (PubMed - Clinical Queries), and UpToDate 16.2, and additional consultation to textbooks. It became clear that transfusion practices are widely variable among intensive care units. Evidence is scarce that routine transfusion in non-hemorrhagic patients should be used in those with > 7 g/dL hemoglobin. There is no consensus on the transfusion threshold in critically ill patients. Cardiovascular disease patients seem to present a higher risk of death than non-cardiovascular patients, for any level of hemoglobin. Transfusion guided by hemoglobin levels and individual oxy-hemodynamic physiologic parameters and clinical context is apparently, the current best accepted strategy, rather than arbitrary and isolated hemoglobin correction.

Independent Validation of the 2008 World Health Organization (WHO) Reclassification of Myelodysplastic Syndromes (MDS) Associated with Ring Sideroblasts

Background: The 2001 WHO classification of myeloid neoplasms distinguished 2 forms of MDS associated with >=15% ring sideroblasts and <5% marrow blasts: refractory cytopenia with multilineage dysplasia and with ring sideroblasts (RCMD-RS) vs. refractory anemia with ring siderblasts (RARS, erythroid-restricted dysplasia). However, the real prognostic value of separating RCMD-RS from RCMD with <15% ring sideroblasts and from RARS is uncertain, and the WHO has proposed merging RCMD-RS and RCMD in the 2008 classification revision. Furthermore, the WHO-based Prognostic Scoring System (WPSS), proposed by Malcovati and colleagues in 2005 as a dynamic system that overcomes some of the limitations of the 1997 International Prognostic Scoring System (IPSS), has undergone limited independent external validation to date and its applicability to sideroblastic MDS in particular is unclear. We assessed the validity of the 2008 WHO reclassification and the WPSS for MDS cases associated with >=15% ring sideroblasts and a normal blast proportion.Methods: We reviewed WPSS and IPSS component parameters at diagnosis and the clinical outcomes of 465 patients (68% males, median age 72) evaluated at our institution over a 13-year period: 140 with RARS, 114 with RCMD-RS, and 211 with RCMD. Patients were assigned a WPSS score and risk category (very low-risk group=0 points; low=1; intermediate=2, high=3 or 4) by summing 3 subscores: 2001 WHO classification (0 for RARS, 1 point for RCMD or RCMD-RS), IPSS cytogenetic risk group (0=good, 1=indeterminate, 2=poor), and red cell transfusion dependence (0=no, 1=yes). Survival was assessed by Kaplan-Meier estimates, and prognostic factors examined by proportional hazards analysis.Results: The median time until death or last followup was 26 months, and 70% of patients were known to have died. The median survival by WHO MDS subtype was 75 months for RARS, 25 months for RCMD-RS, and 26 months for RCMD (Log-Rank p<0.0001 for RARS vs. either RCMD-RS or RCMD; p=0.60 for RCMD vs. RCMD-RS ). Both the WPSS and IPSS predicted overall survival in patients with ring sideroblasts. Median survival for the patients grouped by WPSS risk category was 89 months for very low risk (n=95), 41 for low risk (n=198), 31 for intermediate risk (n=82), and 11 for high risk (n=91) (p<0.0001, except for low risk vs. intermediate risk, p=0.31). (Very high risk WPSS scores cannot be achieved without excess marrow blasts, and such patients were excluded from this analysis.) Median survival by IPSS was 73 months for low-risk, 33 months for intermediate-1, and 8 months for intermediate 2 (p<0.0001). The IPSS' predictive power was unchanged if patients with secondary MDS were included or excluded (the IPSS was based on a review of 816 patients with apparently de novo MDS).Conclusions: These data support the WHO's proposal to merge RCMD and RCMD-RS, and suggest that the adverse prognostic significance of multilineage dysplasia renders the presence of ring sideroblasts unimportant. The WPSS is a valid prognostic tool in patients with MDS associated with ring sideroblasts, but in this subgroup both the WPSS and IPSS stratify patients into 3 risk groups, and the WPSS does not offer additional value over the IPSS. [Display omitted]

United States accused of sabotaging obesity strategy.

In early 2004, the U.S. Department of Health and Human Services disputed some of the scientific evidence underlying the World Health Organization's proposals for curbing obesity. Critics of the DHHS position suggest that it puts the interests of the junk food industry ahead of people's health.

Gender sensitivity in the formulation of Spanish health plans: what it could have been but wasn't

To systematically examine gender sensitivity in the policies formulated in the health plans of the various Autonomous Communities in Spain in which these plans are available. We defined gender sensitivity as the extent to which the health plans took gender into account as a relation category and developed interventions to ameliorate gender-related inequalities. A questionnaire with a structure similar to that of the health plans, which were based on the World Health Organization's proposal, was designed. The questionnaire consisted of an introductory section, which we called the symbolic content, and described the general objectives and values of the health plan. In the other section, which we called the operative content of the health plan, the specific objectives and the interventions to achieve them were expressed in concrete terms. A gender sensitivity symbolic index and gender sensitivity operative index were constructed. Thirteen health plans were analyzed. Those of the Basque Country, the Valencian Community and the Canary Islands showed high symbolic content, which did not always match their subsequent operative implementation. The health plans of the Basque Country, Catalonia and Galicia showed the greatest operative gender sensitivity. Gender sensitivity in health plans varies widely among Autonomous Communities. Some channels for action would be to set up partnerships and networks for health professionals and collectives in order to raise awareness of the problem and build on the experience of the Autonomous Communities whose initiatives are carried out with the greatest gender sensitivity.

An interview with iann barron, chairman of division plc, by gillian bull

The World Health Organization's proposals for posttraumatic stress disorder (PTSD) in the 11th edition of the International Classification of Diseases, scheduled for release in 2018, involve a very brief set of symptoms and a distinction between two sibling disorders, PTSD and Complex PTSD. This review of studies conducted to test the validity and implications of the diagnostic proposals generally supports the proposed 3-factor structure of PTSD symptoms, the 6-factor structure of Complex PTSD symptoms, and the distinction between PTSD and Complex PTSD. Estimates derived from DSM-based items suggest the likely prevalence of ICD-11 PTSD in adults is lower than ICD-10 PTSD and lower than DSM-IV or DSM-5 PTSD, but this may change with the development of items that directly measure the ICD-11 re-experiencing requirement. Preliminary evidence suggests the prevalence of ICD-11 PTSD in community samples of children and adolescents is similar to DSM-IV and DSM-5. ICD-11 PTSD detects some individuals with significant impairment who would not receive a diagnosis under DSM-IV or DSM-5. ICD-11 CPTSD identifies a distinct group who have more often experienced multiple and sustained traumas and have greater functional impairment than those with PTSD.