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Infections, pregnancies, and infertility: perspectives on prevention. World Health Organization.

The World Health Organization sponsored a multicenter, collaborative investigation of the infertile couple by use of a standardized approach. The study was conducted between 1979 and 1984 in 33 centers in 25 countries throughout the developed and developing world. More than 5800 couples completed the investigation. Bilateral tubal occlusion and other infectious infertility etiologies were clearly related to a woman's history of sexually transmitted disease, pelvic inflammatory disease, and pregnancy complications. African centers had the highest rates of infectious infertility, more than threefold that in other regions. The relative contribution of either abortion or childbirth to these infectious causes apparently differed among the four regions investigated. Public health programs aimed at reducing these infections may pay reproductive health dividends.

Africa

Comparative trial of tubal insufflation, hysterosalpingography, and laparoscopy with dye hydrotubation for assessment of tubal patency. World Health Organization.

A World Health Organization-sponsored multicentered trial comparing the efficacy of gaseous tubal insufflation with hysterosalpingography (HSG) and/or laparoscopy plus dye hydrotubation in the assessment of tubal patency was undertaken. Three hundred ninety-three women in eight centers were involved (365 insufflations, 289 HSG, 189 laparoscopy). Patency was proven positive in 56% of insufflation, 45% of salpingography, and 52% of laparoscopy cases. Laparoscopy showed some women to have fibroids and a number of others to have ovarian abnormalities, endometriosis, pelvic adhesions, and/or congenital uterine malformation. Comparison of insufflation and HSG showed a false-positive rate of 42% and false-negative rate 24% in 363 cases. The false-positive rate of insufflation versus laparoscopy was 35% and the false-negative rate 38% of 180 cases. Only 55% of 125 women undergoing both HSG and laparoscopy had similar findings. The results suggest that gaseous tubal insufflation should not be employed as a method of investigating tubal patency. Diagnostic reliability of HSG is poor, but it is useful as a primary screening procedure, particularly when complimented with laparoscopy plus dye hydrotubation, which is the optimum method not only for assessing tubal patency but for discovering other hitherto unsuspected disease.

Clinical Trials as Topic

Convention on psychotropic substances, 1971. The role and responsibilities of the World Health Organization.

1. The world community has realized as early as the beginning of this century that collective action between nations is to be more effective in controlling drugs of abuse. A number of international drug control treaties including the Single Convention on Narcotic Drugs, 1961, controls drugs primarily obtained from plant material (opium, coca leaves and cannabis) and synthetic analogues of morphine. The Convention on Psychotropic Substances, 1971, is aimed at controlling psychotropic substances and was formulated in Vienna in 1971. 2. The Convention on Psychotropic Substances, 1971, lays a great responsibility on the World Health Organization to recommend to the United Nations Commission on Narcotic Drugs notifications initiated by the World Health Organization, or by a party to the Convention, regarding international control.

International Cooperation

World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. I. A multicenter cross-sectional study of menarche. World Health Organization Task Force on Adolescent Reproductive Health.

To study the maturation processes during puberty, the Task Force on Adolescent Reproductive Health of the World Health Organization implemented a multicenter study on the age of menarche. From seven centers in six countries, 3,073 girls between the ages of 11 and 15 years volunteered for a two-year study. The girls were questioned at entry as to whether they had menstruated; social background data were recorded, and height and weight were measured. The median age for menarche was calculated by a life-table technique. The median ages were: Hong Kong-12 years, 9 months; Geneva, Switzerland-13 years, 1 month; Zafed, Israel and Stockholm, Sweden-13 years, 3 months; urban Colombo, Sri Lanka-13 years, 6 months; Ile-Ife, Nigeria-13 years, 9 months; and rural Peradeniya, Sri Lanka-14 years, 5 months. Menarche of the rural Peradeniya girls was later than the urban girls from Colombo and other study centers. The mean heights, weights, and obesity indices (Quetelet's Index) were higher in postmenarcheal girls compared to premenarcheal girls for each age at all centers.

Actuarial Analysis

Nutritional anemia: its understanding and control with special reference to the work of the World Health Organization.

Since 1949, the World Health Organization, recognizing the public health importance of nutritional anemia, has sponsored efforts directed towards its understanding and control. During this period, often as a result of the work of the Organization, advances have been made in many areas. Basic understanding of iron, folate and vitamin B12 nutrition, and the various factors which may influence the availability and requirements of these factors, has greatly increased. Surveys in a number of countries have highlighted the widespread prevalence of nutritional anemia, particularly in developing countries. The major factor responsible is a deficiency of iron, whith folate deficiency also playing a role in some population groups, especially in preganant women. There is increasing evidence that anemia adversely affects the health of individuals and may have profound socioeconomic consequences. Control of nutritional anemia is possible by providing the deficient nutrient(s) either as therapeutic supplements or by fortification of commonly used foodstuffs. Some control programs are reviewed and suggestions for further action outlined. The Organization still has an important role to play in this field, encouraging the development of control programs and providing advice and technical assistance ot member countries.

Adolescent

Rational use of diagnostic imaging in paediatrics. The report of a World Health Organization Study Group.

The World Health Organization (WHO) is the agency of the United Nations with primary responsibility for international health matters and public health. Through the exchange of the knowledge and experience of health professionals from 165 nations WHO promotes comprehensive health services worldwide. As a part of this effort WHO has in recent years been concerned with improving the availability and utilization of diagnostic imaging, especially as it relates to health services in developing countries. Having devised and specified suitable basic radiographic equipment (the WHO BRS) a WHO Scientific Group was convened in 1982 to study the utilization of radiographic procedures and to to recommend their more efficacious and rational use. Then in 1984, recognizing the implications of newer imaging technology on world health, a second WHO Scientific Group considered the design, impact and future use of ultrasonography and computed tomography in developing countries. The findings of these scientific groups were published as part of the WHO Technical Report Series which makes available the recommendations of such international groups of experts. Although some of the needs of children were considered in these previous Technical Reports, WHO felt that the size and socioeconomic importance of the paediatric population worldwide warranted a further study and report to address the particular technical and clinical problems of diagnostic imaging in the paediatric age group. Thus a third WHO Scientific Group met in Geneva from 18 to 24 November 1985 to review established practices and experience in paediatric imaging throughout the world; and to recommend rational guidelines for diagnostic imaging for children to age 14 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Child

Investigation of the applicability of histological classification of bronchial carcinoma according to the World Health Organization.

According to the World Health Organization histological classification of bronchial tumors, clear and giant cell carcinomas are two subtypes of large cell carcinoma. As clear and giant cells can also be observed in other types of bronchial carcinoma, we investigated the frequency of the finding of these cells in different histological types. The tumor size and degree of differentiation, the amount of necrosis and keratinization, and the presence of giant and clear cells were analyzed. Statistical analysis by X2 test showed (for all classified histological types of bronchial carcinomas, except small cell carcinoma) that: 1) larger tumors had a great quantity of giant cells (P less than 0.05; P less than 0.01), 2) large tumors had more clear cells (P less than 0.05; P less than 0.01) and 3) tumors with a greater amount of necrosis had a larger number of giant and clear cells (P less than 0.05; P less than 0.01). Findings of an identical cytological characteristic can cause some difficulty in determination of bronchial cancer.

Adenocarcinoma

Making the World Health Organization work: a legal framework for universal access to the conditions for health.

Improving global health conditions has been one of the most important and difficult challenges for the world community. Despite concerted efforts by international organizations, like the World Health Organization, great disparities in health conditions remain between developed and developing countries, as well as within those countries. The World Health Organization has achieved some successes through its Health for All strategy; however, it can and should encourage member nations to enact national and international laws to protect and promote the health status of their populations. A comparison to the lawmaking efforts in other areas by international organizations indicates that WHO may have the authority and the means to institutionalize efforts to improve global health conditions.

Forecasting

The new program of the World Health Organization in medical virology.

The World Health Organization (WHO) convened a Scientific Group to adapt its program in virus diseases to recent progress in virology. The program consists of (a) general activities, such as reference services and the supplying of reagents by the WHO Collaborating Centres and (b) specific activities to solve problems-including the promotion of necessary research-caused by certain diseases of public health importance. The Group reviewed problems caused by influenza and other respiratory viruses, enteroviruses, gastroenteritis viruses (for which types A and B have been proposed as a convenient nomenclature), viral hepatitis, viruses in water and sewage, arboviruses, arenaviruses and Marburg virus, measles and rubella vaccination, smallpox, rabies, chronic infections, herpesviruses, oncogenic viruses, congenital infections, nosocomial infections, chlamydial and rickettsial infections, and mycoplasma infections.

Arboviruses